PubMed Health⌕ Search

Biomedical subjects

C N Mock

Publications and source records attributed to C N Mock.

At least 19 recordsLinked to original sources
PubMed2000

Low-cost improvements in prehospital trauma care in a Latin American city.

OBJECTIVE: Prehospital care is a critical component of efforts to lower trauma mortality. In less-developed countries, scarce resources dictate that any improvements in prehospital care must be low in cost. In one Latin American city, recent efforts to improve prehospital care have included an increase in the number of sites of ambulance dispatch from two to four and introduction of the Prehospital Trauma Life Support (PHTLS) course. METHODS: The effect of increased dispatch sites was evaluated by comparing response times before and after completion of the change. The effect of PHTLS was evaluated by comparing prehospital treatment for the 3 months before initiation of the course (n = 361 trauma patients) and the 6 months after (n = 505). RESULTS: Response time decreased from a mean of 15.5 +/- 5.1 minutes, when there were two sites of dispatch, to 9.5 +/- 2.7 minutes, when there were four sites. Prehospital trauma care improved after initiation of the PHTLS course. For all trauma patients, use of cervical immobilization increased from 39 to 67%. For patients in respiratory distress, there were increases in the use of oropharyngeal airways (16-39%), in the use of suction (10-38%), and in the administration of oxygen (64-87%). For hypotensive patients, there was an increase in use of large-bore intravenous lines from 26 to 58%. The improved prehospital treatment did not increase the mean scene time (5.7 +/- 4.4 minutes before vs. 5.9 +/- 6.8 minutes after). The percent of patients transported who died in route decreased from 8.2% before the course to 4.7% after. These improvements required a minimal increase (16%) in the ambulance service budget. CONCLUSION: Increase in sites of dispatch and increased training in the form of the PHTLS course improved the process of pre-hospital care in this Latin American city and resulted in a decrease in prehospital deaths. These improvements were low cost and should be considered for use in other less developed countries.

Adult↗
PubMed1999

Epidemiology of transport-related injuries in Ghana.

To better elucidate the incidence, characteristics, and consequences of transport-related injuries in a less developed country in Africa, we undertook an epidemiologic survey in Ghana. A total of 21,105 persons were surveyed, in both an urban area (Kumasi, n = 11,663) and a rural area (Brong-Ahafo, n = 9442). In the preceding year, a total of 656 injuries were reported in the urban area and 928 injuries reported in the rural area. Transport-related mechanisms accounted for 16% of all injuries in the urban and 10% of all injuries in the rural area. The annual incidence of transport-related injuries was almost identical in the two settings, 997/100,000 persons in the urban area and 941/100,000 in the rural area. In both settings, transport-related injuries were more severe than other types of injuries in terms of mortality, length of disability, and economic consequences. In the urban area, the most common transport-related mechanisms were either to passengers involved in crashes of mini-buses or taxis (29%) or to pedestrians struck by these vehicles (21%). In the rural area, the most common transport-related mechanisms were bicycle crashes. The second most common rural mechanisms were motor vehicle crashes, which were the most severe and which involved commercial (83%) rather than private vehicles. Prevention strategies need to be different from those in developed countries and should target commercial drivers more than private road users.

Accidents, Traffic↗
PubMed1999

Monitoring for compartmental syndrome using near-infrared spectroscopy: a noninvasive, continuous, transcutaneous monitoring technique.

