Jack-of-all-trades, master of none: Postgraduate perspectives on interdisciplinary health research in Australia

BACKGROUND: Interdisciplinary health research is increasingly perceived as an expectation of research institutions and funding bodies within Australia. However, little consideration has been given to the extent to which this re-orientation has produced a new type of researcher – an interdisciplinary health researcher. DISCUSSION: As cross-enrolled postgraduate research students, we assert that we do not have an intellectual home. Rather, we must forge a virtual intellectual home through the process of bridging disciplines. In this paper we explain that this virtual home affords us the role of 'interlockers' in future health research. The interlocker role privileges a breadth of understandings across disciplines, rather than a depth in one. SUMMARY: We conclude by reiterating that there is an undeniable need for interdisciplinary health research, and that the roles and actions of interdisciplinary health researchers need to be better understood and catered for. We therefore call for increased consideration and discussion concerning the future roles and capacities of interdisciplinary health researchers such as ourselves

Vampires in the village Žrnovo on the island of Korčula: following an archival document from the 18th century

Središnja tema rada usmjerena je na raščlambu spisa pohranjenog u Državnom arhivu u Mlecima (fond: Capi del Consiglio de’ Dieci: Lettere di Rettori e di altre cariche) koji se odnosi na događaj iz 1748. godine u korčulanskom selu Žrnovo, kada su mještani – vjerujući da su se pojavili vampiri – oskvrnuli nekoliko mjesnih grobova. U radu se podrobno iznose osnovni podaci iz spisa te rečeni događaj analizira u širem društvenom kontekstu i prate se lokalna vjerovanja.The main interest of this essay is the analysis of the document from the State Archive in Venice (file: Capi del Consiglio de’ Dieci: Lettere di Rettori e di altre cariche) which is connected with the episode from 1748 when the inhabitants of the village Žrnove on the island of Korčula in Croatia opened tombs on the local cemetery in the fear of the vampires treating. This essay try to show some social circumstances connected with this event as well as a local vernacular tradition concerning superstitions

Revision of TRISS for intubated patients

The TRISS system is an important, widely used method for predicting survival in trauma patients. One significant shortcoming of TRISS is its inability to include intubated patients in survival analysis because a respiratory rate and a verbal response are not obtainable. This report describes one approach to this problem. Data from 994 patients with blunt trauma were examined. Like TRISS, survival probability was calculated using a logistic regression model that included age and Injury Severity Score (ISS); however, the best motor response and systolic blood pressure were used in place of the Revised Trauma Score (RTS). With this model, the sensitivity, specificity, and misclassification rate were 57%, 98.9%, and 3.6%, respectively. For TRISS, the sensitivity, specificity, and misclassification rate are 58.8%, 99.3%, and 3.0%, respectively. Thus, our model has predictive performance comparable with TRISS. More importantly, it is applicable to intubated patients who are not pharmacologically paralyzed. Further investigation with larger data bases is necessary. © 1992 by Williams & Wilkins

The WAM score: Sensitivity and specificity of a user friendly biological screening test for alcohol problems in trauma patients

Based on a weighted aggregation of three biological alcohol markers (gamma-glutamyltransferase, blood alcohol and mean corpuscular volume), this study presents a screening instrument for alcohol problems in trauma patients. The sex-specific performance of this instrument was explored on 1088 male and 352 female patients, 18 years or older, admitted with blunt or penetrating trauma during a 30-month period to a regional level one trauma center in Seattle, Washington (USA). The sum of the differentially weighted alcohol markers ( WAM ), determined from one blood sample, formed a score continuum ranging from 0 to 24. The WAM scores distributed themselves across the trauma population with higher WAM scores being correlated to higher screening instrument scores for alcohol problems. By using two of the best established screening tests for alcohol problems (CAGE and SMAST) to define cut-off points for likely alcohol abuse/dependence , the WAM score of ≥ 7 in males showed 75% sensitivity and 83% specificity, whereas the WAM score of ≥ 6 for females displayed 85% sensitivity and 85% specificity. We conclude that a weighted combination of biological alcohol markers (WAM score) is a useful tool for identifying alcohol problems among trauma patients. Representing an alternative or addition to a more extensive interview, it could be used as a routine part of the care of trauma patients

The cage questionnaire and the short michigan alcohol screening test in trauma patients: Comparison of their correlations with biological alcohol markers

Study Objectives: To explore and compare the sex-specific correlation of two standard behavioral screening instruments, the Short Michigan Alcohol Screening Test (SMAST) and the CAGE, with a weighted scale that combines the three most commonly used biological alcohol markers (blood alcohol level, mean corpuscular volume, and gamma-glutamyltransferase level). Design: A prospective cohort study. Setting: Regional level I trauma center, in Seattle, Washington. Participants: 1980 male and 602 female patients 18 years of age or older, admitted with blunt or penetrating trauma. Main Results: Spearman rank correlations were used to compare the two screening measures with the weighted scale. The CAGE was found to correlate better than the SMAST with the weighted combination. Correlations for both measures were higher in women than in men. Among the individual biological alcohol markers used to construct the weighted scale, blood alcohol level was the marker that displayed the strongest correlation with both the CAGE and the SMAST. Conclusion-. We conclude that the CAGE questionnaire showed a higher correlation with a combination of biological alcohol markers than did the SMAST, and that the CAGE may be the questionnaire of choice for identification of alcohol problems in patients seen in trauma centers. © 1994 by Williams & Wilkins

