Browsing by Subject "Emergency Medicine"
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Item An Analysis of Osteoporosis-Related Hip Fractures, Using Hospital Discharge Data(2001-12-01) Rubin, Bernard; Antonio A. Rene; Douglas Mains; Muriel MarshallThe purpose of this study is to assess whether a current physician practice may inadequately diagnose osteoporosis in a high risk population of postmenopausal women who have sustained a hip fracture. A review of all patients discharged from Texas hospitals during calendar year 1999 was analyzed, using the Public Use Data File provided through the Texas Health Care Information Council. A total of 13,628 women over the age of 55 were admitted to hospital with a fractured hip. Only 2,233, or 16.3%, of women were also coded with the diagnosis of osteoporosis (P [less than] 0.001). Forty to fifty percent of postmenopausal women have osteoporosis. Therefore, women presenting with a fragility fracture form an even more at-risk subset of the population, such that one would expect a majority of these women to carry a diagnosis of osteoporosis. Percentages of Caucasian, non-Hispanic women in each group were comparable. The age distribution in each group was comparable, implying that the coded diagnosis of osteoporosis was not related to the age of the women when admitted to the hospital. In conclusion, physicians practicing in Texas during calendar year 1999 inadequately diagnosed osteoporosis in a high risk population of postmenopausal women who were admitted to hospital with fractured hip. Future analysis of subsequent analysis databases will be able to identify whether or not continuing medical education efforts will cause physicians to diagnose osteoporosis in this high risk population more frequently.Item Association Between Emergency Hospital Admissions of the Adult Population with Preexisting Respiratory Conditions and Ozone Air Quality Index(2006-12-01) Muzina, Miranda; Terry Gratton; Douglas Mains; Raghbir SandhuMuzina, Miranda, Association Between Emergency Hospital Admissions of the Adult Population with Preexisting Respiratory Conditions and Ozone Air Quality Index. Master of Public Health (Environmental Health), December 2006, 117 pp., 23 tables, 18 figures, references, 128 titles. This study examined if an association exists between seasonal ozone air pollution in the Fort Worth area and patients admitted to local area hospitals with existing asthma, pneumonia, bronchitis and COPD. Ozone is secondary pollutant formed in a complex reaction between oxides of nitrogen and volatile organic compounds, in the presence of sunlight and heat. The EPA has classified the Dallas-Fort Worth area as a non-attainment area by for ozone. The study did not find any apparent association between seasonal ozone AQI and the emergency respiration admissions. The available hospital data significantly limited analyzing the connection between emergency hospitalization and daily fluctuations of ozone. Further studies are needed to address this complex relationship in a broader perspective.Item Descriptive Study of Non-Fatal Occupational Injuries Treated in the Emergency Department(2001-12-01) Sinha, Sony; Antonio A. ReneSinha, Sony, Descriptive Study of Non-Fatal Occupational Injuries Treated in the Emergency Department. Master of Public Health (Epidemiology), December, 2001, 18 pp., 10 tables, 6 titles. This study describes work-related injury visits to the emergency department. The data used for this study was the 1999 National Hospital Ambulatory Medical Care Survey emergency department subsection. The patterns of work-related injury visits by month, day of the week, gender, race/ethnicity, age, primary diagnosis and primary cause of injury are examined. The most common diagnoses for work-related injuries were sprains and strains, open wounds, and superficial injuries (71% of total visits). The Most common causes of work-related injuries were sharp objects, overexertion, being struck, and falls (69% of total visits).Item Evaluation of a Hospital Decontamination Protocol for Mass Casualty Patient Surge(2007-05-01) Hood, Joyce L.; Gratton, Terry; Ramphal, Lilly; Larranaga, MichaelHood, Joyce L., Evaluation of a Hospital Decontamination Protocol for Mass Casualty Patient Surge. Master of Public Health (Occupational Health Practice), May 2007, 43 pp., 3 tables, 10 illustrations, references, 25 titles. Recent studies have expressed concern about hospitals’ ability to decontaminate casualties who have been contaminated with chemical, biological or radioactive agents. Since September 11, 2001, more attention has focused on hospital preparedness, but prior to 9/11, most of the focus was on decontamination in the field rather than pre-hospital. The objective of this study was to evaluate the effectiveness of two urban hospitals’ decontamination teams using quantitative methods. Subjects were contaminated with equal amounts of visible and invisible simulants in six locations. Residual contamination was measured and the team was debriefed regarding opportunities for improvement. Considerable improvements were noted after de-briefing, but initially the surface area of contamination was not appreciably affected before briefing was done. The effect of shower time and residual contamination was also examined. Hospital decontamination preparedness is minimal at best, even in large urban hospitals, increasing the risk of