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Biomedical subjects

L D Britt

Publications and source records attributed to L D Britt.

At least 55 records · Page 3Linked to original sources
PubMed2004

Use of UV-protective windows and window films to aid in the prevention of skin cancer.

People are exposed to ambient solar ultraviolet (UV) radiation throughout their daily routine, intentionally and unintentionally. Cumulative and excessive exposure to UV radiation is the behavioral cause to skin cancers, skin damage, premature skin aging, and sun-related eye disorders. More than one million new cases of skin cancer were diagnosed in the United States this year. UV radiates directly and diffusely scattered by the various environmental and atmospheric conditions and has access to the skin from all directions. Because of this diffuse UV radiation, a person situated under a covering, such as the roof of a car or house, is not completely protected from the sun's rays. Because shade structures do not protect effectively against UV radiation, there have been major advances in photoprotection of glass by the development of specially designed photoprotective windows and films. It is the purpose of this collective review to highlight the photoprotective windows and films that should be incorporated into residential, commercial, and school glass windows to reduce sun exposure. Low-emittence (low-E) coatings are microscopically thin, virtually invisible, metal or metallic oxide layers deposited on a window or skylight glazing surface to reduce the U-factor by suppressing radiative heat flow as well as to limit UV radiation. The exclusive Thermaflect coating uses the most advanced, double-layer soft coat technology to continue to deliver top performance for UV protection as well as prevent heat loss in the home. This product blocks 87% of UV radiation and has an Energy Star certification in all climate zones. Tints and films have been another important advance in glass photoprotection, especially in automobiles. Quality widow film products are high-tech laminates of polyester and metallized coatings bonded by distortion-free adhesives. The International Window Film Association provides members with accreditation in solar control films, safety films, and automotive films in an effort to increase consumer awareness and demand for all professionally installed film window products. The Skin Cancer Foundation has also played a leadership role in certifying window films that limit UV transmission. The Panorama Designer and Safety Films are currently recommended for UV photoprotection by The Skin Cancer Foundation. On the basis of these innovative scientific and industrial advances in window and film photoprotective products, we recommend that they be used in all residential, commercial, and school facilities to provide photoprotection in an effort to reduce skin cancer.

Glass↗
PubMed2004

An organized approach to trauma care: legacy of R Adams Cowley.

The organized approach to caring for trauma patients was introduced into the civilian setting by the innovative pioneer, R Adams Cowley. His system in Maryland has the following 11 components: (1) a State Police Aviation Division that transports patients throughout the State; (2) trained paramedics at the scene of the accident as well as on the helicopter, who will stabilize the patients en route to the Shock Trauma Center; (3) one central dispatch communication center in Baltimore that coordinates information between paramedics and the Trauma Center; (4) a Shock Trauma Center with a helicopter landing zone near the building; (5) trained trauma nurses and trauma technicians to transfer the patient from the helicopter by stretcher to the resuscitation area; if there is a special complication, such as an airway problem, the anesthesiologist and or trauma surgeon may meet the helicopter on the roof as well; (6) trauma surgeons, board-certified in surgery, with a certificate of added qualification in surgical critical care, to treat the critically ill trauma patients in the resuscitation area; (7) a CT scan and portable X-ray units in the admission area that aid in the diagnosis of the injury; (8) operating rooms adjacent to the admission area for repair of trauma injuries; (9) a surgical intensive unit to care for the trauma patient; (10) a team of specialty physicians trained in a wide variety of specialties who work as a multidisciplinary unit caring for the hospitalized patient; and (11) an ambulatory outpatient unit that allows the patient to be followed in the center after discharge. Dr. R Adams Cowley incorporated each of these 11 components for an organized trauma center into Maryland. In recognition of his landmark contributions to trauma, the eight-story Shock Trauma Center was named the R Adams Cowley Shock Trauma Center. There is growing evidence that this organized system in trauma care seen in Maryland must be replicated in every state in our nation. The results of the Health Resources and Services Administration Report in 2002 show serious limitations in our nation's organized approach to emergency and trauma care. This report indicates that many Americans do not have access to well-trained pre-hospital emergency personnel. Between 10 and 15% of the US population does not have access to basic emergency medical and communication services. Moreover, the presence of key trauma system components continues to vary throughout the country, most likely because of growing economic constraints. Emergency communication systems remain fragmented, and adequate training programs and protective equipment for health personnel remains notably absent. The threat of inadequate funding for the state manifests itself in the consistent uneasiness regarding the recruitment and continued retention of trauma care providers. Federal authorities must devise national emergency medical and organized trauma programs to save the lives of injured Americans.

Disaster Planning↗
PubMed2004

Prevention of disabling back injuries in nurses by the use of mechanical patient lift systems.

