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Biomedical subjects

D Rowland

Publications and source records attributed to D Rowland.

At least 37 records · Page 2Linked to original sources
PubMed1997

Impact of a statewide trauma system on rural emergency department patient assessment documentation. OHSU Rural Trauma Research Group.

OBJECTIVE: To determine the association of rural ED patient assessment documentation with state trauma system implementation, hospital trauma categorization level (i.e., Level-3 vs Level-4), injury diagnosis, and patient demographics. METHODS: A pre- vs post-system implementation (historical control) analysis of trauma documentation was performed using a sample of rural ED trauma patients from 4 Level-3 and 5 Level-4 trauma hospitals. The medical records of patients with specific index diagnoses in 4 anatomic regions (head, chest, liver/spleen, and femur/open-tibia) were reviewed for 3-year periods before statewide trauma system implementation and after hospital categorization. Vital sign, % inspired O2, and O2 saturation determinations were identified relative to the first and the last vital signs documented on the ED record. If not documented in the medical chart within 5 minutes of the first or last ED vital sign assessment, these measurements were considered missing. Separately, neurologic documentation (initial and final) also was sought for patients meeting criteria for an index head injury. RESULTS: Of 1,057 patients entered into the database, 532 were evaluated during the pre-system period and 525 were evaluated during the post-system period. Overall, 47% had a head injury, 34% had a chest injury, 23% had a femur/open-tibia injury, and 12% had a spleen/liver injury. There were 142 (13%) patients with an injury in > 1 index area. Except for initial systolic blood pressure, documentation of all other initial and final patient vital signs increased significantly (p < 0.05). Documentation of the Glasgow Coma Scale score (initial and final; p = 0.0001) and a final pupil examination on head-injured patients (p = 0.025) also increased. The effects of hospital level, injury diagnosis, and patient demographics on documentation rate were minimal. CONCLUSION: The study found overall improved ED documentation of trauma patient status in association with implementation of a statewide trauma system. This improvement in documentation suggests an enhanced process of care with trauma system participation.

Adolescent↗
PubMed1997

Unmet long-term care needs of elderly people in the community: a review of the literature.

The extent of unmet need, or the extent to which needed assistance is unavailable for insufficient, is an important issue in public policy and financing of health and support services. This article reviews the research of literature to assess how unmet method is measured, and the extent of unmet needs among elderly people in the community. Measurement difficulties include variable definitions and measures of need across studies, the relative dearth of studies which undertake to measure unmet needs, and varying methodologies used to estimate need and unmet need. In addition, some measures of status and need, such as cognitive impairment and care giver burden are excluded from many estimates. Estimates of unmet need range from around 2 percent to about 35 percent of community dwelling elders, depending on what is included or excluded from the definition. Unmet need is associated with higher disability levels and living alone. The literature suggests that estimates of future unmet need will be mitigated by declining disability levels and increased use of assistive devices among the elder population.

Activities of Daily Living↗
PubMed1996

A differential neural response in the human amygdala to fearful and happy facial expressions.

The amygdala is thought to play a crucial role in emotional and social behaviour. Animal studies implicate the amygdala in both fear conditioning and face perception. In humans, lesions of the amygdala can lead to selective deficits in the recognition of fearful facial expressions and impaired fear conditioning, and direct electrical stimulation evokes fearful emotional responses. Here we report direct in vivo evidence of a differential neural response in the human amygdala to facial expressions of fear and happiness. Positron-emission tomography (PET) measures of neural activity were acquired while subjects viewed photographs of fearful or happy faces, varying systematically in emotional intensity. The neuronal response in the left amygdala was significantly greater to fearful as opposed to happy expressions. Furthermore, this response showed a significant interaction with the intensity of emotion (increasing with increasing fearfulness, decreasing with increasing happiness). The findings provide direct evidence that the human amygdala is engaged in processing the emotional salience of faces, with a specificity of response to fearful facial expressions.

Adult↗
PubMed1996

Loss of disgust. Perception of faces and emotions in Huntington's disease.

Face perception and emotion recognition were investigated in a group of people with Huntington's disease and matched controls. In conventional tasks intended to explore the perception of age, sex, unfamiliar face identity (Benton test) and gaze direction from the face, the Huntington's disease group showed a borderline impairment of gaze direction perception and were significantly impaired on unfamiliar face matching. With a separate set of tasks using computerinterpolated ('morphed') facial images, people with Huntington's disease were markedly impaired at discriminating anger from fear, but experienced less difficulty with continua varying from male to female, between familiar identities, and from happiness to sadness. In a further test of recognition of facial expressions of basic emotions from the Ekman and Friesen (1976) series, interpolated images were created for six continua that lay around the perimeter of an emotion hexagon (happiness-surprise; surprise-fear; fear-sadness; sadness-disgust; disgust-anger; anger-happiness). In deciding which emotion these morphed images were most like, people with Huntington's disease again showed deficits in the recognition of anger and fear, and an especially severe problem with disgust, which was recognized only at chance level. A follow-up study with tests of facially and vocally expressed emotions confirmed that the recognition of disgust was markedly poor for the Huntington's disease group, still being no better than chance level. Questionnaires were also used to examine self-assessed emotion, but did not show such striking problems. Taken together, these data reveal severe impairments of emotion recognition in Huntington's disease, and show that the recognition of some emotions is more impaired than others. The possibility that certain basic emotions may have dedicated neural substrates needs to be seriously considered: among these, disgust is a prime candidate.