secondary contamination within the emergency departments.Item Health Care Access Patterns in Relation to Ethnic/Racial and Health Insurance Status at an Osteopathic Hospital for 1998 through 2001(2003-12-01) Mego, Charles B.W.; Lurie, Sue; Balcazar, Hector; TrevinoMego, III, Charles B.W., Health Care Access Patterns in Relation to Ethnic/Racial and Health Insurance Status at an Osteopathic Hospital for 998 through 2001. Doctor of Public Health (Social and Behavioral Sciences), December 2003, 106 p.p., 25 tables, 5 illustrations, references, 44 titles. The patient population of the Osteopathic Health System of Texas (OHST), an academic health center with a 256-bed teaching hospital, was analyzed for health care access as measured by health services utilization in 1998 through 2001. This study explored the question of whether there was less health care access among minorities than among the White non-Hispanic majority within the patient population at OHST. The Tarrant County population was compared to OHST’s population demographics. This assessment determined which Ethnic/Racial groups had the highest medical services utilization and their payment methods. Patient data obtained from the OHST’s Meditech database was analyzed using Epi-Info. White non-Hispanics made up over fifty percent of the Emergency Room (ER), Inpatient and Outpatient service utilization in 1998 through 2001. The Outpatient component made up just over fifty percent of the OHST’s patient. African-Americans were over represented in the ER, Inpatient, and Outpatient service components relative to the Tarrant County demographics for 1998 through 2001. The Hispanic ER Managed Care category increased 7% and confirmed a growth rate of 29% more ER Managed Care in 2001, as compared to 1998 (URR=1.29, [1.24-`.35], x2 = 142.49, p [less than] .01). The Hispanic ER Medicaid category decreased 4.1% and indicated a reduced growth rate of 17% less ER Medicaid in 2001 as compared to 1998 (URR = 0.83, [0.79-0/87], x2 = 57.69, p,.01). The Hispanic Inpatient Managed Care category increased 13.2% and revealed a positive growth rate with 52% more Inpatient Managed Care in 2001 as compared to 1998 (URR=1.52, [1.44-1.61]. x2 = 224.92, p [less than] .01). The Hispanic Inpatient Medicaid category decreased 14.4% and showed a reduced growth rate of 38% less Inpatient Medicaid in 2001 as compared to 1998 (URR=0.62, [0.59-0.66], x2=274.58, p [less than] .01). The Hispanic and the Other groups relied heavily upon ER Self Pay, with a general decrease in Medicaid coverage and an increase in Managed Care. The Hispanic and Other groups have medical needs that are being neglected at OHST, and may lead to serious health problems that could be more costly if still treatable.Item Intravenous pyruvate to protect heart and brain during closed-chest resuscitation and recovery from cardiac arrest(2014-08-01) Cherry, Brandon H.; Mallet, Robert T.; Olivencia-Yurvati, Albert H.; Raven, Peter B.Cardiac arrest is a leading cause of death in the United States and Western Europe. Cardiopulmonary resuscitation (CPR) is the only means of sustaining the victim until application of defibrillatory countershocks. Although it has been over 50 years since its advent, CPR remains a work in progress. Many initially resuscitated victims later die from the damage sustained from ischemia-reperfusion, and treatments to combat the extensive ischemia-reperfusion injury sustained during cardiac arrest-resuscitation remain elusive. The major mechanism of injury underlying ischemia-reperfusion is the intense overproduction of reactive oxygen and nitrogen species (RONS) that accumulate during reperfusion and compromise normal cell function. RONS formed during resuscitation trigger lipid peroxidation, disable enzymes vital for cell metabolism and survival and, ultimately, induce cell death within affected organs. In order to prevent extensive damage to the central nervous system culminating in permanent neurocognitive disability and death, prospective treatments must possess robust antioxidant properties, traverse the blood-brain barrier between the cerebral circulation and brain parenchyma, and be non-toxic at effective doses. Pyruvate is a natural intermediary metabolite, energy-yielding substrate and antioxidant. Pyruvate neutralizes RONS, thereby dampening oxidative stress and preventing covalent oxidative modification of enzymes and lipid membranes, and generates ATP to support brain function. Pyruvate readily traverses the blood-brain barrier and is non-toxic over a wide range of doses, including those previously demonstrated to protect the heart during cardiopulmonary bypass and the brain during stroke, thereby supporting oxygen and fuel delivery to the recovering brain. Moreover, pyruvate has been shown to promote cardiac electromechanical and metabolic recovery following cardiac arrest and open-chest CPR. This study tested whether infusion of pyruvate during, CPR and early recovery can decrease the biomarkers of oxidative stress after cardiac arrest. Isoflurane-anesthetized pigs were subjected to 6 min electrically-induced, untreated ventricular fibrillation, followed by 4 min closed-chest CPR, defibrillation and either 1 or 4 h recovery. Beginning at 5.5 min arrest, either sodium pyruvate or NaCl control were infused iv for the duration of CPR and for the first 60 min after recovery of spontaneous circulation (ROSC). Arterial