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Biomedical subjects

A L Kellermann

Publications and source records attributed to A L Kellermann.

At least 37 records · Page 2Linked to original sources
PubMed1998

Collaboration in emergency medicine research: a consensus statement.

The role of collaboration in medical research and how it applies to emergency medicine (EM) research are discussed. The guidance of the Division of Health Sciences Policy of the Institute of Medicine is reviewed. Application of the principles of collaborative efforts and recognition of each individual's contribution are overviewed. Emergency physicians can and should be invaluable contributors to collaborative research. Collaborative research relationships, whether established at individual institutions or through national clinical trials, must be developed deliberately. The specialty of EM must make the necessary commitment of time and resources to ensure that these occur.

Academic Medical Centers↗
PubMed1998

Preventing youth violence: what works?

Between 1985 and 1992, serious youth violence in the United States surged to unprecedented levels. The growing use of firearms to settle disputes has contributed to this phenomenon. Youth are most often victimized by one of their peers. In response to this problem, a wide variety of programs have been implemented in an attempt to prevent youth violence or reduce its severity. Few have been adequately evaluated. In general, interventions applied between the prenatal period and age 6 appear to be more effective than interventions initiated in later childhood or adolescence. Community-based programs that target certain high-risk behaviors may be beneficial as well. A sustained commitment to evaluation research is needed to identify the most effective approaches to youth violence prevention.

Adolescent↗
PubMed1997

Alcohol and illicit drug abuse and the risk of violent death in the home.

CONTEXT: While acute alcohol and illicit drug use are common in homicide and suicide victims, the role of chronic substance use in violent death is unclear. OBJECTIVE: To measure the magnitude of risk of violent death in the home associated with alcohol use or chronic abuse and use of illicit drugs. DATA SOURCES: Data obtained from a case-control study of risk factors for homicide and suicide in 3 large metropolitan areas of the United States. DESIGN: Matched case-control study including 388 homicide cases, 438 suicide cases, and equal numbers of controls matched for age, sex, race, neighborhood, and county. Data were analyzed by means of conditional logistic regressions in which other potential risk factors for violent death were also considered. OUTCOME AND EXPOSURE MEASURES: Homicide and suicide victims were identified from medical examiner reports in Shelby County, Tennessee; King County, Washington; and Cuyahoga County, Ohio. Structured interviews were conducted with proxy respondents close to the decedents to obtain information about alcohol or illicit drug use, and history of alcohol-related hospitalization or trouble at work because of drinking by the subject. Data about alcohol use by others living in the same house as the subject were also obtained. RESULTS: The risks of homicide and suicide associated with alcohol or illicit drug use were elevated, as were the risks of violent death associated with several indicators of chronic alcohol abuse. In addition, nondrinkers living in a home with alcohol users were at increased risk of homicide (odds ratio, 1.7; 95% confidence interval, 0.98-3.0), and non-drug-using individuals residing in homes with illicit drug users were at greatly increased risk of homicide (odds ratio, 11.3; 95% confidence interval, 4.4-28.8). CONCLUSIONS: Alcohol and illicit drug use appear to be associated with an increased risk of violent death. The risk of homicide was increased for non-substance-abusing individuals living in households in which other members abused alcohol or drugs. The concept of the individual at risk of homicide should be broadened to include not only the abuser but also those who may be at risk because of their exposure to others.

Adolescent↗
PubMed1997

Risk factors for violent death of women in the home.