Occupational back pain in nurses (OBPN) constitutes a major source of morbidity in the health care environment. According to the National Institute for Occupational Safety and Health (NIOSH), occupational back injury is the second leading occupational injury in the United States. Among health care personnel, nurses have the highest rate of back pain, with an annual prevalence of 40-50% and a lifetime prevalence of 35-80%. The American Nursing Association believes that manual patient handling is unsafe and is directly responsible for musculoskeletal disorders encountered in nurses. It has been well documented that patient handling can be done safely with the use of assistive equipment and devices that eliminate these hazards to nurses that invite serious back injuries. The benefit of assistive patient handling equipment is characterized by the simultaneous reduction of the risk of musculoskeletal injury to the nursing staff and improvement in the quality of care for patient populations. To understand the cause of disabling injuries in health care workers, several factors must be considered, including the following: (1) anatomy/physiology of the back, (2) risk factors, (3) medical legal implications, and (4) prevention. Among nurses, back, neck, and shoulder injuries are commonly noted as the most prevalent and debilitating. While mostly associated with dependant patient care, the risk for musculoskeletal injury secondary to manual patient handling crosses all specialty areas of nursing. The skeletal defects of an abnormal back make the back more susceptible to occupational injury, even under normal stress conditions. Workers compensation guidelines for occupational back injury differ in public and private health care sectors from state to state. Nursing personnel should be reminded that the development of back pain following occupational activities in the hospital should be reported immediately to the Occupational Health Department. A nurse's failure to report OBPN immediately has resulted in numerous denials of claims for rehabilitation and compensation that nurses deserve. Experts believe that training in proper body mechanics does not prevent back injury. Consequently, focus has been placed on other innovative injury prevention programs, including the use of engineering controls as well as the "lift team" method. Ergonomics involves the use of mechanical devices (e.g., walking belt and mechanical hoist) to aid in patient lifting and transferring tasks. Guldmann Inc. has devised ceiling lift systems and slings during the past 20 years. They have successfully completed thousands of installations worldwide, covering a wide range of challenging conditions and complex environments. The Guldmann ceiling-mounted hoist system consists of a wide range of lifting units, rail components, and a complete assortment of lifting slings and accessories. Its sling is made of polyester, which is characterized by its strength and elasticity. It retains its shape and is dirt repellent and easy to maintain. The Guldmann network has one of the largest and indisputably most experienced group of certified installers in the United States. The "lift team" method was devised to remove nursing personnel from the everyday task of moving patients. This type of intervention assumes that lifting is a specialized skill to be performed only by expert professional patient movers who have been thoroughly trained in the latest lifting device techniques.

Back Injuries↗
PubMed2004

Duodenal ulceration into the cystic artery with resultant massive hemorrhage.

Anterior duodenal ulceration with erosion into the cystic artery is an extremely rare source of upper gastrointestinal hemorrhage. Interventions that have previously been reported include open exploration with cholecystectomy, open exploration while leaving the gallbladder in situ, and angiographic management. We report a case of massive upper gastrointestinal bleeding related to duodenal ulcer penetration of the cystic artery and discuss potential management strategies.

Adult↗
PubMed2003

A template for change and response to work hour restrictions.

Surgical program directors are seeking how to best meet the work hour restrictions recently mandated by the American College of Graduate Medical Education. Implementation of an 80-hour work week forces major change to graduate medical education, especially surgical education. Creative restructuring of surgical training is necessary to ensure compliance. Developing an innovative solution to meet these requirements must consider programmatic needs, requiring commitment to a change process. The Department of Surgery at Eastern Virginia Medical School experienced a 5-month strategic planning process that generated the Mendoza plan. This plan uses an every third night call model and a night float model to meet site-specific needs. The specifics of the Mendoza plan protect the cornerstone of surgical education, which is continuity of patient care and resident education. The Mendoza plan, and the process leading to its development, may provide insightful information for other surgical residency programs planning to meet work hour guidelines.

Facility Regulation and Control↗
PubMed2003

Blunt thoracic aortic injury: old problem and new technology.

The lethal nature of transmural aortic injuries has remained constant; however, both the diagnostic and therapeutic interventional options have improved. Although aortography is still the "gold standard" against which all other diagnostic modalities are measured, contrast-enhanced spiral thoracic computed tomography has emerged as the diagnostic study that could potentially supplant aortography. The advent of the fast spiral computed tomography scanners offer several advantages, including being less affected by patient motion and volume-averaging artifacts than the earlier generation CT scanners. The operative has broadened from primary repair and interposition prosthetic graft placement (with possible use of shunt or roller vs. centrifugal bypass) to the potential widespread use of endovascular stents. The Eastern Virginia Medical School (EVMS) experience during the first 10-year period (see table below) highlights the majority of patients undergoing interposition prosthetic graft placement. There was no use of shunts during this period. At the midpoint of the second 10-year period (1997-2007), the method of repair is exclusively interposition graft placement. The role of endovascular stent insertion in the management of these injuries is currently being debated. [table: see text]

Aorta, Thoracic↗
PubMed2003

Laparoscopy in the evaluation of penetrating thoracoabdominal trauma.

