Creation of a register on alcohol-impaired driving.
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Accidents, Traffic↗
Biomedical subjects
C Goss
Publications and source records attributed to C Goss.
Interventions for preventing injuries in problem drinkers.
BACKGROUND: Alcohol consumption has been linked with injuries through motor vehicle crashes, falls, drowning, fires and burns, and violence. In the US, half of the estimated 100,000 deaths attributed to alcohol each year are due to intentional and unintentional injuries. The identification of effective interventions for the reduction of unintentional and intentional injuries due to problem drinking is, therefore, an important public health goal. OBJECTIVES: To assess the effect of interventions for problem drinking on subsequent injury risk. SEARCH STRATEGY: We searched 12 twelve computerized databases: MEDLINE (1966-8/96), EMBASE (1982-1/97), Cochrane Controlled Trials Register (1997, issue #1), PsycINFO (1967-1/97), CINAHL (1982-10/96), ERIC (1966-12/96), Dissertation Abstracts International (1861-11/96), IBSS (1961-1/97), ISTP (1982-1/97) and three specialized transportation databases, using terms for problem drinking combined with terms for controlled trials; bibliographies of relevant trials; and contact with authors and government agencies. The electronic and bibliographic searches were updated in May 2002. SELECTION CRITERIA: Randomized controlled trials of interventions among participants with problem drinking, which are intended to reduce alcohol consumption or to prevent injuries or their antecedents, and which measured injury-related outcomes. DATA COLLECTION AND ANALYSIS: Two authors extracted data on participants, interventions, follow-up, allocation concealment, and outcomes, and independently rated allocation concealment quality. MAIN RESULTS: Of 23 eligible trials identified, 22 had been completed and 17 provided results for relevant outcomes. Completed trials of problem drinkers that compared interventions for problem drinking to no intervention reported reduced motor-vehicle crashes and related injuries, falls, suicide attempts, domestic violence, assaults and child abuse, alcohol-related injuries and injury emergency visits, hospitalizations and deaths. Reductions ranged from 27% to 65%. Because few trials were sufficiently large to assess effects on injuries, individual effect estimates were generally imprecise. We did not combine the results quantitatively because the interventions, patient populations, and outcomes were so diverse. The most commonly evaluated intervention was brief counseling in the clinical setting. This was studied in seven trials, in which injury-related deaths were reduced: relative risk (RR) 0.65; 95% confidence interval (CI) 0.21 to 2.00. However, this reduction may have been due to chance. The majority of trials of brief counseling also showed beneficial effects on diverse non-fatal injury outcomes. REVIEWERS' CONCLUSIONS: Interventions for problem drinking appear to reduce injuries and their antecedents (e.g. falls, motor vehicle crashes, suicide attempts). Because injuries account for much of the morbidity and mortality from problem drinking, larger studies are warranted to evaluate the effect of treating problem drinking on injuries.
Accident Prevention↗
Characterization of binding of Escherichia coli strains which are enteropathogens to small-bowel mucin.
Before an enteropathogen binds to the small bowel, it must interact with the small-bowel mucus (SBM) layer. To determine whether this interaction involves specific binding of diarrheagenic Escherichia coli, we used a quantitative assay with labeled, purified rabbit SBM. Binding of SBM from an adult rabbit was significantly greater to strain 162, an agglutinating E. coli strain, than it was to RDEC-1, a rabbit pathogen, and was significantly greater to strain 2348/PMAR, an enteropathogenic E. coli strain, than it was to strains 1392+ and 1392-, which are enterotoxigenic E. coli strains with and without colonizing fimbriae, respectively. Binding of strains RDEC-1, 2348/PMAR, and 162-4 was significantly greater to SBM than to bovine serum albumin. Binding of all strains increased in a linear fashion with increasing amounts of SBM and was reproducible (r = 0.85). Binding was significantly greater at pH 5.7 than at pH 7.4 or 8.0 for all five strains. Temperature did not alter the binding of any strain. Strains 162-4 and RDEC-1 bound significantly more to proximal SBM than to rabbit distal SBM, while strains 1392+ and 1392- bound significantly more to distal SBM. Oxidation of sugars from SBM significantly decreased the binding of all strains. Each pathogenic E. coli strain bound distinctively to SBM; the SBM sugars appeared to mediate this binding for all E. coli strains. Binding was also dependent on mucin characteristics, as binding varied by region of the gut (increased for proximal SBM for strains 162-4 and RDEC-1 and for distal SBM for strains 1392+ and 1392-). The developmental age of the gut significantly affected binding only of the rabbit pathogen RDEC-1.
