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Biomedical subjects

J Firestone

Publications and source records attributed to J Firestone.

5 recordsLinked to original sources
PubMed2006

Changes in coping style following traumatic brain injury and their relationship to productivity status.

The use of maladaptive coping strategies following traumatic brain injury (TBI) is known to be associated with increased depression and a lower productivity status. What is not known is whether coping behaviours change following TBI and if they do change whether these changes account for significant variance in outcome. Seventy-three significant others of TBI survivors were recruited at the time their friend/family member was injured and followed prospectively. They reported on their friend/family member's pre-injury and 6-month coping behaviours using the Coping with Health Injuries and Problems Scale. The use of emotional pre-occupation coping (p = .02) increased significantly and approached significance for distraction coping(p = .08). These changes in coping also accounted for significant variance (22%, p = .02) in productivity status over and above that accounted for by demographics and injury severity. Whether maladaptive coping changes can be prevented with a view to improving outcomes is a question that now needs to be explored.

Adaptation, Psychological↗
PubMed1997

Clinical course of crack cocaine body stuffers.

STUDY OBJECTIVE: To describe the clinical course of a cohort of patients presenting to the emergency department with acute crack cocaine body-stuffer syndrome. METHODS: We conducted a retrospective cohort study in the ED of a county hospital with 75,000 visits per year. Our study cohort comprised all patients who presented between January 1993 and April 1995 and who met the definition of a crack cocaine body stuffer. We defined a crack cocaine body stuffer as anyone who admitted to or was strongly suspected of ingesting crack cocaine as a means of escaping detection by authorities, not for recreational purposes or as a means of transporting the drug across borders. RESULTS: We identified 98 cases; most such patients were brought to the ED by law enforcement agents. Most were male and younger than 30 years. Self-report by patients indicated that the amount of crack cocaine ingested ranged from 1 to more than 15 rocks. Most commonly the drug was unwrapped (28%) or wrapped in a plastic sandwich bag (29%). Generalized seizures developed in 4% of the patients; in all these patients seizures occurred within 2 hours of ingestion. In no patient did dysrhythmias develop. Many patients had minor signs of cocaine intoxication: 54% were tachycardic, 23% were hypertensive, 22% were agitated, and 19% required sedation. CONCLUSION: Mild cocaine intoxication is common in crack cocaine body stuffers, with seizures occurring within 2 hours of ingestion in a small percentage of patients.

Adult↗
PubMed1997

Long-term functional outcome of inpatient pediatric cardiopulmonary resuscitation.

OBJECTIVE: There is limited information published regarding the long-term outcome of pediatric survivors of inpatient cardiopulmonary resuscitation (CPR). The purpose of this study was to document the long-term (i.e., > or = 1 year after the arrest) functional outcome of children surviving inpatient CPR. METHODS: We reviewed the medical records of children (i.e., less than 18 years of age) receiving advanced CPR (i.e., chest compressions, assisted ventilation, and resuscitation medications) as inpatients in a tertiary care children's hospital. Prospective telephone follow-up of the survivors a minimum of one year after the arrest was performed. A change in the survivors' Pediatric Cerebral Performance Category (PCPC) scale was determined. RESULTS: Approximately half of the 92 subjects were diagnosed with sepsis syndrome. None (0/44) of the patients with sepsis syndrome survived at one year. None (0/24) of the patients who experienced a single episode of advanced CPR > or = 30 min in duration survived one year. Although 36% (33/92) of the patients resuscitated were alive 24 h after their arrest, the proportion surviving fell steadily to 10% (9/92) at one year. Although five of the nine survivors were moderately to severely disabled at one year, the majority (8/9) had little or no change in their PCPC score at one year compared to their prearrest level of function. CONCLUSION: Survival of inpatient pediatric CPR is small. Children surviving inpatient advanced CPR may have little or no change from prearrest function. The survival of hospitalized children with sepsis syndrome requiring CPR or receiving greater than > 30 min of advanced CPR is extremely low.

Adolescent↗
PubMed1996

Out-of-hospital treatment of opioid overdoses in an urban setting.

OBJECTIVES: To investigate clinical outcomes in a cohort of opioid overdose patients treated in an out-of-hospital urban setting noted for a high prevalence of i.v. opioid use. METHODS: A retrospective review was performed of presumed opioid overdoses that were managed in 1993 by the emergency medical services (EMS) system in a single-tiered, urban advanced life support (ALS) EMS system. Specifically, all patients administered naloxone by the country paramedics were reviewed. Those patients with at least 3 of 5 objective criteria of an opioid overdose [respiratory rate < 6/min, pinpoint pupils, evidence of i.v. drug use. Glasgow Coma Scale (GCS) score < 12, or cyanosis] were included. A response to naloxone was defined as improvement to a GCS > or = 14 and a respiratory rate > or = 10/min within 5 minutes of naloxone administration. ED dispositions of opioid-overdose patients brought to the county hospital were reviewed. All medical examiner's cases deemed to be opioid-overdose-related deaths by postmortem toxicologic levels also were reviewed. RESULTS: There were 726 patients identified with presumed opioid overdoses. Most patients (609/726, 85.4%) had an initial pulse and blood pressure (BP). Most (94%) of this group responded to naloxone and all were transported. Of the remainder, 101 (14%) had obvious signs of death and 16 (2.2%) were in cardiopulmonary arrest without obvious signs of death. Of the patients in full arrest, 2 had return of spontaneous circulation but neither survived. Of the 609 patients who had initial BPs, 487 (80%) received naloxone i.m. (plus bag-valve-mask ventilation) and 122 (20%) received the drug i.v. Responses to naloxone were similar; 94% i.m. vs 90% i.v. Of 443 patients transported to the country hospital, 12 (2.7%) were admitted. The admitted patients had noncardiogenic pulmonary edema (n = 4), pneumonia (n = 2), other infections (n = 2), persistent respiratory depression (n = 2), and persistent alteration in mental status (n = 2). The patients with pulmonary edema were clinically obvious upon ED arrival. Hypotension was never noted and bradycardia was seen in only 2% of our presumed-opioid-overdose population. CONCLUSIONS: The majority of the opioid-overdose patients who had initial BPs responded readily to naloxone, with few patients requiring admission. Noncardiogenic pulmonary edema was uncommon and when present, hypoxia was evident upon arrival to the ED. Naloxone administered i.m. in conjunction with bag-valve-mask ventilation was effective in this patient population. The opioid-overdose patients in cardiopulmonary arrest did not survive.

Adult↗