BACKGROUND: The diagnosis of compartmental syndrome (CS) may be delayed because current monitoring techniques are invasive and intermittent and the compartment pressure (CP) that predicts ischemia is variable. Fiber-optic devices using near-infrared (NIR) wavelength reflection can determine the redox state of light-absorbing molecules and have been used to monitor venous hemoglobin saturation to detect ischemia during low-flow states. The purpose of this study was to determine if NIR spectroscopy can provide continuous, transcutaneous, noninvasive monitoring for muscle ischemia in an animal model of CS. METHODS: Nine swine were anesthetized and a 20-mm NIR probe was placed over the anterolateral compartment of the hind leg to provide continuous determination of muscle oxyhemoglobin level. Needles were inserted into the compartment to measure CP. A nerve stimulator was placed over the peroneal nerve to induce dorsiflexion twitch. Albumin was infused into the muscle to incrementally increase CP until there was complete loss of dorsiflexion, then after 20 minutes fasciotomy was performed. RESULTS: All animals lost dorsiflexion at CP of 43+/-14 mm Hg. There was a significant inverse correlation between CP and oxyhemoglobin level (r = -0.78; p < 0.001) and a correlation between oxyhemoglobin and perfusion pressure (mean arterial pressure minus CP) (r = 0.66; p < 0.001). Redox state was a more consistent predictor of twitch loss than perfusion pressure. CONCLUSION: Muscle oxyhemoglobin level measured by NIR spectroscopy strongly reflected CP, perfusion pressure, and loss of dorsiflexion twitch. Currently available portable NIR devices may provide the benefit of continuous, noninvasive monitoring for CS. Further studies to determine the role of this technology in the detection of compartmental syndrome are warranted.

Animals↗
PubMed1999

Systematic review of published evidence regarding trauma system effectiveness.

OBJECTIVE: Provide a systematic review of the published literature assessing the affect of trauma center/system implementation on patient outcomes. DATA SOURCES: A bibliographic search of MEDLINE (1966-May of 1998), HealthSTAR (1995-May of 1998), and CINAHL (1982-May of 1998). Additional manuscripts were identified in the references of reviewed manuscripts. Literature was limited to English language reports on trauma systems in the United States and Canada. STUDY SELECTION: Initial inclusion criteria were based on methodologic criteria (i.e., a comparative [controlled] study). Authors independently assessed the strength of evidence demonstrated by each article. DATA EXTRACTION: Included articles were classified into three groups based on study design: panel review studies, trauma registry comparison studies, and population-based studies. Key demographic, sampling frame, study design, and outcome variables were tabulated for each included study. Potential sources of bias were also identified and tabled. DATA SYNTHESIS: A total of 12, 11, and 17 studies were incorporated into individual evidence tables for panel review, registry comparison, and population-based studies, respectively. Included studies rely on weak evidence (Class III) to assess the impact of trauma systems on patient care and outcome. CONCLUSIONS: To date, studies assessing trauma system efficacy rely on hospital deaths as the primary indicator of effectiveness. Future research should use more sophisticated study designs (Class II) and expand available outcome measures to assess the entire continuum of care, including prehospital, rehabilitation outcomes, and long-term quality of life.

Data Collection↗
PubMed1999

Incidence and outcome of injury in Ghana: a community-based survey.

Injury is an increasingly significant health problem in most low-income countries. However, strategies for preventing injury have not been well addressed. The present study was carried out to measure the incidence and outcome of various mechanisms of injury in Ghana in order to provide data for use in developing priorities for injury prevention efforts. For this purpose, using two-stage cluster sampling and household interviews, we surveyed 21,105 persons living in 431 urban and rural sites. During the preceding year, 1609 injuries resulting in one or more days of loss of normal activity were reported. Injury-related mortality was slightly higher in the urban (83 per 100,000) than in the rural area (53 per 100,000). However, the burden of disability from nonfatal injuries, as assessed by disability days, was higher in the rural (4697 disability days per 1000 person-years) than in the urban area (2671 days per 1000 person-years). Based on incidence rates and disability times, the major types of injury in the urban area were transport-related injury and falls. In the rural area, agricultural injuries predominated, followed by falls and transport-related injury. In rural and urban areas combined, 73% of motor vehicle-related injuries involved commercial vehicles. In this and other similar developing-country settings, injury prevention efforts should focus on falls and on transport safety in both urban and rural areas, with special attention being paid to commercial vehicles. In rural areas, agricultural injuries contributed the largest burden of morbidity, and should be a priority for prevention efforts.

Adolescent↗
PubMed1998

Childhood injuries in an urban area of Ghana a hospital-based study of 677 cases.