The Effects of Alcohol Abuse on Readmission for Trauma

To determine the effect of admission for trauma with concurrent acute alcohol intoxication or chronic alcohol abuse on the risk of subsequent recurrence of trauma. —Prospective cohort study. —Level I regional trauma center. —A total of 2578 patients 18 years or older admitted with blunt or penetrating trauma within 24 hours of injury and surviving to discharge. All patients had a blood alcohol concentration (BAC) test, a γ-glutamyltransferase (GGT) test, and the short Michigan Alcohol Screening Test (SMAST) performed on admission. —Readmission to the trauma center for new trauma. Average follow-up was 28 months (range, 16 to 40 months). —The overall rate of readmission for new injuries was 1.3 per 1000 patient-months of follow-up. Patients who were intoxicated on the initial admission (BAC \u3c22 mmol/L [100 mg/dL]) were 2.5-fold as likely to be readmitted than those not intoxicated (95% confidence limits, 1.6, 3.9). The relative risks for patients with positive SMAST scores and abnormal GGT values were 2.2 (95% confidence limits, 1.4, 3.5) and 3.5 (95% confidence limits, 2.2, 5.5), respectively. The increased risks remained significant for intoxication and abnormal GGT values after adjustment for gender, race, Medicaid status, and mechanism of injury. —Alcohol abuse is associated with an increased risk of readmission for new trauma. Trauma patients should be screened for alcohol problems; referral of problem drinkers for appropriate care may decrease their risk of admission for subsequent trauma. (JAMA. 1993;270:1962-1964). © 1993, American Medical Association. All rights reserved

Effects of alcohol intoxication on the initial assessment of trauma patients

Study objectives: To evaluate the influence of alcohol intoxication on the initial assessment and treatment of trauma patients. Design: A prospective study of 2,237 trauma patients 18 years of age or older admitted to a Level I trauma center over a 19-month period. Results: The study population was primarily male (78%) and white (73%) and had sustained blunt trauma (79%). One thousand fifty-three patients (47.1%) had positive blood alcohol concentration (BAC); median BAC in patients with any detectable alcohol was 179 mg/dL. When stratified by injury severity categories and compared with nonintoxicated (BAC less than 100 mg/dL) patients, intoxicated patients with an Injury Severity Score (ISS) of 1 to 15 were more likely to undergo the following: field and/or ED intubation (relative risk [RR], 2.22; 95% confidence interval [Cl], 1.7 to 2.7); diagnostic peritoneal lavage (RR, 1.83; Cl, 1.43 to 2.3); head computed tomography scanning (RR, 1.18; Cl, 1.0 to 1.4); and intracranial pressure monitoring (RR, 1.41; Cl, 0.74 to 2.7). The effects were less pronounced for those patients with an ISS of more than 15, except for intracranial pressure monitoring where patients with an ISS of more than 15 were 47% more likely to have intracranial pressure monitoring if intoxicated (RR, 1.47; Cl, 1.2 to 1.9). Conclusion: Acute intoxication appears to alter the initial assessment of injury severity, resulting in an increased use of invasive diagnostic and therapeutic procedures. © 1992 American College of Emergency Physicians

The effects of alcohol intoxication on the initial treatment and hospital course of patients with acute brain injury

The effect of alcohol intoxication at the time of injury on hospital outcome was evaluated in 520 adult patients diagnosed with brain injury who were admitted to the emergency department of Harborview Medical Center. Data were collected for each subject’s status from field intervention through hospitalization. Serum alcohol levels were measured from blood drawn in the emergency room, and the subjects were stratified into two groups: Intoxicated (±100 mg/dL, n=191) and nonintoxicated (\u3c100 mg/dL, n=329). Compared with subjects who were not intoxicated, intoxicated patients were more likely to be intubated in the field or emergency department (relative risk [RR] = 1.3, 95% Confidence interval [CI] = 1.1–1.5), require placement of an intracranial pressure bolt (RR = 1.4, 95% CI = 1.1–1.8), develop respiratory distress requiring ventilatory assistance during hospitalization (RR = 1.8, 95% CI = 1.0–3.3), or develop pneumonia (RR = 1.4, 95% CI = 0.9–2.2). The similarities in the clinical presentation of patients with acute brain injury and those who are intoxicated appear to influence prehospital care and also suggest that a more objective assessment of cerebral injury than provided by clinical diagnostic measures alone is required, thus accounting for the elevated likelihood of intracranial pressure monitoring in intoxicated trauma patients. © Williams & Wilkins 1992. All Rights Reserved

The Effect of Acute Alcohol Intoxication and Chronic Alcohol Abuse on Outcome From Trauma

To determine the effect of acute alcohol intoxication and chronic alcohol abuse on morbidity and mortality from trauma. —Prospective cohort study. —Blunt or penetrating trauma patients at least 18 years of age admitted to one trauma center or dying at the injury scene. —Mortality, complications (infection, pneumonia, respiratory failure, or multiple organ failure), and length of hospital stay. —Acute intoxication had no effect on risk of dying—at the injury scene, within the first 24 hours of hospitalization, after the first 24 hours, or overall. Acute intoxication also did not increase the risk of complications and was associated with shorter lengths of stay. Patients with both biochemical and behavioral evidence of chronic alcohol abuse had a twofold increased risk of complications, particularly pneumonia and any infection, compared with those with no evidence of chronic alcohol abuse. —Chronic, but not acute, alcohol abuse adversely affects outcome from trauma. Attention to the problem of chronic alcohol abuse in trauma patients is necessary, and screening trauma patients for chronic alcohol abuse appears to be warranted. (JAMA. 1993;270:51-56). © 1993, American Medical Association. All rights reserved