Guidelines for the Management of Severe Head Injury: Are Emergency Physicians Following Them?

The Brain Trauma Foundation published “Guidelines for the Management of Severe Head Injury” in 1995. These evidence-based clinical guidelines (CGs) recommended against prophylactic hyperventilation and glucocorticoid use and advocated for aggressive blood pressure (BP) resuscitation, and the careful use of mannitol. Objective: To survey Michigan emergency physicians (MEPs) to test their adherence to these guidelines. Methods: An anonymous mail survey was sent to all 566 MEPs who are members of the American College of Emergency Physicians. Three clinical scenarios involving severe head injury were presented, all with Glasgow Coma Scale (GCS) scores of 8 or less. The physicians were asked to choose from 15 diagnostic and treatment options, which included: intubation and hyperventilation, BP resuscitation, intravenous (IV) mannitol administration, and IV glucocorticoid administration. Results: Three hundred nineteen (56%) surveys were returned. Forty-six percent [95% confidence interval (95% CI) = 40% to 51%] of the MEPs elected to use prophylactic hyperventilation; very few administered IV glucocorticoids. Seventy-eight percent (95% CI = 75% to 81%) corrected hypotension with systolic BP < 90 mm Hg; 83% (95% CI = 80% to 86%) also administered mannitol appropriately. Conclusions: A majority of MEPs are managing severe head injury patients in accordance with the “Guidelines for the Management of Severe Head Injury,” with the exception of avoiding prophylactic hyperventilation. More education and/or exposure to the evidence regarding prophylactic hyperventilation of severely head injured patients may improve adherence to the guidelines.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74731/1/aemj.9.8.806.pd

The importance of parental knowledge in the association between ADHD symptomatology and related domains of impairment

Parents of children with ADHD experience several difficulties while raising their children and report lower levels of knowledge about their children’s life and behaviors. A recent study found that low levels of parental knowledge mediated the association between ADHD symptoms and risk-taking behavior (RTB) in adolescents. The current study aimed to investigate this previous finding further by replicating it, by taking peer influence into account as additional social factor of importance and by extending it and also investigate the role of parental knowledge in the association between ADHD symptoms and homework problems. Three studies were performed: study 1 (N=234) replicated previous work on parental knowledge mediating the association between ADHD symptoms and RTB, study 2 (pre-registered, N=313) added peer influence, and study 3 (pre-registered, N=315) assessed whether parental knowledge mediated the association between ADHD symptoms and homework behavior. Parental knowledge consistently mediated the association between ADHD symptoms on one hand and RTB and homework problems on the other, and also predicted stronger resistance to peer influence. Because parental knowledge was repeatedly linked to ADHD-related problems, it seems promising to include parental knowledge in treatment of ADHD-related problems in adolescents, by improving the parent-child relationship. Future studies should test more directly how improvement of the parent-child relationship can be used to optimize parental knowledge, which in its turn reduces ADHD-related problems

Determination of Porphyrins in Bile Using High Performance Liquid Chromatography and Some Clinical Applications

Peer Reviewe

Binomial level densities

It is shown that nuclear level densities in a finite space are described by a continuous binomial function, determined by the first three moments of the Hamiltonian, and the dimensionality of the underlying vector space. Experimental values for $^{55}$Mn, $^{56}$Fe, and $^{60}$Ni are very well reproduced by the binomial form, which turns out to be almost perfectly approximated by Bethe's formula with backshift. A proof is given that binomial densities reproduce the low moments of Hamiltonians of any rank: A strong form of the famous central limit result of Mon and French. Conditions under which the proof may be extended to the full spectrum are examined.Comment: 4 pages 2 figures Second version (previous not totally superseeded