The evaluation of penetrating thoracoabdominal trauma for the presence of a diaphragmatic injury presents a diagnostic challenge to the trauma surgeon. The use of diagnostic laparoscopy (DL) in this setting was reviewed at a level-one trauma institution. Eighty patients (71 males, 9 females) with penetrating injuries to the thoracoabdominal region underwent DL to rule out injury to the diaphragm. Fifty-eight patients (72.5%) had a negative study and were spared a celiotomy. In the remaining 22 patients (27.5%), injury to the diaphragm was identified. This subset of patients underwent a mandatory celiotomy to rule out an associated intra-abdominal injury. Seventeen out of 22 (77.2%) patients had a positive exploration requiring surgical intervention, representing an associated intra-abdominal injury rate of 21.2 per cent. Intra-abdominal injuries requiring repair included small bowel, colon, spleen, liver, and stomach, in descending order. There were no missed injuries or deaths. One patient with a left diaphragmatic injury secondary to a stab wound developed a subdiaphragmatic abscess. Respiratory insufficiency secondary to atelectasis was the most common complication. Diagnostic laparoscopy is an essential and safe modality for the evaluation of diaphragmatic injuries in penetrating thoracoabdominal trauma.

Abdominal Injuries↗
PubMed2003

Nonoperative trauma management: has the pendulum swung too far? The distinguished Dr. William Matory lecture.

Over the last decade, the role of nonoperative management has revolutionized the specialty of trauma. However, this management paradigm has generated substantial controversy in several areas, including penetrating neck and abdominal trauma. Evidence-based analysis will be the ultimate guideline to determine what is optimal management. To prevent the pendulum from swinging too far, there should always exist a high index of suspicion to possible complications associated with the nonoperative approach. Also, the specific choice of management should be institution- and resource dependent.

Humans↗
PubMed2002

Protocol-driven ventilator management in a trauma intensive care unit population.

HYPOTHESIS: The use of weaning and sedation protocols affects the intensive care unit (ICU) course of a trauma population. DESIGN: Nonrandomized before-after trial. SETTING: A level I trauma center. PATIENTS: Three hundred twenty-eight consecutive trauma patients receiving mechanical ventilation treated in the ICU between October 1, 1997, and November 1, 1999. INTERVENTION: Sedation and weaning protocols were used to treat patients receiving mechanical ventilation during the second year of this study. MAIN OUTCOME MEASURES: Self-extubation rates, ventilator days, number of ICU days, and charges. RESULTS: There were 168 patients in the preprotocol group (year 1: October 1, 1997, to October 31, 1998) and 160 patients in the postprotocol group (year 2: November 1, 1998, to November 30, 1999). The groups were similar in age (P =.68), Injury Severity Score (P =.06), and Glasgow Coma Scale score (P =.29). There were no differences in self-extubation rates (P =.57), ventilator days (P =.83), ventilator charges (P =.83), number of ICU days (P =.67), or ICU charges (P =.67) between the 2 groups. No statistical difference was identified in any of these categories when long-term ventilator patients (defined as ventilator length of stay > or =3 SDs above the mean) were excluded. CONCLUSIONS: Use of weaning and sedation protocols did not affect the measured outcomes in this study. These findings may reflect difficulties inherent in the protocols or with their utilization. Further subgroup analysis focusing on ventilator-associated pneumonias and mortality may demonstrate benefits not identified herein.

Adult↗
PubMed2002

PDTC and Mg132, inhibitors of NF-kappaB, block endotoxin induced vasodilation of isolated rat skeletal muscle arterioles.

