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Portland, OR, United States

Beers S.R.,University of Pittsburgh | Wisniewski S.R.,University of Pittsburgh | Garcia-Filion P.,Trauma Research | Tian Y.,University of Pittsburgh | And 4 more authors.
Journal of Neurotrauma

The Glasgow Outcome Scale (GOS) and its most recent revision, the GOS-Extended (GOS-E), provide the gold standard for measuring traumatic brain injury (TBI) outcome. The GOS-E exhibits validity when used with adults and some adolescents, but validity with younger children is not established. Because the GOS-E lacks the developmental specificity necessary to evaluate children, toddlers, and infants, we modified the original version to create the GOS-E Pediatric Revision (GOS-E Peds), a developmentally appropriate structured interview, to classify younger patients. The criterion, predictive, and discriminant validity of the GOS-E Peds was measured in 159 subjects following TBI (mild: 36%; moderate: 12%; severe: 50%) at 3 and 6 months after injury. Participants were included from two studies completed at the Pediatric Neurotrauma Center at Children's Hospital of Pittsburgh. We assessed the relationship among GOS-E Peds, the GOS, and the Vineland Adaptive Behavior Scales as well as other standardized measures of functional, behavioral, intellectual, and neuropsychological outcome. Premorbid function was assessed 24-36h after injury. The GOS-E Peds showed a strong correlation with the GOS at 3 and 6 month time points. Criterion-related validity was also indicated by GOS-E Peds' association with most measures at both time points and at injury severity levels. The 3 month GOS-E Peds was associated with the 6 month GOS-E Peds, everyday function, behavior, and most cognitive abilities. Discriminant validity is suggested by weak correlations between both 3 and 6 month GOS-E Peds and premorbid measures. The GOS-E Peds is sensitive to severity of injury and is associated with changes in TBI sequelae over time. This pediatric revision provides a valid outcome measure in infants, toddlers, children, and adolescents through age 16. Findings support using the GOS-E Peds as the primary outcome variable in pediatric clinical trials. © Mary Ann Liebert, Inc. Source

Lamis R.L.,Institute for Safe Medication Practices | Kramer J.S.,Wesley Medical Center | Hale L.S.,Wichita State University | Zackula R.E.,University of Kansas | Berg G.M.,Trauma Research
American Journal of Health-System Pharmacy

Purpose. The association between fall risk and inpatient medications was evaluated. Methods. A retrospective, case-control study was performed to compare the medication use of patients sustaining at least one fall during hospitalization (case group) with a control group of patients who did not fall. Data were collected from medical records and generated reports. A fall was defined by the hospital as an event in which the patient comes to rest on the floor from a lying, standing, or sitting position. Adult patients (>18 years of age) admitted between January 1 and December 31, 2006, experiencing a fall at least 48 hours after hospital admission were included in the case group. Each case was matched with one control by age (within five years), sex, admission date (within 30 days), patient care unit, and length of stay. Medications administered within 48 hours before the fall for the case group or designated fall date and time for the control group were documented. Results. Of the 414 documented fall events, 209 patients met the inclusion criteria. Of those patients, 96 matched control patients on all criteria. Significantly more case patients received a greater number of central nervous system (CNS) agents compared with matched control patients (p = 0.017). There was no statistically significant difference in the number of medications from all other drug classes or the total number of medications received by the groups. Conclusion. In a sample of hospitalized patients, CNS agents were significantly associated with falls. Copyright © 2012, American Society of Health-System Pharmacists, Inc. All rights reserved. Source

Edlich R.F.,University of Virginia | Edlich R.F.,Trauma Research | Cochran A.A.,Washington State University | Greene J.A.,Washington State University | And 2 more authors.
Journal of Emergency Medicine

Background: Peanut allergies affect 1.5% of children. The majority of reactions to peanuts are mild, but peanut allergy is also the most common cause of fatal anaphylactic reactions to food. Case Report: The purpose of this case report was to describe a 1-year old boy who developed difficulty breathing after eating a peanut food product. The boy was taken immediately by his mother to an Emergency Department, exhibiting severe respiratory distress. After speaking to the child's mother, the emergency physician (EP) realized that the wheezing was due to a peanut food allergy. The child's respiratory symptoms responded within 10 min to bronchodilatator inhalation. The EP gave the mother educational information regarding the management of asthma and the proper use of metered dose inhalers with spacer devices. The EP referred the child to a clinical allergist who specializes in the management of food allergies. The diagnosis was made by skin prick testing as well as in vitro measurement of peanut-specific immunoglobulin E. Conclusion: The allergist explained that the mainstay of management of peanut allergy is avoidance of the allergenic food. Patient education involved teaching the mother to avoid high-risk situations such as dinner with family members who are not informed about the child's allergy to peanuts, encouraging the child to wear a Medic Alert Bracelet, and teaching the family and child to recognize early symptoms of allergic reactions and to manage an anaphylactic reaction, including the use of self-injectable epinephrine, as well as activating emergency services. © 2011 Elsevier Inc. Source

