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Biomedical subjects

D L Covington

Publications and source records attributed to D L Covington.

35 records · Page 2Linked to original sources
PubMed1993

Oral contrast is not necessary in the evaluation of blunt abdominal trauma by computed tomography.

The administration of oral contrast (OC) is widely recommended for computed tomography (CT) of the abdomen in patients with blunt trauma. The purpose of this study was to determine whether routine abdominal CT scans performed without OC were associated with diagnostic error in patients with blunt trauma. Four hundred ninety-two patients were identified from our Trauma Registry who had CT scans for the evaluation of blunt abdominal trauma between January 1988 and December 1991. Seventy-six percent (372) of the CT scans were interpreted as negative, and 24% (120) were considered positive. OC was used in 8 (1.6%) of 492 patients. Only 1 of 372 patients whose initial non-OC--enhanced scan was negative subsequently required surgery. There were 5 bowel injuries among the 42 patients who underwent an abdominal operation; in none would the use of OC have ensured the preoperative diagnosis. We found that the omission of OC did not represent a disadvantage to patients with blunt trauma undergoing a routine abdominal CT scan. Potential time delays and the hazards associated with the use of OC were minimized.

Abdominal Injuries↗
PubMed1993

Hospital resources used to treat the injured elderly at North Carolina trauma centers.

OBJECTIVE: The purpose of this paper is to compare the hospital resources used by elderly, adult, and pediatric patients treated in hospitals reporting to the North Carolina Trauma Registry (NCTR). DESIGN: We analyzed data on all patients entered into the NCTR from 1 January 1988 to 31 December 1990. SETTING: The NCTR is a statewide registry of all trauma patients admitted for at least 24 hours or dead on arrival at the eight Level I and II trauma center hospitals in North Carolina. PATIENTS: The total number of patients included in the study was 21,214; elderly adults included those age 65 and older (n = 2808), adults included those 15 to 64 years old (n = 15,776), and pediatric patients included those 0 to 14 years old (n = 2630). MAIN OUTCOME MEASURES: We examined hospital resources using three measures: overall length of hospital stay in days, intensive care unit (ICU) length of stay in days for those admitted to the ICU, and total hospital charges billed during the hospitalization. RESULTS: Controlling for injury severity, we found that elderly adults had longer mean hospital and ICU lengths of stay and higher mean hospital charges than adults or children. Whereas only 22% of injuries to elderly adults were transportation-related, transportation injuries generated 38% of their hospital charges. Sixty-eight percent of their injuries were caused by falls, generating total hospital charges of $17.6 million, an average of 15 days in hospital stay and 9 days in ICU stay. CONCLUSION: A 10% reduction in both transportation injuries and falls among the elderly could save $3.5 million in this population over 3 years.

Accidents, Traffic↗
PubMed1992

Results of staged bilateral carotid endarterectomy.

To determine differences in outcome between unilateral and staged bilateral carotid endarterectomies, we reviewed 850 carotid endarterectomies done by 14 surgeons in a community hospital. Results of 528 unilateral procedures were compared with those of 161 bilateral procedures. Data were abstracted from records for an 11-year period. Twelve of the patients in the unilateral group had nonfatal strokes, and 14 died within 30 days of surgery (stroke + death rate, 4.9%). There were no nonfatal strokes among patients in the bilateral group, and nine died (stroke + death rate, 5.6%). Seven of 14 deaths in the unilateral group and six of nine deaths in the bilateral group were due to neurologic events. In the bilateral group, death was associated with postoperative hypertension and a short intersurgical interval. The stroke + death rate was not significantly different between unilateral and bilateral procedures and compared favorably with North American Symptomatic Carotid Endarterectomy Trial guidelines and other published reports. Staged bilateral carotid endarterectomy can be safely performed in a community hospital.

Carotid Artery Diseases↗
PubMed1990

The effects of a prematurity prevention program on births to adolescents.

This study evaluates the effectiveness of the North Carolina Prematurity Prevention Program in reducing low-birthweight births among adolescents seeking prenatal care at the New Hanover Memorial Hospital obstetric clinic. Modeled on programs developed by Papiernik and Creasy, the program includes three components: staff education, patient identification, and patient education. Thirteen percent of the clinic population is 13-17 years old. The same prematurity prevention protocol is used for both adults and adolescents. Overall, 12% of the 847 women who delivered prior to the program had a low-birthweight infant. Among the 748 women who delivered during the program, the number of low-birthweight infants declined to 9.5%. For mothers 13-17 years old, 14% of the preprogram group had a low-birthweight infant, as did 14% of those in the program. A logistic regression model, controlling for certain risk factors, suggests that the program was not effective in reducing low-birthweight births among these adolescents (OR = 0.9; 95% CI = 0.2, 1.8).

Adolescent↗
PubMed1990

Community hospital carotid endarterectomy in patients over age 75.

