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L Camp

Publications and source records attributed to L Camp.

16 recordsLinked to original sources
PubMed2001

A population-based study of geriatric trauma in a rural state.

BACKGROUND: Urban geriatric trauma patients are known to die more often than their younger counterparts. Little is known of the fate of geriatric trauma patients in a rural environment where delays to definitive treatment are frequent. We hypothesized that rural trauma patients would do worse than their urban counterparts because of prolonged delays to definitive care. METHODS: Five-year retrospective analysis of all trauma deaths occurring within a rural state and retrospective outcome analysis of trauma patients admitted to a tertiary care facility who were less than 55 years old (defined as young) and 55 or more years old (defined as old). Outcome analysis was performed comparing old and young rural hospitalized patients to the Major Trauma Outcome Study data set collected in major urban trauma centers. RESULTS: Of the total trauma deaths in the state, 32.5% were old. Old patients were less likely to die at the scene of the injury than were their younger counterparts (R2 = 0.84, p < 0.001). Hospitalized old patients had a significantly higher mean Revised Trauma Score and a significantly lower Injury Severity Score, a higher complication rate, and a higher mortality rate than did hospitalized young patients. The young group had a significantly better survival (W = 0.59, Z = -3.49, p = 0.0001) than the MTOS data set, but the old group had a significantly worse survival (W = -1.8, Z = -3.49, p = 0.001). CONCLUSION: In a rural environment, old trauma patients die more commonly in the hospital than their younger counterparts, who die more commonly at the scene. Old trauma patients who die in the hospital were less severely injured than their younger counterparts who died in the hospital. Old patients admitted to this rural trauma center have a significantly worse survival than their urban counterparts despite the fact that young rural trauma patients do significantly better than their urban counterparts. Understanding the demographics of rural geriatric trauma may be useful in allocating resources in rural trauma system design. It must be understood that despite relatively low injury severity and physiologic stability, there is a significant potential for rural geriatric trauma patients to do poorly.

Adolescent↗
PubMed1999

Study of the outcome of patients transferred to a level I hospital after stabilization at an outlying hospital in a rural setting.

OBJECTIVE: To determine the characteristics and outcome of transferred trauma patients in a rural setting. METHODS: We conducted a case-control study of all trauma admissions to a rural Level I trauma center to examine a 3.5-year (1993-1996) comparison of trauma patients admitted directly with those transferred (RTTP) after being initially stabilized at an outlying hospital. We used prehospital times, Injury Severity Score (ISS), LD50ISS (the ISS at which 50% of patients died), Revised Trauma Score, probability of survival, Acute Physiology and Chronic Health Evaluation II, and observed survival as main outcome measures. RESULTS: RTTPs (39.4%) spent an average of 182+/-139 minutes at the outlying hospital and 72+/-42 minutes in transport to the trauma center. Proportionately more head/neck and patients with multiple injuries composed the RTTP group. The RTTP were more severely injured (ISS 11.1+/-8.5; Acute Physiology and Chronic Health Evaluation II 16.2+/-5.8; Revised Trauma Score 7.44+/-1.1) than the trauma patients admitted directly (ISS 7.9+/-5.3; Acute Physiology and Chronic Health Evaluation II 13.1+/-6.3; Revised Trauma Score 7.8+/-0.4; p < 0.05). However, both groups had the same LD50ISS (ISS = 35). When logistic regression was applied with death as the dependent variable, both ISS and age contributed significantly (p = 0.0001) but transfer status did not (p = 0.473). CONCLUSION: Rural trauma centers admit a high percentage of RTTP. These RTTP have a higher injury severity and acuity than their trauma patients admitted directly counterparts. Trauma care in rural areas that involves initial stabilization at outlying hospitals does not adversely affect mortality.

APACHE↗
PubMed1998

The community continuity experience: generalist training for preclinical medical students.

Many medical schools are planning community-based experiences for preclinical students. In August 1994, The University of Texas Medical Branch at Galveston began placing all 200 first-year medical students in generalists' offices in a new course called the Community Continuity Experience. The office nurse served as site facilitator. Activities during the second term provided more opportunities for students to interview patients as well as to observe the site physicians. The course committee used feedback from student evaluations and focus groups to change the implementation of the curriculum. We found that nurses as site facilitators effectively managed the students' activities, that continuity of site was more important to students than breadth of exposure, that the optimum focus of activities was the examination room, that training in actual skill development (e.g., methods of patient education) was desired before site activities, and that careful integration of preclinical patient-oriented courses was important to expose students to a coherent approach to learning skills for patient assessment.

Attitude of Health Personnel↗
PubMed1997

Trauma deaths in a mature urban vs rural trauma system. A comparison.

