Biomedical subjects

Alicia J Mangram

Publications and source records attributed to Alicia J Mangram.

4 recordsLinked to original sources

PubMed2006

The effects of preinjury clopidogrel use on older trauma patients with head injuries.

BACKGROUND: This study was designed to determine whether or not older trauma patients on clopidogrel have an increased risk of morbidity and mortality. METHODS: A retrospective review was performed on all trauma patients > or =50 years of age between January 1, 2002, and August 31, 2005. The charts of those patients who had documented preinjury use of clopidogrel were further reviewed. A control group of patients with no history of clopidogrel use was matched for age, sex, mechanism of injury, and injury severity score. RESULTS: During this time period, there were 1,020 trauma patients > or =50 years of age admitted, 43 of which had documented preinjury clopidogrel use (P). A higher percentage of patients in the P group underwent cranial surgery, had episodes of rebleeds, and required transfusions of blood products than in the control group. The mortality and length of stay were comparable in both groups. CONCLUSION: This study indicates that the preinjury use of clopidogrel may cause significant morbidity in patients with closed-head injuries. Further studies are needed to suggest specific treatment modalities.

Accidental Falls↗

PubMed2005

Laparoscopic converted to open cholecystectomy minimally prolongs hospitalization.

BACKGROUND: There has been little information about the length of stay (LOS) after laparoscopic converted to open cholecystectomy (CON) in the past few years. The aim of this study was to evaluate the LOS and postoperative complications for elective CON in a more recent time period. METHODS: A retrospective chart review was performed of all patients admitted to the Day Surgery Unit for elective laparoscopic cholecystectomy (LC) converted to open cholecystectomy (OC) from January 2000 through December 2003. Indications for CON, operative time, LOS, pain control, and complications were evaluated. RESULTS: The CON rate was 3%, and the reason for CON to open was most commonly cited as inability to identify anatomy. On average, patients were discharged on postoperative day 3 (range 2 to 8). The postoperative complication rate was 17%. CONCLUSIONS: When the dissection is tedious, the surgeon should feel comfortable in converting from laparoscopic to open cholecystectomy. This can be done with the knowledge that it does not add significant length of stay as previously reported.

Adult↗

PubMed2005

Families' perception of the value of timed daily "family rounds" in a trauma ICU.

Daily communications between the ICU trauma patients' families and the trauma team are often limited due to the unpredictable nature of subsequent patient admissions and operative procedures. In order to improve the lines of family-physician communication and educate residents regarding family communication, our level I trauma center instituted daily "Family Rounds" (FR). FR occur at the same time every day, in the patient's ICU room. The purpose of this study was to determine whether families valued the scheduled daily FR, to establish whether FR improved the family-physician relationship, and to delineate strengths and weaknesses of the present structure of our FR. We mailed surveys to family members of trauma patients hospitalized in the trauma ICU for > or = 3 days. A total of 55 (22%) families responded. Combining "excellent" and "good" responses, 86.5 per cent of families looked forward to having a specific time of day to meet with the trauma team, and 90 per cent liked having rounds in the ICU room with the patient. However, 36 per cent did not like having only scheduled time for FR. The majority, 75 per cent, believed that all concerns were addressed during FR, and 84.9 per cent rated their overall experience as either excellent or good. Scheduled FR appear to improve communication between trauma surgeons and patients' families, enhance the family-physician relationship, and strengthen our surgical residency teaching program.

Adolescent↗

PubMed2004

Are negative appendectomies still acceptable?

BACKGROUND: The goal was to ascertain if there was a significant change in the negative appendectomy (NA) rate in our community hospital with the increased use of computed tomography (CT). METHODS: This was a retrospective chart review of all appendectomies for acute disease performed at our institution from January 2000 to December 2002. There is no established protocol; therefore, CT scans were performed at the discretion of the involved physicians. The results of the physical exams, CT scans and pathology were recorded. RESULTS: Three hundred eighty-nine appendectomies were performed for appendicitis. There was a progressive increase in the use of CT: 52% in 2000, 74% in 2001, and 86% in 2002. There was also a decrease in the NA rate over the 3 years: 17% in 2000, 9% in 2001 and 2% in 2002. The perforated appendicitis rate decreased from 25% in 2000 to 9% in 2002. CONCLUSION: The appropriate utilization of CT scan as an aid in the diagnosis of acute appendicitis should decrease the NA rate to 2%.

Acute Disease↗