OBJECTIVES: To determine risk factors for violent death of women in the home, and particularly, to assess the strength and direction of any association between domestic violence or keeping firearms and homicide or suicide in the home. METHODS: Subgroup analysis of a large population-based case-control study database was performed, defining cases as all homicides and suicides occurring in the homes of female victims in 3 metropolitan counties: Shelby County, Tennessee; King County, Washington; and Cuyahoga County, Ohio. Randomly selected control subjects were matched to the victims by neighborhood, sex, race, and age range. Exposures to potential risk factors were ascertained by interviewing a proxy for the victim 3 to 6 weeks after the violent death occurred. These answers were compared with those obtained from controls using matched-pairs methods. RESULTS: All cases (n = 266) were identified in the 3-county area, including 143 homicides and 123 suicides, during a 5-year period. Matching controls (n = 266) were also identified. Firearms were involved in 46% of the homicides and 42% of the suicides. Independent risk factors for suicide in the home included a history of mental illness (odds ratio [OR], 258.8; 95% confidence interval [CI], 18.2-3679.8), living alone (OR, 13.4; 95% CI, 2.0-87.8), and having 1 or more guns in the home (OR, 4.6; 95% CI, 1.2-17.5). Independent risk factors for homicide included living alone (OR, 5.1; 95% CI, 2.0-13.2), illicit drug use by any member of the household (OR, 4.9; 95% CI, 1.3-15.9), prior domestic violence (OR, 4.0; 95% CI, 1.5-10.5), 1 or more guns in the home (OR, 3.4; 95% CI, 1.6-7.1), and previous arrest of any member of the household (OR, 3.0; 95% CI, 1.3-6.6). The increased risk of homicide associated with domestic violence, firearms, or illicit drugs was attributable to the homicides at the hands of a spouse, intimate acquaintance, or close relative. CONCLUSIONS: Among women, mental illness and living alone increase the risk of suicide in the home, and household use of illicit drugs and prior domestic violence increase the risk of homicide. Instead of conferring protection, keeping a gun in the home is associated with increased risk of both suicide and homicide of women. Household use of illicit drugs, domestic violence, and readily available firearms place women at particularly high risk of homicide at the hands of a spouse, an intimate acquaintance, or a close relative. Many factors place women at increased risk of violent death in the home. Community- and clinic-based interventions should target those with identifiable risk factors.

Domestic Violence↗
PubMed1996

Injuries due to firearms in three cities.

BACKGROUND: To describe the incidence and outcome of injuries due to firearms, we conducted a population-based study of fatal and nonfatal gunshot wounds in three cities: Memphis, Tennessee; Seattle; and Galveston, Texas. METHODS: Records of the police, medical examiners, ambulance crews, and hospital emergency departments and hospital admissions were monitored to identify all injuries caused by firearms that were severe enough to prompt emergency medical treatment. These records were linked to generate a complete picture of each event. Census data were used to calculate rates of injury for various population groups. RESULTS: A total of 1915 cases of injury due to firearms were identified between November 16, 1992, and May 15, 1994. The crude rate of firearm injury per 100,000 person-years was 222.6 in Memphis, 143.6 in Galveston, and 54.1 in Seattle. Approximately 88 percent of the injuries were incurred during confirmed or probable assaults; 7 percent were sustained in the course of suicide or attempted suicide; unintentional injuries accounted for 4 percent of the cases. Handguns were used in 88 percent of the cases in which the type of weapon was recorded. Five percent of the 1677 victims who were brought to a hospital emergency department could not be resuscitated; 53 percent were hospitalized, and 42 percent were treated and released. Ninety-seven percent of the deaths occurred within 24 hours of the injury. Emergency department and inpatient charges exceeded $16.5 million. CONCLUSIONS: Injuries due to firearms, most involving handguns, are a major cause of morbidity and mortality in U.S. urban areas. The incidence varies greatly from city to city.

Adolescent↗
PubMed1996

Ambulatory visits to hospital emergency departments. Patterns and reasons for use. 24 Hours in the ED Study Group.

