Biomedical subjects

C R Gross

Publications and source records attributed to C R Gross.

49 records · Page 3Linked to original sources

PubMed1989

Head injury mortality in two centers with different emergency medical services and intensive care.

The authors report data collected prospectively on 551 cases of head injury in New Delhi, India, and 822 cases in Charlottesville, Virginia. The mortality rate, adjusted for initial severity of injury, was 11.0% in New Delhi versus 7.2% in Charlottesville (p less than 0.02). There was a striking similarity in mortality rates at both centers when comparing patients with the least severe head injuries and those with the most severe injuries according to the motor score of the Glasgow Coma Scale (GCS M). However, in the group with an abnormal but purposeful motor response (GCS M = 5), the mortality rate was 12.5% in New Delhi versus 4.8% in Charlottesville (p less than 0.01). The relative absence of prehospital emergency care and the delay in admission after head injury in New Delhi are cited as two possible causes for the differences in mortality rates in this subgroup of patients with "moderate" head injuries.

Adult↗

PubMed1989

A report from the NIDDK Liver Transplantation Database.

The development and pilot phase of the NIDDK LTD project has been successfully completed by recruiting and uniformly evaluating at baseline and follow-up of 176 candidates and 101 transplant patients from 5 LTD Clinical Centers (Baylor University Medical Center, Mayo Clinic, University of California at Los Angeles, University of Minnesota, and University of Pittsburgh). The first set of analyses presented in this report describes the characteristics of the candidates, recipients and donors who were enrolled in the LTD pilot study. Other findings must be regarded as trends until more data become available. Candidates who presented with fulminant or subacute liver failure as well as those with lupoid type chronic active hepatitis had the highest selection rate for transplantation while those with malignancy and alcoholic cirrhosis had the lowest. Overall, little selection occurred on the basis of age alone. Early posttransplantation recovery characterized by prolonged ICU stay, or by death or retransplantation in the ICU, were significantly influenced by operative and recipient factors. Generally, when function of other organ systems was impaired, the event rates were higher. Abnormal neurological status represented the greatest risk. For the ICU course, patients with fulminant disease fared the worst and cirrhotics the best. Long operation (greater than 8 hrs) and blood use in excess of 3,000 ml had 2-3 times the risk for long ICU stay or adverse ICU events. Surprisingly, donor and harvesting factors also played a significant role in the early posttransplantation course. Such trends were shown for drug abuser donors and for rapid hepatectomy time. The harvesting surgeon's assessment of the donor and the graft had good predictive value of the ICU course. Finally, patients who required retransplantation within 6 weeks more often had donors with histories of longer hospitalization and fewer grafts that were deemed excellent or good at harvest.

Databases, Bibliographic↗

PubMed1987

Interobserver reliability in the interpretation of computed tomographic scans of stroke patients.

Interobserver reliability in interpretation of computed tomographic images was studied by six senior neurologists who independently evaluated on a standardized Stroke Data Bank form the brain lesions of 17 patients. The results analyzed with kappa statistics yielded moderate to substantial agreement on most items of interest including the stroke pathology and anatomy. In general, the levels of agreement were as high as previously reported for the diagnosis of the mechanism of the stroke, and much higher than on many stroke history items and items of neurologic examination. Excellent agreement was obtained for the detection of infarcts and intracerebral hemorrhage, and substantial agreement was obtained on whether the computed tomographic images were normal or indicative of small deep infarcts, superficial and deep infarcts, and aneurysms. The level of agreement on anatomy of the lesions was best for the frontal, parietal, and temporal lobes, putamen, cerebellum, and subarachnoid space. Implications for clinical research and diagnosis are discussed.

Adult↗

PubMed1987

Reliability of the activities of daily living scale and its use in telephone interview.

Activities of daily living (ADL), a popular outcome assessment tool for studies of disabled populations, was evaluated for use in multicentered studies. The interobserver reliability of a modified Barthel Index of the ADL was evaluated on 18 stroke patients. Reliabilities between administrators of the ADL and between observers of the ADL administrations were r = .99 for total scores and r greater than .90 for most of the individual component items. The validity of ADL evaluation based on telephone interviews was demonstrated relative to ADL scores obtained on 72 patients in a direct test of their performance capabilities. The correlations between the performance-based ADL and the interview-based ADL were r greater than .97 for the total score and r greater than .85 for most of the individual items. The modified Barthel Index of the ADL is a reliable measure for assessing stable stroke patients, supporting its use in multicenter studies. In addition, the high validity observed in the telephone interview supports its use in longitudinal studies and large surveys where direct performance evaluation is not feasible or too costly.

Activities of Daily Living↗

PubMed1986

Interobserver agreement in the diagnosis of stroke type.