To the best of our knowledge, there has not been any recent available study of trauma-related hospitalisation of paediatric patients in an urban area of the sub-Saharan countries. Accidental injury, especially among children, has become one of the most serious major health problems facing developing countries, including those in sub-Saharan Africa. We reviewed 677 children admitted to the Komfo Anokye Teaching Hospital in Kumasi, Ghana, from August 1995 to July 1996 to elicit the incidence of various injuries, causes, rates of injury, and survival of children aged 0 to 14 years who had sustained trauma during this period. The most common mechanisms of injury were pedestrian knockdowns (40.0%), falls (27. 2%), and burns (17.6%). The annual rate of injury was 230/100000 children. Boys sustained higher injury rates in all age groups than girls, with an overall rate of, 136/100000 children as compared to 92/100000 for girls. Rates of injury were higher for children over 5 years of age in six of the seven specific causes of injury studied. When analysing the region of principal injury, for severe injuries (abbreviated injury scale 3-5) the extremities suffered most, followed by the skin and head. There was increased mortality for patients with an injury severity score >20. The overall mortality for this study was 5.5%. There is, therefore, a need to establish prevention priorities and to design effective prevention strategies for children of school-going age, who are most at risk of sustaining trauma.

Accidents↗
PubMed1998

Injury control in Africa: getting governments to do more.

Despite increasing recognition of injury as a major public health problem worldwide, it has received limited attention and resources. This lack of attention is most notable in low-income countries. As part of efforts to develop coordinated injury control activities in Africa, a round table session was held at the Third International Conference on Injury Prevention and Control in Melbourne, Australia. The aims of the forum were to provide injury control researchers from Africa the opportunity to come together and reflect on issues of injury control in Africa, to deliberate on strategies of getting African governments to show more interest in injury control, and to solicit more assistance from the international donor community Participants from Ghana, Kenya, South Africa and Zimbabwe presented the magnitude of the injury burden in their respective countries, reflected on current research efforts and highlighted the preventive efforts being undertaken. The forum made many recommendations including several regarding specific actions required of African governments, individual researchers and donor agencies.

Accidents, Home↗
PubMed1998

Trauma mortality patterns in three nations at different economic levels: implications for global trauma system development.

BACKGROUND: Whereas organized trauma care systems have decreased trauma mortality in the United States, trauma system design has not been well addressed in developing nations. We sought to determine areas in greatest need of improvement in the trauma systems of developing nations. METHODS: We compared outcome of all seriously injured (Injury Severity Score > or = 9 or dead), nontransferred, adults managed over 1 year in three cities in nations at different economic levels: (1) Kumasi, Ghana: low income, gross national product (GNP) per capita of $310, no emergency medical service (EMS); (2) Monterrey, Mexico: middle income, GNP $3,900, basic EMS; and (3) Seattle, Washington: high income, GNP $25,000, advanced EMS. Each city had one main trauma hospital, from which hospital data were obtained. Annual budgets (in US$) per bed for these hospitals were as follows: Kumasi, $4,100; Monterrey, $68,000; and Seattle, $606,000. Data on prehospital deaths were obtained from vital statistics registries in Monterrey and Seattle, and by an epidemiologic survey in Kumasi. RESULTS: Mean age (34 years) and injury mechanisms (79% blunt) were similar in all locations. Mortality declined with increased economic level: Kumasi (63% of all seriously injured persons died), Monterrey (55%), and Seattle (35%). This decline was primarily due to decreases in prehospital deaths. In Kumasi, 51% of all seriously injured persons died in the field; in Monterrey, 40%; and in Seattle, 21%. Mean prehospital time declined progressively: Kumasi (102 +/- 126 minutes) > Monterrey (73 +/- 38 minutes) > Seattle (31 +/- 10 minutes). Percent of trauma patients dying in the emergency room was higher for Monterrey (11%) than for either Kumasi (3%) or Seattle (6%). CONCLUSIONS: The majority of deaths occur in the prehospital setting, indicating the importance of injury prevention in nations at all economic levels. Additional efforts for trauma care improvement in both low-income and middle-income developing nations should focus on prehospital and emergency room care. Improved emergency room care is especially important in middle-income nations which have already established a basic EMS.