We compared the prevalence of stroke and death in 133 patients aged 75 and older in whom 170 carotid endarterectomies were performed with that in 501 patients less than age 75 in whom 640 carotid endarterectomies were performed. There were three strokes (2%) in patients aged 75 and older and nine strokes (1%) in younger patients (p = 0.7). There were 8 deaths (5%) in patients aged 75 and older and 14 deaths (2%) in younger patients (p = 0.1). After controlling for the possible confounding effects of diabetes, prior stroke, history of angina, prior carotid artery disease, previous vascular surgery, history of myocardial infarction, preoperative hypertension requiring medication, and female gender, a logistic regression model showed that patients aged 75 and older were no more likely to have a stroke or death than patients under age 75. We conclude that age alone is not a contraindication to the safe performance of carotid endarterectomy in the community hospital.

Age Factors↗
PubMed1988

Effects of the North Carolina Prematurity Prevention Program among public patients delivering at New Hanover Memorial Hospital.

Twelve per cent of the 847 women who delivered in one hospital prior to implementation of the North Carolina Prematurity Prevention Program had low-birthweight births compared with 9.5 per cent of the 748 women who delivered during the program. Controlling for known risk factors, both low- and very-low birthweight births among Whites (Odds Ratio 2.0 and 3.7 respectively) and very-low-birthweight births among Blacks (OR 2.9) were reduced.

Education, Continuing↗
PubMed1985

Cesarean delivery in northeast region of Brazil, 1978-80.

This study presents information on cesarean section rates for the last baby born to 1,746 women in Northeast Brazil between January 1978 and the date of a 1980 household survey. For hospital deliveries, the c-section rate is 19 per cent. Rates were highest in the major urban areas and lowest in rural areas. Within residence categories, the section rate was related directly to education, early prenatal care, and delivery in private hospitals.

Adolescent↗
PubMed1983

Sterilization in Honduras: assessing the unmet demand.

The purpose of this study was to evaluate and compare the availability of sterilization services at two hospitals in Honduras. Approximately 7,000 women who had given birth at the Hospital Materno Infantil in Tegucigalpa and the Hospital Leonardo Martinez in San Pedro Sula were asked about their desire for sterilization. Of the women who wanted to be sterilized, a considerable percentage had not been sterilized four months after they had given birth--58 percent of those who had delivered at Materno Infantil and 79 percent of those who had delivered at Leonardo Martinez. Twenty-three percent of the women who delivered at Materno Infantil and 4 percent of the women who delivered at Leonardo Martinez were sterilized before they were discharged. The difference may be attributed to the poor quality of the facilities at Leonardo Martinez.

Adolescent↗
PubMed1982

Interval sterilizations. A substitute for postpartum procedures, an example from Southeast Brazil.

From December 1979 to February 1980, data were collected on access to postpartum sterilization for all obstetric patients at a large maternity hospital in Campinas, Brazil. Of the 827 women wanting no additional children and having knowledge of sterilization, 481 (58%) reported that they wanted to be sterilized. Of these women, 226 (47%) were sterilized postpartum. One year following their deliveries, follow-up forms were administered to the women desiring sterilization, but who had not been sterilized postpartum, to determine if they had been sterilized over the course of the year. Only 13% of the women had been sterilized, but almost 75% of the women not sterilized said they were still interested in getting sterilized. Of the women interviewed, 18% either had become pregnant again since the initial survey or were currently pregnant.

Adult↗
PubMedDate not supplied

Physician attitudes and family planning in Nigeria.

This study examines family planning attitudes and practices of 681 Nigerian physicians selected from cities in which large university teaching hospitals are located. About half of the physicians were practicing family planning; the method of choice was the IUD. Obstetrician/gynecologists and general practitioners were more likely to provide methods to their patients than were other types of physicians. The physicians were concerned about population growth and favored family planning, yet a substantial minority believed that family planning is foreign to the culture and that it promotes promiscuity. Physicians were reluctant to promote family planning on a wide scale; many disapproved of non-physicians providing oral contraceptives or IUDs.

Adult↗
PubMedDate not supplied

Why women don't get sterilized: a follow-up of women in Honduras.

In 1980, a study to determine interest in and access to sterilization for females was initiated at two Ministry of Health hospitals in Honduras. Results of the baseline study showed that 42 percent of women desiring sterilization from the Tegucigalpa hospital and 21 percent from the San Pedro Sula hospital had had a tubal ligation. A second study was conducted two years later, following up the interested but unsterilized women from the baseline study. Results show that 33 percent of women in the Tegucigalpa group, compared to 15 percent in the San Pedro Sula group, had been sterilized. Part of this difference can be attributed to an increase in sterilization facilities in Tegucigalpa over the two years after the baseline study was conducted. Among the major reasons women gave for not having been sterilized were financial and time constraints. Over the two-year period, the authors estimate that, of women interested in sterilization at delivery, 52 percent in total were sterilized in Tegucigalpa and 29 percent in San Pedro Sula.

Adult↗