Age Factors↗
The therapeutic effect of taking a patient's history by computer.
Sixty young women who presented at a general-practice health centre had their medical and social history taken by a computer before having an interview with the doctor. The average length of the automated interview was 90 minutes for the 54 patients who completed the programme, during which an average of 211 questions were answered. The patients found this method acceptable and we think that one of the main reasons for this was that the computer programme was so designed that the patients felt that the doctor was involved throughout.The computer/patient interview also appeared to have therapeutic benefits, and the computer's summary of the history was a sensitive indicator of those topics about which the patient was most concerned. This combination enabled the doctor to communicate more quickly and in greater depth in the time available. In effect, the time which the doctor could spend with the patient was magnified.We suggest that the benefits of this system for taking a history from a patient, of which one is the fact that any language or combination of languages can be used, could be extended to all classes of society.
Computers↗
Experience with preformed catheters for coronary angiography by the brachial approach.
Experience with a simplified technique for selective coronary angiography by the brachial cutdown approach using preformed coronary catheters in over 500 cases is described. This technique has facilitated selective catheterization of the coronary arteries in patients where use of the Sones catheter has proven difficult or impossible. Particularly, coronary arteries in patients with a dilated aortic root, high-rising left coronary artery or tortuous subclavian artery are easily catheterized with the preformed catheters described in this report. Shortened procedure time, an acceptable morbidity (1.4%) and mortality (0.2%), and improved coronary opacification by virtue of the ease in selectively entering the coronary ostia make these preformed catheters a useful modification to coronary angiography by the transbrachial approach.
Angiography↗
Audit of sedated versus unsedated gastroscopy: do patients notice a difference?
Unsedated diagnostic gastroscopy has become widely accepted as a diagnostic procedure which avoids the risk of an anaesthetic. It also provides advantages for patients and hospitals in converting the procedure to an ambulatory care investigation. Patient perception of the procedure can sometimes differ from that of medical and nursing staff. We have decided to report our usual clinical practice by auditing 100 consecutive patients undergoing this procedure in a large rural private hospital. Patient tolerance was analyzed in various categories including degree of comfort, degree of pain, ease of breathing and willingness to repeat the procedure under the same conditions. The perceived comfort rating was compared between the patient, the endoscopist and the endoscopy nurse. A total of 100 consecutive patients were evaluated; 55 chose to be sedated and 45 were unsedated. Of the 100 patients tested, 88% stated they would have the procedure the same way if a repeat procedure was required. There was no significant difference between male/female or sedated/unsedated patients. The most important consideration for patients who chose to have the procedure unsedated was the ability to speak to the endoscopist immediately post-procedure. Patient rating of pain was not significantly different between the sedated and unsedated groups. There was no significant difference in the independent assessment by the endoscopist and the nurse with respect to patient comfort in both the sedated and the unsedated groups. However, their assessment differed significantly from the patients own rating, as endoscopists and gastrointestinal (GI) nurses rated the patient degree of comfort as higher than the patients themselves (P < 0.01 for doctor/patient and nurse/patient score, Student's t-test). No complications were reported in either group of patients during the audit. Unsedated diagnostic gastroscopy is perceived to be an acceptable alternative to a sedated procedure by the majority of patients. Patients rate the procedure as more uncomfortable than their health care professionals, but the majority of patients would still have the repeat procedure the same way.
Adult↗