Cross-Cultural Comparison↗
PubMed1998

Getting together for injury control.

The proceedings of a round table session on injury control in Africa, held as part of the Third International Conference on Injury Prevention and Control, are outlined in the present article. The prospects for collaborative efforts in this field seem reasonable, but increased support from governments and the international donor community is essential if the immense burden of injury is to be significantly diminished.

Accident Prevention↗
PubMed1997

Low utilization of formal medical services by injured persons in a developing nation: health service data underestimate the importance of trauma.

BACKGROUND: Assessment of the societal importance of trauma relies, in large part, on hospital and other health service data. Such data are of limited value in developing nations if a significant proportion of injured persons do not receive formal medical care. METHODS: We undertook an epidemiologic study of trauma in Ghana. Via household visits, we surveyed 21,105 persons living in 432 urban and rural sites. RESULTS: During the preceding year, there had been 13 fatal injuries (62 per 100,000) and 1,597 nonfatal injuries resulting in > or = 1 days of lost activity (7 per 100). Of the fatally injured, only 31% received formal medical care (hospital or clinic). Of the nonfatal injuries, 58% received formal care, but with major differences between urban and rural sites. Only 51% of rural injured received formal medical care, compared with 68% of urban injured (p < 0.001). Even among those with more severe injuries (disability time > or = 1 month), 26% of rural injured never had formal care. Overall hospital use was especially low, with only 27% of all injured persons using hospital services. Among those with more severe injuries, 60% of urban, but only 38% of rural injured received hospital care (p < 0.001). CONCLUSIONS: These data indicate low utilization of formal medical services by injured persons in this developing nation. Even many of those with severe injuries do not receive medical care, especially in rural areas. Assumptions that rely on health service data, especially hospital data, underestimate the importance of trauma. Appropriate commitment of health care resources might thus be affected. Population based data are needed to fully assess the extent and societal impact of injuries in developing nations.

Data Interpretation, Statistical↗
PubMed1996

Health care utilization as a marker for suicidal behavior on an American Indian Reservation.

OBJECTIVE: Overall suicide mortality rates are higher among American Indians than in the general population and are particularly high among Indians residing in the upper Midwest. The identification, during encounters with health care providers, of individuals at high risk of suicide is a potential intervention strategy. The purpose of this study was to examine whether increased health care utilization and symptom patterns were associated with suicide and suicide attempts among American Indian patients in an Indian Health Service facility. DESIGN: A case-control study design was used. SETTING/PATIENTS: Cases of completed suicides over a 6-year period and cases of suicide attempts over a 15-month period were identified on a Plains Indian Reservation. The pattern of utilization of health services by these subjects prior to their suicide or attempt was compared with that of control subjects matched for age and gender. MAIN RESULTS: Only 24% of subjects who died of suicide used the reservation clinic or hospital for services in the 6 months prior to their suicide, compared with 54% of controls (odds ratio [OR] 0.28; 95% confidence interval [CI], 0.09, 0.87). The patterns of symptom complaints and diagnoses for these visits did not differ significantly between case and control subjects. Case subjects who attempted suicide were more likely to be seen during the 6 months prior to their attempt than control subjects (57% vs 40%, OR 1.72; 95% CI 0.75, 3.93). Persons who attempted suicide were more likely to have documentation of psychological and interpersonal problems than were control subjects. Only 14% of subjects completing suicide had a previous history of suicide attempts. CONCLUSIONS: In this region, American Indians who committed suicide were less likely to use clinical services provided by the Indian Health Service prior to their death. However, there was a relatively strong association between suicide attempts and the prior use of health services, particularly the use of mental health services. In this American Indian population, clinic-based methods for early detection and intervention to prevent imminent suicide would reach fewer than one fourth of suicide victims. Further research is needed to identify the usefulness of community outreach efforts to identify and intervene among individuals at high risk of death by suicide.

Adult↗
PubMed1996

Assessment of two clinical trials: interferon-gamma therapy in severe injury.

