Patterns of Injuries in Drowning Patients - Do These Patients Need a Trauma Team?

Introduction. Drowning is a major public health hazard worldwide, but associated traumatic injuries are rare. This study examined injuries and interventions performed on this population to assess the need for the trauma team activation. Methods. A 12-year retrospective review was conducted on all fatal and non-fatal drowning patients who underwent a trauma work-up. Data collection included demographics, injury characteristics, interventions, and outcomes. Results. Forty-three patients met inclusion criteria. Median patient age was six years (interquartile range 2 - 20) with 27.9% of patients under the age of 2 years. Most patients were white (62.8%) and male (69.8%), with median GCS score of 3 (60.5% had initial GCS = 3 with 25.6% with GCS = 15). Only two patients suffered traumatic injuries. Only two patients required operations, neither of which suffered traumatic injury. Eleven patients suffered anoxic brain injury (25.6%). Overall mortality was 48.8% (n = 21). Conclusion. Patients who present with drowning and no traumatic mechanism have a very low rate of traumatic injuries. Work-up and treatment would be appropriate for emergency physicians without the need for a trauma activation

Integrating Health Literacy Questions into a Statewide Behavioral Risk Factor Surveillance System (BRFSS) Questionnaire

Objectives. The purpose of this pilot study was to evaluate the feasibility of adding health literacy questions to a state health assessment questionnaire. Methods. Researchers conducted a series of telephone interviews (N = 20) to test the telephone administration of three health literacy screening questions with a convenience sample. Feedback obtained during the telephone interviews was used to revise the questions for clarity. The revised questions were proposed as an addition to the Kansas Behavioral Risk Factor Surveillance System (BRFSS). Results. Pilot data included minor modifications to the language of the questions to broaden their interpretation outside of a hospital setting. Most participants (90%, n = 18) had adequate health literacy. The proposed questions were approved for addition to the BRFSS questionnaire. Prompts were added to a telephone script to aid BRFSS survey administrators. Conclusion. As one of the first statewide health literacy assessments, this study has demonstrated one method for collecting baseline data. This new methodology has the potential to impact both patient care and broad public health efforts

Outcomes Following Blunt Traumatic Splenic Injury Treated with Conservative or Operative Management

Introduction Laparotomy, embolization, and observation are described for blunt splenic injury management. This study evaluated outcomes of blunt splenic injury management based on baseline factors, splenic injury severity, and associated injuries. Methods A nine-year retrospective review was conducted of adult patients with blunt splenic injury. Collected data included demographics, injury characteristics, treatment modality, complications, and outcomes (mechanical ventilation, days on mechanical ventilation, intensive care unit [ICU] admission and length of stay, hospital length of stay, and in-hospital mortality). Categorical and continuous variables were analyzed using χ2 analysis and one-way analysis of variance for normally distributed variables and a non-parametric test of medians for variables that did not meet the assumption of normality, respectively. Results Splenic injury grade was similar between operative and embolization groups, but severe hemoperitoneum was more common in the operative group. Complications and mortality were highest in the operative group (50.7% and 26.3%, respectively) and lowest in the embolization group (5.3% and 2.6%, respectively). Operative patients required more advanced interventions (ICU admission, mechanical ventilation). There were no differences between those treated with proximal versus distal embolization. Observation carried a failure rate of 11.2%, with no failures of embolization. Conclusions Embolization patients had the lowest rates of complications and mortality, with comparable splenic injury grades to those treated operatively. Further prospective research is warranted to identify patients that may benefit from early embolization and avoidance of major abdominal surgery

Efficacy of Intravenous Acetaminophen as Adjunct Post-Operative Analgesic in Cardiac Surgery: A Retrospective Study

Introduction. The dose-dependent adverse events associated with post-operative opioid use may be reduced when opioids are used in conjunction with intravenous acetaminophen. The purpose of this study was to compare outcomes in median sternotomy patients receiving intravenous acetaminophen in addition to intravenous opioids versus intravenous opioids only. Methods. A retrospective study was conducted on 122 adult patients undergoing median sternotomy at a regional tertiary-referral center. Data collected included patient demographics, length of stay, opioid and intravenous acetaminophen use, adverse effects, and transition time to oral pain medication. Results. There was no difference between groups in demographics, preoperative risk scores, operative procedures, intravenous opioid consumption, transition time to oral pain medications, or length of stay. Acetaminophen use was associated with lower rates of atrial fibrillation (7.0% vs. 24.6%, p = 0.009) and nausea/vomiting (8.9% vs. 32.3%, p = 0.002), but higher rates of urinary retention (15.8% vs. 3.1%, p = 0.014), constipation (50.0% vs. 20.0%, p = 0.001) and respiratory depression (7.1% vs. 0.0%, p = 0.043). Conclusion. Intravenous acetaminophen was not associated with a reduction in length of stay or opioid consumption, but was associated with lower rates of atrial fibrillation, nausea, and vomiting. Additional studies are needed to determine if intravenous acetaminophen administration reduces atrial fibrillation in this population

Examining Communication and Patient Recall in a Family Medicine Residency

Background. Understanding key aspects of effective physician-patient communication could benefit residency education and improve patient comprehension of health information. Discrepancies between what physicians say and what patients understand can reduce quality of care (e.g., patient adherence and satisfaction), making it imperative to know when gaps in patient understanding exist. The objective of this study was to identify residents’ efforts to assess patient understanding and the degree to which patients recalled information and instructions provided in the medical encounter. Methods. Residents and patients were observed in routine medical encounters in a Midwestern family medicine residency center. Patients were surveyed immediately following the encounter for recall of information and recommendations from the encounter, satisfaction with physician communication, and health literacy. Results. A total of 21 physician-patient encounters were observed. An inverse relationship was noted (Spearman’s rho = -0.43, N = 21, p = 0.05) between number of topics discussed during the encounter and the percentage of information recalled. Conclusions. Patient recall was related inversely to the number of topics covered by resident physicians. These results challenge physicians and medical educators to study and employ further those elements of physician-patient communication that enhance patient recall and understanding

Should Infants with Blunt Traumatic Brain Injuries and Intracranial Hemorrhage Have Routine Repeat Imaging?