OBJECTIVE: To compare the timing, severity, and injury characteristics of patients dying from trauma in an urban vs a rural setting. DESIGN: Retrospective review of autopsy database (urban) and medical examiner database (rural), with selected medical chart review. SETTING: An organized urban trauma system with 6 trauma centers and a rural state with no formal trauma system and 1 trauma center. PATIENTS: All trauma fatalities occurring in an urban (n = 612) and a rural (n = 143) setting during a 1-year period. RESULTS: In the urban system, 248 patients (40.5%) died at the scene of injury compared with 103 (72%) patients in a rural environment. During the first 24 hours of hospitalization 243 (39.7%) urban patients died compared with 23 (16%) rural patients. Eighty-nine urban patients (14.5%) and 17 rural patients (11.8%) survived for more than 24 hours but later died in the hospital. The mean age of those who died was significantly greater in the rural trauma system than in the urban trauma system (P < .001), and the Injury Severity Score was significantly less in the rural trauma system than in the urban trauma system (P < .01). In the patients who died after being admitted to the hospital for more than 24 hours there was a significantly higher rate of preexisting comorbidity in the rural patients than in the urban patients (P < .05). The most frequent cause of death in the rural setting was multisystem organ failure; head injury was the most common cause of death in the urban setting. CONCLUSIONS: Patients who die in a rural area without a formal trauma system are more likely to die at the scene, are less severely injured, and are older. Rural trauma patients who are admitted to a hospital and who survived for at least 24 hours before dying are older, less severely injured, have significantly more comorbidities, and are more likely to die of multisystem organ dysfunction than their urban counterparts. These differences reflect the different patient populations and injury patterns that confront urban and rural trauma centers. The higher proportion of scene deaths in the rural environment may reflect the longer discovery and transport times that occur in a rural setting.

Adolescent↗
PubMed1997

Financial outcome of treating trauma in a rural environment.

The financial plight of the urban trauma center is well documented. However, the financial status of the rural trauma center is largely unknown. We hypothesized that our rural trauma center with a high number of blunt trauma patients, a wide spectrum of injury severity, and a large percentage of insured patients would prove to be financially advantageous to the institution. From January 1994 to June 1995, 1,119 consecutive trauma admissions had a complete financial profile compiled including actual costs, reimbursements, and reimbursement ratio (RR = reimbursement/actual costs). Our injury severity profile was very skewed with a preponderance of less severely injured patients (mean Injury Severity Score = 9.6 +/- 7.8). The payor profile of these patients included 49.2% fee-for-service (RR = 1.43), 25.4% diagnosis-related group-based (RR = 0.92), 8.77% per diem (RR = 0.51), and 1.25% capitated (RR = 0.47). Overall, the RR for the trauma unit was 1.11, representing a net profit overall. Cost closely tracked both hospital and intensive-care unit length of stay (R2 = 0.925). Likewise, reimbursement also was reflected in both hospital and intensive-care unit length of stay (R2 = 0.735). We conclude that our rural trauma center, with a favorable payor mix and low injury severity, is financially profitable.

Adult↗
PubMed1997

Trauma registry injury coding is superfluous: a comparison of outcome prediction based on trauma registry International Classification of Diseases-Ninth Revision (ICD-9) and hospital information system ICD-9 codes.

BACKGROUND: Trauma registries are an essential but expensive tool for monitoring trauma system performance. The time required to catalog patients' injuries is the source of much of this expense. Typically, 15 minutes of chart review per patient are required, which in a busy trauma center may represent 25% of a full-time employee. We hypothesized that International Classification of Disease-Ninth Revision (ICD-9) codes generated by the hospital information system (HI) would be similar to those coded by a dedicated trauma registrar (TR) and would be as accurate as TR ICD-9 codes in predicting outcome. METHODS: One thousand eight hundred twelve patients admitted to a Level I trauma center during 2 years had International Classification of Disease Injury Severity Scores (ICISS) calculated based on HI and TR ICD-9 codes. The relative predictive powers of these two ICISSs were then compared for every patient using Receiver Operator Characteristic Curve Area (ROC) and Hosmer Lemeshow Statistics. RESULTS: Eighty-nine percent of patients (1,608 of 1,812) had identical HI and TR ICISSs. Eleven patients' ICISSs differed by >0.1, and only two patients' scores differed by >0.2. ICISS proved to be a powerful predictor of outcome whether derived from HI (ROC = 0.884; 95% confidence interval (CI) = 0.850-0.917) or TR (ROC = 0.872; 95% CI = 0.837-0.908). Although these predictive powers were not significantly different (p = 0.076), the trend was for HI to perform better than TR. ISS calculated for the same data set using the MacKenzie dictionary proved significantly less predictive of outcome than either ICISS (ROC(MacKenzie) = 0.843; 95% CI = 0.792-0.884; p = 0.034). CONCLUSION: We conclude that in our hospital TR data on individual injuries can be replaced by HI data without loss of predictive power. ISS based on the MacKenzie dictionary should be abandoned because it is much less predictive of outcome than ICISS.

Adolescent↗
PubMed1994

Developmental changes in narrative and non-narrative discourse in children with and without brain injury.