Interobserver agreement is essential to the reliability of clinical data from cooperative studies and provides the foundation for applying research results to clinical practice. In the Stroke Data Bank, a large cooperative study of stroke, we sought to establish the reliability of a key aspect of stroke diagnosis: the mechanism of stroke. Seventeen patients were evaluated by six neurologists. Interobserver agreement was measured when diagnosis was based on patient history and neurologic examination only, as well as when it was based on results of a completed workup, including a computed tomographic scan. Initial clinical impressions, based solely on history and one neurologic examination, were fairly reliable in establishing the mechanism of stroke (ie, distinguishing among infarcts, subarachnoid hemorrhages, and parenchymatous hemorrhages). Classification into one of nine stroke subtypes was substantially reliable when diagnoses were based on a completed workup. Compared with previous findings for the same physicians and patients, the diagnosis of stroke type was generally more reliable than individual signs and symptoms. These results suggest that multicentered studies can rely on the independent diagnostic choices of several physicians when common definitions are employed and data from a completed workup are available. Furthermore, reliability may be less for individual measurements such as signs or symptoms than for more-complex judgments such as diagnoses.

Adult↗

PubMed1985

Interobserver variability in the assessment of neurologic history and examination in the Stroke Data Bank.

Interobserver reliability in obtaining neurologic histories and examinations was investigated among neurologists collaborating in the Stroke Data Bank (SDB). Seventeen in-hospital stroke patients were examined by six neurologists experienced in stroke over the course of three days. Patients were examined twice a day for two successive days, with each patient seen by four different neurologists. Data were recorded on SDB forms, according to definitions and procedures established for the SDB. Percent agreement and kappa coefficients were calculated to assess the levels of agreement for each item. Important differences in levels of agreement were found among items on both neurologic history and examination. Agreement among neurologists was higher for neurologic examination than for history. Patterns of agreement for items with low prevalence or with numerous unknown ratings are discussed. Improvement in interobserver agreement due to data editing for intra-observer consistency was shown.

Adult↗

PubMed1983

The National Traumatic Coma Data Bank. Part 1: Design, purpose, goals, and results.

This paper describes the pilot phase of the National Traumatic Coma Data Bank, a cooperative effort of six clinical head-injury centers in the United States. Data were collected on 581 hospitalized patients with severe non-penetrating traumatic head injury. Severe head injury was defined on the basis of a Glasgow Coma Scale (GCS) score of 8 or less following nonsurgical resuscitation or deterioration to a GCS score of 8 or less within 48 hours after head injury. A common data collection protocol, definitions, and data collection instruments were developed and put into use by all centers commencing in June, 1979. Extensive information was collected on pre-hospital, emergency room, intensive care, and recovery phases of patient care. Data were obtained on all patients from the time of injury until the end of the pilot study. The pilot phase of the Data Bank provides data germane to questions of interest to neurosurgeons and to the lay public. Questions are as diverse as: what is the prognosis of severe brain injury; what is the impact of emergency care; and what is the role of rehabilitation in the recovery of the severely head-injured patient?

Accidents↗

PubMedDate not supplied

Clinical indicators of dehydration severity in elderly patients.

STUDY OBJECTIVE: To determine which of the signs and symptoms of dehydration obtainable from patient history and physical examination in the emergency department are most useful in assessing the severity of dehydration in elderly patients. DESIGN: Prospective, correlational study. SETTING: Two university teaching hospitals. PATIENTS: Fifty-five patients aged 60 or older presenting to the emergency department with suspected dehydration were studied. MEASUREMENTS AND MAIN RESULTS: In the emergency department, patients were evaluated by a standardized history and physical examination that included assessment of 38 signs and symptoms commonly attributed to dehydration. The relationships between the presence and intensity of these putative dehydration indicators and an independent rating of dehydration severity based on a comprehensive review of the medical record were evaluated. Also evaluated were the relationships between these dehydration indicators and patient age. Indicators that correlated best with dehydration severity but were unrelated to patient age included: tongue dryness (P less than 0.001), longitudinal tongue furrows (P less than 0.001), dryness of the mucous membranes of the mouth (P less than 0.001), upper body muscle weakness (P less than 0.001), confusion (P less than 0.001), speech difficulty (P less than 0.01), and sunkenness of eyes (P less than 0.01). Other indicators had only weak associations with dehydration severity or were also related to age. Patient thirst was unrelated to dehydration severity. CONCLUSIONS: A set of signs and symptoms related to dehydration severity in elderly patients has been identified. These indicators may be more useful for evaluation of dehydration severity in the emergency department than other commonly used indicators.

Aged↗

PubMedDate not supplied

Use of complementary therapies, adherence, and quality of life in lung transplant recipients.

PURPOSES: The purpose of this study was to describe complementary and alternative medicine (CAM) use by lung transplant patients and to determine whether CAM users differ from nonusers with respect to health status, quality of life, or medical adherence. METHODS: A mailed survey seeking CAM, quality of life, and adherence information was sent to 145 lung transplant recipients, and 99 responded. RESULTS: The majority (88%) used at least 1 form of CAM (median, 2; range, 0-17). Prayer (68%), support groups (43%), and relaxation techniques (31%) were the most common. Only 44% of users reported discussing CAM with their providers. CAM users were adherent to their transplant regimen. Few differences were found between CAM users and nonusers. Education, high symptom burden, female sex, and depression symptoms were associated with various types of CAM use. CONCLUSION: Most lung transplant recipients are using CAM. Providers must explore potential for interaction or enhancement between CAM and standard therapy to optimize care.