blood was sampled pre-arrest and at 5, 15, 30, 60, 120, 180, and 240 min ROSC for analyses of blood gases and plasma constituents. At either 1 h (i.e. end of treatment infusion) or 4 h ROSC, a craniotomy was performed, the pig was euthanized, the brain was removed, and biopsies from hippocampus and cerebellum were snap-frozen in liquid nitrogen for biochemical analysis. The first phase of this project tested the hypothesis that intravenous administration of sodium pyruvate during precordial compressions and the first 60 min ROSC restores hemodynamic, metabolic, and electrolyte homeostasis in a closed chest porcine model of cardiac arrest. Resuscitation with pyruvate sharply decreased the incidence of lethal pulseless electrical activity (PEA) following defibrillatory countershocks, and lowered the dosage of vasoconstrictor phenylephrine required to maintain systemic arterial pressure. Pyruvate also enhanced glucose clearance, elevated arterial bicarbonate, and raised arterial pH. The second phase of this project tested the hypothesis that pyruvate prevents the decrease in activity of the brain’s antioxidant enzymes following cardiac arrest and hyperoxic (100% O2). Activities of glutathione peroxidase and glutathione reductase were decreased at 60 min ROSC vs. sham in both the hippocampus and cerebellum. Pyruvate partially preserved glutathione peroxidase activity at 1 h ROSC, but by 4 h, after 3 h of pyruvate clearance from the circulation, the enzyme’s activity fell to the same extent as in NaCl-infused pigs. Interestingly, the glutathione peroxidase/reductase activity fell sharply in non-arrested sham pigs between the time points corresponding to 1 and 4 h ROSC, suggesting that hyperoxia resulting from ventilation with 100% produced sufficient oxidative stress to inactivate the enzymes. Similarly, lactate dehydrogenase activity fell between 1 and 4 h ROSC in hippocampus and especially cerebellum. In sham pigs, lactate dehydrogenase activity decreased from the time points corresponding to 1 and 4 h ROSC, and pyruvate had no effect on lactate dehydrogenase in either region of the brain. Thus, cardiac arrest and hyperoxic ventilation disabled a critical antioxidant system in two ischemia-sensitive brain regions. Pyruvate afforded partial protection of these enzymes which waned after pyruvate cleared from the circulation. We conclude that 1) Pyruvate infusion during cardiac arrest, CPR and early recovery promotes conversion from ventricular fibrillation to a productive sinus rhythm instead of lethal PEA; 2) Pyruvate hastened glucose clearance, a prognostic measure used clinically; 3) Pyruvate elevated the arterial bicarbonate concentration and raised arterial pH, which combats the acidemia normally observed following ROSC; 4) Cardiac arrest-resuscitation and hyperoxic ventilation disabled the glutathione peroxidase-reductase system, a critical component of the brain’s antioxidant defenses, in hippocampus and cerebellum; and 5) Pyruvate delayed oxidative inactivation of glutathione peroxidase in the cerebellum, but this effect subsided as pyruvate elevated. These investigations demonstrate the therapeutic effects and limitations of pyruvate as a resuscitative treatment to hasten electrocardiographic and metabolic recovery post cardiac arrest.Item Multidisciplinary Team Response to Support Survivors of Mass Casualty Disasters(2013-01-01) Weeks, Susan; Smith, Lisa; Adams, LavonneDisaster response begins at the local level, but when needs as immense, promoting effective care and recovery for survivors may require activation of multiple systems from other parts of the country or even the world. One technique humanitarian response organizations may use to integrate services is formation and deployment of multidisciplinary response teams. Literature suggests the need for integrated assessment of disaster survivors and collaborative response efforts (1). Although multidisciplinary teams in health care are prevalent, their use in disaster has been less frequently studied. Our systematic review seeks to synthesize evidence about effectiveness of multidisciplinary team response to mass casualty disasters.Item North Texas Health & Science - 2011, Issue 2(University of North Texas Health Science Center at Fort Worth, 2011-01-01)Item Synergy 2008: Annual Research Report(2008-01-01)Item The Effect of Self Administered Workers' Compensation on Employee Safety Programs(1997-12-01) Smitha, Matt W.Smitha, Matt W., The Effect of Self Administered Workers’ Compensation on Employee Safety Programs. Master of Public Health, December 1997, 72 pp., three tables, seven figures, reference list, 28 titles. In Texas nonsubscribers to workers’ compensation have been under ongoing attack as powerful interest groups such as casualty insurance carriers have lobbied for an end to the elective system. Seventy-two nonsubscribing Texas companies were surveyed. Logistic regression with an alpha level of p=0.05 found the safety program qualitative score, Wald (1)=10.1992, p=0.0014 to be a significant predictor of increased management attention to safety while the other variables of total losses, frequency rate, and severity rate together in the same model were found to not be significant predictors of the same dependent response. Eighty-one percent of organizations surveyed reported that management attention to safety had increased after the company became a nonsubscriber.