Adult↗
PubMed1996

The incidence and distribution of leukaemia and lymphoma within Northern Ireland in the period 1989-1993.

This is the first attempt to systematically record haematological malignancies in Northern Ireland. The methods are identical to a similar effort in other parts of the UK, except that an independent cross check with a cancer registry source was not possible. In addition problems with the census may create differences. Generally, the rates for the leukaemias are slightly lower than in England and Wales, except for acute lymphoblastic leukaemia whilst non-Hodgkin's lymphoma rates are higher. It remains to be seen how stable this situation is as further data are accumulated.

Adolescent↗
PubMed1995

Triage in an established trauma system.

OBJECTIVE: The goal of this study was to determine patient and injury characteristics that predict undertriage and overtriage. DESIGN: This study was a retrospective analysis of admissions for acute injury. MATERIALS AND METHODS: All admissions for acute injuries in a 2 1/2-year period were included (N = 26,025). ICD-9 clinical modification codes were converted to Injury Severity Scores. MAIN RESULTS: Seventy-nine percent of severely injured patients were admitted to level I trauma centers. Severely injured patients admitted to other hospitals (undertriage) were more likely elderly (odds ratio = 5.44) and less likely had multisystem injuries (odds ratio = 0.55). One-fourth of patients with minor injuries were admitted to level I trauma centers (overtriage). Overtriaged patients were more likely intoxicated, obese, or had an injury to the head or face. CONCLUSIONS: In a developed trauma system, severely injured elderly trauma patients (especially females) are at risk for undertriage. The characteristics of patients at risk for overtriage reflect the difficulties of prospective out-of-hospital triage.

Adult↗
PubMed1995

Health insurance: the size and shape of the problem.

Assessment of experiences with health care will continue to be important given the rapid changes in the health care system and retreat from broad national attention on health reform. This paper reports on the findings of the 1993 Kaiser/Commonwealth Survey of Americans and their health insurance. The survey findings highlight the chronic problem of uninsurance as well as concerns among those with insurance, including the worry that benefits will be reduced or become unaffordable. Limited choice of health plans and providers and having to join a managed care plan are further concerns. These findings suggest that many Americans' needs remain unaddressed, but they will have to be considered as the health care system is restructured.

Consumer Behavior↗
PubMed1994

Commentary: Lessons from Medicaid--improving access to office-based physician care for the low-income population.

Medicaid offers important lessons about providing access to office-based physician services for the poor. First, differentials in physician fees between Medicaid and other payers compromise access to care and are difficult to reverse. Second, managed care alone is not enough to attain equity in access, especially if differentials in payment rates between Medicaid and private patients in managed care settings are allowed to grow. Finally, financing strategies alone are not sufficient to resolve the shortage of health care providers in medically underserved areas. In these areas, payment policy must be combined with resource development to ensure that vulnerable populations have access to care.

Health Policy↗
PubMed1993

Explaining the recent growth in Medicaid spending.

Medicaid spending more than doubled from 1988 to 1992, reversing a long trend of cost containment in the program. Reasons for the cost explosion are severalfold. (1) Congress expanded eligibility to more children, pregnant women, and low-income elderly persons. (2) The recession has added more people to the Medicaid rolls. (3) Growing numbers of disabled cash assistance recipients have increased Medicaid enrollment. (4) States have increased their use of federal Medicaid funds to supplement previously state-funded programs and have become more skillful in leveraging federal funds to defray the cost of their Medicaid programs. This DataWatch explores the relative impact of enrollment changes, inflation, and increased reimbursement on the increase in Medicaid spending.

Cost Control↗
PubMed1992

Government.

Explore the source record for details and available documents.

Federal Government↗
PubMed1992

Health care for all: comparing proposals for reform. A roundtable discussion: Part 2.

Part 1 of this roundtable discussion [Geriatrics 1992; 47(Sept):34-48] examined the flaws in our current healthcare system and factors that are interfering with our nation's ability to achieve reforms. This month, the panelists discuss the benefits and drawbacks of the major healthcare reform proposals, including managed care, single-payer systems, and so-called "play or pay." The practical aspects of any redistribution of healthcare resources are considered as each panelist outlines a favored approach. The influence of special interests, such as the insurance industry, is also discussed.

Health Policy↗