Adolescent↗

PubMedDate not supplied

Stroke in south Alabama: incidence and diagnostic features--a population based study.

This study has attempted to identify all persons from an area of southern Alabama who had a stroke in 1980 and were hospitalized. Data were gathered on disease onset, clinical course, laboratory results, history of risk factors, and outcome. The age-adjusted incidence rates for initial stroke were 109 per 100,000 for whites and 208 per 100,000 for blacks. Age-specific rates were higher in blacks than whites, and highest for black females. The distribution of cases by type of stroke was: atherothrombotic (6%), embolic (26%), lacunar (13%), infarction of unspecified origin (40%), parenchymatous hemorrhage (8%), subarachnoid hemorrhage (6%), and unidentified type (1%). Blacks had higher incidence rates for hemorrhages, and black females had the highest incidence rate for lacunar stroke. The overall stroke incidence rates in this series were not significantly higher than those from prior population studies, suggesting that southern Alabama is not part of the so-called "Stroke Belt" area of the southeastern United States.

Adult↗

PubMedDate not supplied

The pilot Stroke Data Bank: definition, design, and data.

Four university centers collaborated to contribute 1158 patients with acute episodes of cerebrovascular disease to the pilot Stroke Data Bank, initiated by NINCDS in 1978. During the pilot project a standard set of data collection forms were developed and used at each of the collaborating centers. Data on clinical course, laboratory findings, therapy and outcome were gathered prospectively throughout the patient's hospitalization and at specified follow-up intervals. Using operational definitions of stroke sub-types, consecutive cases were systematically allocated to specific categories of brain and vascular pathology. The definitions were based on clinical criteria as well as on laboratory data, including computerized tomography (CT), and angiography findings. This paper describes the pilot Stroke Data Bank and presents the distribution of cases by diagnostic and demographic categories. It represents one of the largest series of prospectively collected stroke cases studied by CT (90% of the cases) and angiography (42%). Based upon the methods and processes of this pilot study, a main phase of the Stroke Data Bank has been established to address a number of questions pertaining to stroke classification, evolution, diagnosis, and prognosis.

Adult↗

PubMedDate not supplied

Screening for depression in stroke patients: the reliability and validity of the Center for Epidemiologic Studies Depression Scale.

This study examined the inter-observer reliability and validity of the Center for Epidemiologic Studies Depression Scale (CES-D) as a measure of depressive symptomatology in stroke patients, and its utility as a screening tool for depression in this population. The CES-D Scale is a brief questionnaire originally designed for use in community surveys. Twenty-seven non-aphasic patients enrolled in the Stroke Data Bank at the University of Maryland were interviewed by a research nurse using the CES-D. On the same day, each patient was independently evaluated by a research assistant using a psychiatric battery for depression and measures of cognitive, physical, and social functioning. Forty-one percent (11/27) of the patients were depressed according to clinical criteria for major or minor depression. With a cutpoint corresponding to the upper (most severe) 20% in community surveys, the CES-D Scale picked up 73% (8/11) of the depressed patients. In this sample no nondepressed patient scored over 16 on the CES-D (no false positives). The CES-D Scale scores correlated significantly with the other depression measures (r = .57 to r = .82, p less than .002) and did not correlate with the measures of cognitive, physical, or social functioning. Based on 24 patients who received a CES-D Scale score from both the nurse and the research assistant, inter-rater reliability was high (r = .76, p less than .001). Thus, the CES-D was found to be reliable and valid as a screening tool for assessing depression in stroke patients.

Adult↗

PubMedDate not supplied

Patient perceptions of benefits and concerns following pancreas transplantation.

The purpose of this study was to assess patient perceptions of the impact of pancreas transplantation on various aspects of life, as well as perceptions of the benefits of and concerns with the procedure. All surviving adult patients who had received a pancreas transplant at a midwestern hospital and were at least 1 year posttransplant at the time of the study (N = 138) were sent a self-report questionnaire that included demographic data, questions about life satisfaction, quality of life, symptoms, and health impact. Patients with pancreas graft function reported less pain with healthcare treatment, fewer episodes of feeling physically ill, fewer dietary restrictions, less interference with family life, fewer health limitations in interpersonal relationships and leisure activities, and feeling good about themselves compared with those without graft function. A majority of patients with functioning grafts cited the following benefits: freedom from insulin reactions, normal blood sugars, freedom from insulin injections, freedom from a specialized diet, decreased chance of amputation, feeling better physically, more feelings of hope for the future, and more freedom and control over life. Major concerns posttransplant included side effects and the expense of immunosuppressive medications.

Activities of Daily Living↗