Two recent studies have examined the efficacy of interferon-gamma in reducing infection and death in patients sustaining severe injury. Both included multi-center, randomized, double-blinded placebo-control design. The first trial, conducted at four university trauma centers, enrolled 213 patients, while the second trial involved nine university trauma centers and 416 subjects. Recombinant human interferon-gamma (100 micrograms) was administered subcutaneously daily for 10 days in the first trial and 21 days in the second, in addition to standard supportive therapy. In both trials infection rates were similar in the treatment arms. Although the death rate related to infection was not affected in the first study, the second trial suggested an improved outcome from this complication. The outcome of the larger trial was flawed by dominant findings at one center that had the highest enrollment, infection, and death rates. Confounding variable analysis presented here explains much of the difference between center findings in the larger trial. Thus, the benefit of interferon-gamma as an immune adjuvant in severe injury is clouded by study design flaws evaluating its use and by the inability to identify appropriate subjects using clinical criteria.

Adolescent↗
PubMed1995

Clinical significance of antibiotic endotoxin-releasing properties in trauma patients.

OBJECTIVE: To test the hypothesis that antibiotics leading to greater endotoxin release are associated with greater mortality in septic trauma patients. DESIGN: Post hoc analysis of data from a previously conducted prospective, randomized, multicenter study designed to evaluate the efficacy of interferon gamma in preventing infection and death in trauma patients. SETTING: Nine level I trauma centers. PATIENTS: Severely injured trauma patients at high risk for sepsis. Eighty percent (N = 334) of the enrolled patients developed some manifestation of gram-negative sepsis, defined by the administration of gram-negative specific antibiotics. MAIN OUTCOME MEASURES: The in-hospital mortality rate of patients who received penicillin-binding protein 3/tumor necrosis factor (PBP3/TNF)-specific antibiotics associated with the greatest degree of endotoxin release and TNF production (PBP3/TNF group, n = 78: aztreonam, ceftazidime, and cefotaxime sodium) was compared with that of patients not receiving these agents (non-PBP3/TNF group, n = 256). RESULTS: Mortality in the PBP3/TNF group (17%) was higher than in the non-PBP3/TNF group (8%, P = .02). The two groups were similar in their mean (+/- SD) Injury Severity Scores (34 +/- 9), ages (31 +/- 12 years), and initial degree of bacterial contamination. CONCLUSIONS: Antibiotics that are associated with greater release of endotoxin and production of TNF are also associated with greater mortality in septic trauma patients. Decisions regarding antibiotic administration may need to consider the endotoxin-releasing properties of antibiotics in addition to their antibacterial sensitivity spectrum. Prospective studies of the effect of endotoxin-releasing properties of antibiotics on mortality are warranted.

Adult↗
PubMed1995

Injury prevention strategies to promote helmet use decrease severe head injuries at a level I trauma center.

Head injuries (HIs) remain a major contributor to trauma mortality, with many deaths occurring despite optimal use of available therapy. Injury prevention is vital to decrease the impact of HIs. Helmets can decrease the severity of HIs in both bicycle crashes (BCs) and motorcycle crashes (MCCs). A major challenge is to increase helmet use. A mandatory motorcycle helmet law in 1990 and information campaigns aimed at bicyclists have increased the percentage of riders wearing helmets in Washington State. We hypothesized that there would be an associated decrease in the proportion of severe HIs in BC and MCC admissions to the state's only level I trauma center. We analyzed injury region and outcomes for all 466 BC and 992 MCC instate admissions from 1986 to 1993. For BCs, the proportion of severe HIs (Abbreviated Injury Scale score of 4 or 5) declined from 29% in 1986 to 11% in 1993 (p = 0.02). BC trends paralleled helmet use in observations on 8,860 bicycle riders in the area, in which the percentage of helmeted riders rose from 5% in 1987 to 62% in 1993 (p < 0.001). For MCCs, severe HIs declined from 20% before passage of the helmet law to 9% afterward (p < 0.001). Mortality decreased for BCs and MCCs (p < 0.05), and length of hospital stay and ICU stay decreased for BCs (p < 0.05). The percentage of helmeted BC admissions rose from 0% to 32% (p = 0.009), and helmeted MCC admissions rose from 41% to 80% (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗
PubMed1995

Trauma care systems in urban Latin America: the priorities should be prehospital and emergency room management.