OBJECTIVES: To characterize the reasons ambulatory patients use hospital emergency departments (EDs) for outpatient care and to determine the proportion of ED patients who initially are assessed as having nonurgent conditions, but subsequently are hospitalized. DESIGN: Cross-sectional survey during a single 24-hour period of time. SETTING: Fifty-six hospital EDs nationwide. PATIENTS OR OTHER PARTICIPANTS: Consecutive ambulatory patients presenting for care. Patents who arrived by ambulance were excluded. RESULTS: Of 6441 ambulatory patients (79 percent of all ED visits) who were eligible for study, interviews were obtained from 6187 (96 percent). A total of 5323 patients (86 percent) had clinical reasons or preferences for seeking care at an ED, including 2799 (45 percent) who thought they had an emergency or an urgent condition or were too sick to go elsewhere. Nineteen percent (n=1199) reported that they were sent to the ED by a health care professional. Patients with a regular clinician or with insurance cited similar reasons for seeking care at an ED. A total of 3062 patients (50 percent) cited 1 or more nonfinancial barriers to care as an important reason for coming to the ED, and 949 (15 percent) cited financial considerations. A total of 3045 patents (49 percent of ambulatory patients and 37 percent of total ED visits) were assessed at triage as having a nonurgent condition; 166 of them (5.5 percent; 95 percent confidence interval, 4.7 percent-6.3 percent) were admitted to the hospital. CONCLUSIONS: Most ambulatory patients seek care in an ED because of worrisome symptoms or nonfinancial barriers to care. Although many ambulatory patients appear to have nonurgent conditions based on triage classification, a small but disturbing percentage of nonurgent patients are hospitalized.

Adolescent↗
PubMed1996

Killing heat.

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Heat Stress Disorders↗
PubMed1996

Gun acquisition and use by juvenile offenders.

OBJECTIVES: To learn how, when, where, and why juvenile offenders acquire guns. DESIGN: Following acquisition of informed consent, we conducted semistructured interviews between June and November 1995 with a convenience sample of 63 juvenile offenders aged 13 through 18 years, each of whom was incarcerated at a detention center in metropolitan Atlanta, Ga. SETTING: Five detention centers in metropolitan Atlanta. MAIN OUTCOME MEASURES: Frequency of handgun acquisition and use, age at and method of first handgun acquisition, feelings experienced when carrying guns, development of gun-carrying behavior, drug use, and gang membership. RESULTS: The mean age of respondents was 15.7 years. Forty-one male and 12 female respondents had owned a gun. Eighty-four percent of gun carriers acquired their first gun before the age of 15 years; more than half received their first gun passively, without any specific plan to do so. Adolescents who purposefully obtained their first handgun were more likely to become frequent or constant carriers. Forty percent felt safer and 40% said they felt more energized, excited, or powerful while carrying a gun. However, 34% reported increased anxiety about getting caught. Almost all stated that guns are readily available from a wide range of sources. CONCLUSION: Knowledge of the developmental patterns of gun carrying by delinquent adolescents could be useful in formulating effective strategies to reduce firearm violence.

Adolescent↗
PubMed1996

Research directions in emergency medicine.

The goal of emergency medicine is to improve health while preventing and treating disease and illness in patients seeking emergency medical care. Improvements in emergency medical care and the delivery of this care can be achieved through credible and meaningful research efforts. Improved delivery of emergency medical care through research requires careful planning and the wise use of limited resources. To achieve this goal, emergency medicine must provide appropriate training of young investigators and attract support for their work. Promotion of multidisciplinary research teams will help the specialty fulfill its goals. The result will be the improvement of emergency medical care which will benefit not only the patients emergency physicians serve but also, ultimately, the nation's health.

Emergency Medicine↗
PubMed1995

Weapon involvement in home invasion crimes.

OBJECTIVE: To study the epidemiology of home invasion crimes and determine the frequency with which firearms are used to resist these crimes. DESIGN: Prospective case series. SETTING: Atlanta, Ga (population 402,877). METHODS: Between June 1 and August 31, 1994; Atlanta Police Department reports were screened to identify every case of unwanted entry into an occupied, single-family dwelling. Cases of sexual assault and incidents that involved cohabitants were excluded. RESULTS: A total of 198 cases were identified during the study interval. Half (99 cases) involved forced entry into the home. The victim and offender were acquainted in one third of cases. A firearm was carried by one or more offenders in 32 cases (17%). Seven offenders (3.5%) carried knives. In 42% of cases, the offender fled without confronting the victim. Victims who avoided confrontation were more likely to lose property but much less likely to be injured than those who were confronted by the offender. Resistance was attempted in 62 cases (31%), but the odds of injury were not significantly affected by the method of resistance. Forty cases (20%) resulted in one or more victims' being injured, including six (3%) who were shot. No one died. Three victims (1.5%) employed a firearm in self-protection. All three escaped injury, but one lost property. CONCLUSION: A minority of home invasion crimes result in injury. Measures that increase the difficulty of forced entry or enhance the likelihood of detection could be useful to prevent these crimes. Although firearms are often kept in the home for protection, they are rarely used for this purpose.