Introduction.  The practice of repeat head CT imaging in infants as a distinct population is poorly studied.  The purpose of this study was to evaluate the incidence and utility of repeat head CT in the infant population.  Methods.  A 10-year retrospective review was conducted of infants with blunt traumatic head injuries (N = 50) that presented to a trauma center. Information from the hospital trauma registry and patient medical records were extracted regarding the size and type of injury, number and results of computed tomography (CT) imaging, changes in neurological exams, and any interventions that were required. Results.  Most patients (68%) had at least one repeat CT, with 26% showing progression of hemorrhage.  Decreased GCS was associated with having repeat CT scans.  Nearly one in four infants had a change in management associated with repeat imaging.  Repeat CT scans resulted in operative interventions in 11.8% of cases and longer ICU stays in 8.8% of cases.  Repeat CT scans were associated with increased hospital length of stay, but not with increased ventilator days, ICU length of stay, or mortality.  Worsening bleeds were associated with mortality, but not with other hospital outcomes. Conclusions.  Changes in management following repeat CT appear to be more common in this population than in older children or adults.  Findings from this study support repeat CT imaging in infants, however, further research is needed to validate results of this study

Assessing Medical Student’s Ability to Interpret Traumatic Injuries on Computed Tomography Before and After the Third Year Clerkships

Introduction. Exposure to radiologic images during clinical rotationsmay improve students’ skill levels. This study aimed to quantifythe improvement in radiographic interpretation of life-threateningtraumatic injuries gained during third year clinical clerkships (MS-3). Methods. We used a paired-sample prospective study design tocompare students’ accuracy in reading computed tomography (CT)images at the beginning of their third year clerkships (Phase I) andagain after completion of all of their third year clerkships (Phase II).Students were shown life-threatening injuries that included head,chest, abdomen, and pelvic injuries. Overall scores for Phase II werecompared with Phase I, as well as sub-scores for each anatomicalregion: head, chest, abdomen, and pelvis. Results. Only scores from students participating in both Phase Iand Phase II (N = 57) were used in the analysis. After completingtheir MS3 clerkship, students scored significantly better overall andin every anatomical region. Phase I and Phase II overall mean scoreswere 1.2 ± 1.1 vs. 4.6 ± 1.8 (p < 0.001). Students improved the mostwith respect to injuries of the head and chest and the area of leastimprovement was in interpreting CT scans of the abdomen. Althoughimprovements in reading radiographic images were noted after theclerkship year, students accurately diagnosed only 46% of life-threateningimages on CT scan in the trauma setting. Conclusions. These results indicated that enhanced education isneeded for medical students to interpret CT scans.Kans J Med 2018;11(4):91-94

Impacto de un sistema ERP en la productividad de las PYME

Teniendo en cuenta que la mayoría de las empresas en Colombia son del tipo PYME y que la toma de decisiones depende de la visión del fundador, lo cual puede dificultar la generación de avances en la apropiación de TIC (Tecnologías de Información y de Telecomunicaciones); los entes directivos y gerenciales de las empresas pueden solventar los problemas detectados en el sector “Elaboración de Productos de Panadería y Bizcochería”, apoyados en la utilización de diferentes soluciones tecnológicas, entre las que se encuentran los sistemas Enterprise Resource Planning (ERP), como formas de integrar y manejar la información de cada una de las áreas o departamentos de la empresa [1].La disminución de los inconvenientes de las pequeñas y medianas empresas, y por ende el incremento de la productividad, puede ser abordado desde el desarrollo de un prototipo de software ERP que da respuesta a las siguientes preguntas: ¿qué características son relevantes en una aplicación informática para el apoyo en la gestión de recursos en las pyme del sector?, ¿de qué manera se debe gestionar la información para que esté disponible a las personas, según la responsabilidad y rol que asume en la estructura organizativa?, y ¿de qué forma una solución de este tipo influye positivamente en el incremento de la productividad de las PYME

Senior Recital: Christian Fabrizio Artieda, jazz guitar

This recital is presented in partial fulfillment of requirements for the degree Bachelor of Music in Music Education. Mr. Artieda studies jazz guitar with Trey Wright.https://digitalcommons.kennesaw.edu/musicprograms/1137/thumbnail.jp

External coding and salience in the tactile Simon effect

Previous studies have demonstrated a tactile Simon effect in which stimulus codes are generated based on the stimulated hand, not on limb position in external space (the somatotopic Simon effect). However, given evidence from visual Simon effect studies demonstrating that multiple stimulus codes can be generated for a single stimulus, we examined whether multiple stimulus codes can be generated for tactile stimuli as well. In our first experiment using four stimulators (two on each side of the hand), we found novel evidence for a hand-centered Simon effect, along with the typical somatotopic Simon effect. Next, we examined whether the potential salience of these somatotopic codes could be reduced, by testing only one hand with two stimulators attached. In Experiments 2\u20134, we found a strong hand-centered Simon effect with a diminished somatotopic Simon effect, providing evidence that stimulus salience can change the weighting of somatosensory stimulus coding. Finally, we also found novel evidence that the hand-centered Simon effect is coded in external, not somatotopic, coordinates. Furthermore, the diminished somatotopic Simon effect when testing on one hand only provides evidence that salience is an important factor in modulating the tactile Simon effect