Trauma is a significant cause of premature death in developing nations, but financial resources to deal with it are extremely limited. To determine which segments of a developing nation's trauma system would be most amenable to improvements, we compared management and outcome of all seriously injured patients (Injury Severity Score of > or = 9 or died) treated over 1 year by the trauma systems associated with an urban hospital in Latin America, Regional Trauma Center 21 (n = 545) in Monterrey, Mexico, and a level I trauma center in the United States, Harborview Medical Center (n = 533) in Seattle, Wash. Mortality was higher in Monterrey (55%) than in Seattle (34%, p < 0.001), because of a preponderance of prehospital and emergency room (ER) deaths. In Monterrey, 40% of seriously injured patients died in the field and 11% in the ER, compared with 21% in the field and 6% in the ER in Seattle (p < 0.001). There were significant differences in prehospital care between the two trauma systems. Scene and transport times were < 30 minutes for 47% of Monterrey cases vs. 75% in Seattle (p < 0.001). For patients with arrival blood pressure < 80, prehospital intubations had been performed on 5% of Monterrey patients vs. 79% in Seattle (p < 0.001) and en route fluid resuscitation administered to 70% of Monterrey patients vs. 99% in Seattle (p < 0.001). The observed mortality patterns indicate that priorities for trauma system improvement in urban Latin America should focus on more rapid prehospital transport and improved en route and ER resuscitation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Admissions for injury at a rural hospital in Ghana: implications for prevention in the developing world.

OBJECTIVES: Strategies for injury prevention have been extensively studied in developed nations but not in the developing world. This study sought to determine which mechanisms of injury were common in a rural developing area and which were important contributors to mortality and disability. METHODS: All 614 patients admitted for injuries to a rural African hospital between 1987 and 1991 were analyzed retrospectively for mechanism of injury and outcome, as assessed by mortality and long-term functional status. RESULTS: The leading mechanisms of injury were transport related (29%) and burns (16%). Burns accounted for 61% of injuries in children under 5 years. Mortality was 7.3% in the series, with 24% of deaths owing to transport injuries. Disability developed in 103 (22%) of the 462 survivors available for assessment, with most disability resulting from transport injuries (26% of all disabilities), burns (13%), and agricultural injuries (14%). CONCLUSIONS: Among injured patients who presented for treatment in this rural developing area, the largest burden of mortality and disability was from burns and transport-related injuries. Population-based studies are needed to substantiate whether these should be priorities for injury prevention efforts.

Adolescent↗
PubMed1994

Maternal knowledge, attitude and practices regarding childhood acute respiratory infections in Kumasi, Ghana.

Acute respiratory infections (ARI) are a major cause of paediatric mortality and morbidity, particularly when associated with delays in treatment. A study of mothers' knowledge, attitudes and practices regarding ARI in their children aged less than 5 years was conducted in an urban Ghanaian population. One hundred and forty-three women traders were interviewed in open air markers in Kumasi, Ghana. Based on Western standards, there was a poor maternal understanding of the aetiology of ARI. A variety of herbal and home care therapies, including some which have potentially harmful effects, were routinely employed for the prophylaxis and treatment of ARI. For example, castor oil and enemas (25.9%) were reported as agents to prevent ARI, and antibiotics were prescribed by the parents in 39.9% for treating coughs. While the mothers exhibited an understanding of symptoms which differentiate between mild and severe ARI, a substantial number indicated that they would delay accessing a health care facility in the presence of the following symptoms which signify severe respiratory distress: dyspnoea (11.2%); tachypnoea (18.9%); chest retraction (21.7%); cough, fever and anorexia (30.0%); and cough, fever and lethargy (57.3%). These findings support the need for an ARI health education programme in Ghana.

Acute Disease↗