This study presents a set of narrative and non-narrative tasks and analytic procedures for examining the discourse development of children with perinatal brain injury and typically developing children. Three oral discourse genres were collected at ages 5, 6, and 7: script, picture description, and replica play narration. Genre performances were assessed for the presence of hypothesized genre features. Results suggest these tasks and procedures are able to characterize development in discourse abilities for both a normative group and for children with perinatal brain injury. The group of children with brain injury produced shorter discourse performance with more off-task talk. This group also showed difficulty in fully differentiating the various genre types and in creating integrated discourse performances. However, most of these children demonstrated considerable growth in control of genre features over this time period. The possible utility of these tasks and procedures for clinical assessment is discussed.

Brain Injuries↗
PubMed1994

A case report of severe external resorption.

External root resorption is a multifactorial process with many causes. Except for transient surface resorption, it is usually considered an irreversible process. Treatment can arrest or retard the resorptive process. Many factors that have been associated with this process include physiologic resorption, local factors, systemic conditions, and idiopathic resorption. This case report documents a 29-year-old white male who suffered a motor vehicle accident and dental trauma nine years ago. The accident resulted in the lateral displacement of the maxillary right canine. The maxillary right lateral incisor, right central incisor and left central incisors were avulsed. The right central incisor was never recovered from the accident site. The other teeth were replanted 90 minutes after the accident and rigidly splinted for six months. They then received root canal treatment, approximately one month after the splint was removed (seven months from time of the trauma). On annual examination, the patient complained of a loose maxillary fixed prosthesis. He was diagnosed with severe external resorption on the right lateral and left central incisors, and severe external replacement resorption on the right canine. This case report reviews the current trends in the treatment of avulsed teeth and the resorptive process.

Adult↗
PubMed1993

The influence of gender and race on mean body temperature in a population of healthy older adults.

Body temperature is known to vary with environmental conditions, physical activity, and illness. There is also some suggestion that body temperature is higher in women than men, and higher in blacks than whites. This study was undertaken to determine if previously described differences in body temperature found in relatively uncontrolled settings associated with gender and race can be reproduced under carefully controlled conditions. Temperature was measured orally with calibrated mercury-in-glass thermometers in 92 healthy community-dwelling volunteers aged 64 years and older. Environmental conditions were carefully controlled and patients with physical conditions or medication regimes known to alter body temperature were excluded. The mean body temperature for all subjects was 36.86 degrees C +/- 0.23 degrees C. The means for white men and women did not differ significantly. There was a statistically significant difference between black and white women, with blacks having 0.13 degrees C higher temperature. We conclude that body temperature varies with race in older women. No significant gender-related difference in normal body temperature was found in these healthy elderly white men and women. Differences in body temperature between men and women found in younger patient populations may reflect the temperature elevations in women associated with menstruation.

Age Factors↗
PubMed1993

Trauma nurse coordinator: three unique roles.

Three nursing positions were created to effectively manage the Trauma Nurse Coordinator (TNC) role and responsibilities: Trauma Director, Clinical Nurse Specialist and Trauma Researcher. By using this innovative approach, the quality of trauma care improved as shown by decreased complication rates, lengths of stay, and trauma costs. In addition, trauma referrals, research and education increased.

Clinical Nursing Research↗
PubMed1984

A third-year family medicine clerkship based in an academic family practice center.

In this paper, the authors describe the planning, curriculum, and evaluation of a five-week family medicine clinical clerkship for third-year students based in an academic family practice center. The program is an outpatient experience utilizing several innovative techniques: (a) problem-based learning that focuses on patient management tutorials, (b) consultation sessions with individuals offering specialized expertise, (c) supervised patient care in a family practice center and with a nursing home inpatient teaching service, and (d) workshops on various topics, such as office-surgical techniques, practice management, and alternative methods of health care. Evaluation of the course has demonstrated the merits of careful planning with student input, the need for flexibility, and the value of focusing on concepts in ambulatory care.

Academic Medical Centers↗
PubMed1980

Purpose of the medical encounter: identification and influence on process and outcome in 200 encounters in a model family practice center.

This study concerned two questions: Why does the patient come to the physician? And, how does patient-physician agreement as to the primary purpose affect the process and outcome of the medical encounter? Separate interviews of patients and physicians following 200 medical encounters revealed a preponderance of visits for continuing care, a paucity of visits for social and emotional problems, and a number of visits in which "concern" as the patient's primary purpose was misperceived by the physician. There was no statistically significant relationship when agreement (or lack of agreement) between patient and physician as to the purpose of the encounter was compared with patient age and sex, number of previous visits of the patient to the physician, and subsequent patient-physician agreement as to the diagnosis, prognosis, therapy, and satisfaction. There was also no statistically significant relationship when patient-physician concordance as to visit purpose was compared with education level of the patient or with physician perception of the patient's intended compliance. In both concordance and non-concordance groups, physicians underestimated both patient satisfaction with the encounters and intended compliance.

Adult↗