Crime↗
PubMed1995

Medical devices made into weapons by prisoners: an unrecognized risk.

STUDY OBJECTIVE: The alteration of a knee immobilizer into a sharp weapon by a prisoner prompted us to survey neighboring penal institutions to determine the frequency of such events. DESIGN: We mailed a nine-item survey to all detention facilities in Tennessee, Arkansas, and Mississippi. A second survey was sent to nonresponding institutions 6 weeks after the initial mailing. SETTING: The Regional Medical Center at Memphis, the designated facility for evaluation and treatment of prisoners from the county jail and state penitentiary. PARTICIPANTS: Survey respondents included 25 state penitentiaries, 31 county jails, 1 state minimum-security facility, 1 state maximum-security facility, 1 work-release center, 1 county detention center for drunken-driving offenders, and 1 federal penitentiary. RESULTS: Of the 81 institutions surveyed, 77% responded to one of the two mailings. Forty percent responded in the affirmative when asked whether stolen or unauthorized medical equipment from outside their institutions had been discovered among inmates. When respondents were questioned as to whether medical equipment, prescribed or not, had been used or altered in a criminal manner, 34% responded "yes." Medications and medical appliances were listed in the responses. CONCLUSION: A survey of 81 local and neighboring penal institutions in a three-state area revealed that the illicit use of medicine and medical devices by prisoners is a legitimate safety concern of prison personnel and health care workers when medical care for inmates must be sought outside the security of their institutions. The modification of medical equipment into weapons by incarcerated patients, although clearly recognized as a security and safety problem by police authorities, appears to be unappreciated by health care workers providing episodic care to inmates.

Adult↗
PubMed1995

Three-rescuer CPR: the method of choice for firefighter CPR?

STUDY OBJECTIVE: To compare the quality of CPR provided by firefighters performing three-rescuer CPR with that achieved by firefighters trained to provide standard two-rescuer CPR. DESIGN: Eight months after training a large number of firefighters to perform three-rescuer CPR, we used a quasi-experimental design to compare the performance of a randomly selected subset of these companies to that achieved by a control group of engine companies that received refresher training in standard two-rescuer CPR. Both groups used bag-valve masks to provide rescue ventilations. Testing was conducted on a no-notice basis with a recording mannequin. Key actions were scored by an experienced observer using explicit pass-fail criteria. Mannequin-generated strip charts were used to calculate the rate and depth of chest compressions and the ventilatory rate, volume, and minute ventilation in a blinded manner. SETTING: Fire stations of the Memphis Fire Department. The department is the sole provider of first-responder emergency care to the citizens of Memphis, Tennessee (population, 610,000). RESULTS: Three-rescuer teams delivered a mean minute ventilation substantially greater than that produced by two-rescuer teams (7.7 +/- 5.3 L versus 4.9 +/- 4.2 L, P < .001). Intergroup differences in the mean depth of chest compressions were less marked, but they were still significant (17.2 +/- 8.3 mm of recorder-needle deflection versus 13.7 +/- 7.0 mm, P < .001). CONCLUSION: Three rescuers can produce better CPR than two when a bag-valve-mask device is used. The technique is easily learned and readily retained.

Cardiopulmonary Resuscitation↗
PubMed1995

Clinical emergency medicine, today and tomorrow.

Properly staffed and equipped EDs are essential to a modern system of health care. In a relatively brief period, emergency medicine has emerged as a major medical specialty. Despite formidable barriers, emergency medicine has substantially improved the quality of prehospital and ED care in the United States. If sufficient support for the specialty can be secured, the future of emergency medicine is bright. If not, the nature of emergency care in the United States will be profoundly changed for years to come.

Emergency Medicine↗
PubMed1995

Moonlighting.

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Clinical Competence↗