Winter M.A.,Medical Center Blvd | Berg G.M.,Trauma Research | Berg G.M.,University of Kansas

Study Objective. To evaluate the impact of various body weights and serum creatinine (Scr) concentrations on the bias and accuracy of the Cockcroft- Gault creatinine clearance (C-G Clcr) equation compared with measured 24-hour Clcr. Design. Retrospective analysis. Setting. Tertiary care hospital. Patients. A total of 3678 patients with stable renal function and who underwent a 24-hour urine collection between July 1, 1996, and June 30, 2010. Measurements and Main Results. For each patient, C-G Cl cr was calculated and compared with a measured 24-hour Cl cr. Body weight adjustments to the calculation were performed based on the following weight classifications: underweight, normal weight, overweight, obese, and morbidly obese. In addition, C-G Clcr was calculated by using rounded Scr values based on two Scr thresholds-0.8 mg/dl and 1 mg/dl-for patients with measured Scr values below those thresholds. Those patients were then evaluated after stratification into two age groups: all ages and a subgroup of patients aged 65 years or older. The Scr-rounded C-G Clcr values were compared with the C-G Clcr values using actual Scr values. Mean differences were calculated, and accuracy was evaluated. Use of actual body weight in the calculations for underweight patients resulted in an unbiased Clcr of -0.22 ml/minute (p=0.898). Use of ideal body weight in the calculations of patients of normal weight returned an unbiased Clcr of -1.3 ml/ minute (p=0.544). An unbiased C-G Cl cr could not be calculated for other weight categories. In those patients, adjusted body weight using a factor of 0.4 (ABW0.4) was the least biased and most accurate. In patients aged 65 years or older with an Scr less than 0.8 mg/dl and less than 1 mg/dl, actual Scr was unbiased (-3 ml/min [p=1] and -9 ml/min [p=0.279], respectively) and more accurate than rounded Scr. In patients of all ages with an Scr less than 0.8 mg/dl and less than 1 mg/dl, actual Scr proved less biased (-4.5 ml/min [p=0.038] and -5.5 ml/min [p<0.001], respectively) and more accurate than rounded Scr. Conclusion. An unbiased C-G Clcr can be calculated using actual body weight in underweight patients and ideal body weight in patients of normal weight. Using ABW0.4 for overweight, obese, and morbidly obese patients appears to be the least biased and most accurate method for calculating their C-G Clcr. Rounding S cr in patients with low Scr did not improve accuracy or bias of the Clcr calculations. Copyright © 2012 Pharmacotherapy Publications, Inc. Source

Ngampramuan S.,Mahidol University | Cerri M.,University of Bologna | del Vecchio F.,University of Bologna | Corrigan J.J.,Trauma Research | And 5 more authors.

Nausea is a prominent symptom and major cause of complaint for patients receiving anticancer chemo- or radiation therapy. The arsenal of anti-nausea drugs is limited, and their efficacy is questionable. Currently, the development of new compounds with anti-nausea activity is hampered by the lack of physiological correlates of nausea. Physiological correlates are needed because common laboratory rodents lack the vomiting reflex. Furthermore, nausea does not always lead to vomiting. Here, we report the results of studies conducted in four research centers to investigate whether nausea is associated with any specific thermoregulatory symptoms. Two species were studied: the laboratory rat, which has no vomiting reflex, and the house musk shrew (Suncus murinus), which does have a vomiting reflex. In rats, motion sickness was induced by rotating them in their individual cages in the horizontal plane (0.75 Hz, 40 min) and confirmed by reduced food consumption at the onset of dark (active) phase. In 100% of rats tested at three centers, postrotational sickness was associated with marked (~1.5°C) hypothermia, which was associated with a short-lasting tail-skin vasodilation (skin temperature increased by ~4°C). Pretreatment with ondansetron, a serotonin 5-HT3 receptor antagonist, which is used to treat nausea in patients in chemo- or radiation therapy, attenuated hypothermia by ~30%. In shrews, motion sickness was induced by a cyclical backand-forth motion (4 cm, 1 Hz, 15 min) and confirmed by the presence of retching and vomiting. In this model, sickness was also accompanied by marked hypothermia (~2°C). Like in rats, the hypothermic response was preceded by transient tail-skin vasodilation. In conclusion, motion sickness is accompanied by hypothermia that involves both autonomic and thermoeffector mechanisms: tail-skin vasodilation and possibly reduction of the interscapular brown adipose tissue activity. These thermoregulatory symptoms may serve as physiological correlates of nausea. Source

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