NF-kappaB is a ubiquitous transcription factor that mediates the inflammatory response. Inhibition of NF-kappaB may be of potential therapeutic benefit in the treatment of septic shock. The antioxidant pyrrolidine dithiocarbamate (PDTC) has been shown in previous work to selectively inhibit NF-kappaB activation. Likewise, the proteasome inhibitor MG132 inhibits NF-kappaB formation and degradation of its inhibitor I-kappaB. The goal of this study was to determine if PDTC and MG-132 could inhibit resistance arteriole vasodilation in response to endotoxin and to determine PDTC's site of action in our isolated vessel preparation. Male Sprague-Dawley rats were given an intraperitoneal injection of PDTC, an intravenous injection of MG132, or a sham injection. First-order cremasteric arterioles were isolated, cannulated, and pressurized. A segment of thoracic aorta was then placed in series with the microvascular preparation. Vessels were allowed to achieve spontaneous myogenic tone in a bath of buffer over 1 h (t = 0). Internal vessel diameters were measured and the response to endotoxin (ET) or continued infusion of buffer was measured over 1 h (t = 60). Group 1 (n = 7) was a time-control group. Group 2 (n = 7) was exposed to ET only, Group 3 (n = 5) received PDTC and was exposed to ET, Group 4 (n = 5) received PDTC only, Group 5 (n = 4) received MG132 only, and Group 6 (n = 5) received MG132 and was exposed to ET. To determine the site of action of PDTC, a segment of aorta from an animal treated with PDTC was placed in series with a cremasteric arteriole from an animal receiving a sham injection. The preparation was then exposed to ET, and this is Group 7 (n = 4). Group 8 (n = 4) received ET and was composed of thoracic aorta from an animal receiving a sham injection and a cremasteric arteriole from a PDTC-treated animal. Spontaneous tone was similar in the eight groups at the end of the equilibration period (t = 0). After 1 h (t = 60), Group 2 (vessels exposed to ET only) had significantly less tone (26.1%+/-2.6%; P < 0.01) than Group 1 (39.0%+/-2.4%), Group 3 (39.3%+/-3.1%), Group 4 (41.2%+/-1.6%), Group 5 (39.2%+/-2.9%), Group 6 (41.0%+/-2.7%), Group 7 (45.1%+/-6.5%), and Group 8 (41.1%+/-4.5%). We conclude that PDTC and MG132, inhibitors of NF-kappaB, block ET-induced vasodilation in isolated rat skeletal muscle arterioles. PDTC has effects at both the level of the aortic segment as well as the resistance arteriole. Inhibitors of NF-kappaB may potentially be of therapeutic benefit in the treatment of septic shock.

Animals↗
PubMed2002

Blunt trauma and the role of routine pelvic radiographs: a prospective analysis.

BACKGROUND: We hypothesized that clinical factors accurately identify those trauma patients at high risk for pelvic fractures making routine films unnecessary. METHODS: Blunt trauma patients were prospectively analyzed both with and without a clinical protocol. The protocol group had pelvic films obtained only if they had a Glasgow Coma Scale score < 13 or had signs and symptoms of pelvic or back injury. RESULTS: The protocol patients with fractures (n = 45) had a higher Injury Severity Score (p = 0.001) and lower systolic blood pressure (p = 0.04) than those without fractures (n = 475). All 45 patients with pelvic fractures were identified by history and physical examination (p = 0.001). The clinical assessment resulted in a sensitivity and a negative predictive value of 100%. A total of 273 films were eliminated, resulting in a charge savings of $51,051. A comparison between the protocol and nonprotocol groups showed the nonprotocol patients with pelvic fractures to have a higher Injury Severity Score (p < 0.002). All of these patients' pelvic fractures were identified by clinical evaluation (67 of 67). CONCLUSION: In the awake and alert patient, the need for a pelvic radiograph was readily identified by clinical examination. Because elimination of this film would result in financial savings, its routine use should be removed from standard trauma protocols in the minimally injured patient and limited to severely injured patients as recommended by the Advanced Trauma Life Support protocol.

Adult↗
PubMed2001

Interleukin-10 prevents loss of tone of rat skeletal muscle arterioles exposed to endotoxin.

BACKGROUND: The anti-inflammatory cytokine interleukin-10 (IL-10) is known to inhibit the development of septic shock in animal models. This study was conducted to investigate the effect of IL-10 on the loss of vascular tone during exposure to endotoxin. Unlike numerous proinflammatory cytokines, the effects of IL-10 at the level of the microvasculature have not been previously studied. MATERIALS AND METHODS: First-order rat cremasteric arterioles (n = 27) were placed in an isolated vessel preparation and allowed to achieve spontaneous tone. An opened segment of thoracic aorta was then placed upstream from the arteriole in the superfusion line. The resistance arteriole of this in-series model, in contrast to the isolated arteriole alone, demonstrates a significant loss of tone when exposed to endotoxin. Following 1 h of equilibration in the presence or absence of IL-10 (20 ng/ml), the aorta and arteriole were then superfused with 2.5 microg/ml endotoxin or physiologic buffer for 60 min and serial arteriolar diameter measurements were recorded. Group 1 was exposed to endotoxin only, Group 2 was a time control, and Group 3 was pretreated with IL-10 prior to endotoxin exposure, while Group 4 was a control pretreated with IL-10 only. RESULTS: After the 60-min equilibration period there were no differences among the four groups in arteriolar tone. At t = 120 min, the percentage of tone in the control group was 43.6 +/- 3% (mean +/- SEM) and this was not changed by treatment with IL-10 (47.0 +/- 7% tone). Endotoxin alone caused arteriolar tone to fall to 31.4 +/- 3% (P < 0.05). However, endotoxin applied to arterioles pretreated with IL-10 was without effect (47.5 +/- 2%). CONCLUSIONS: Resistance arterioles pretreated with IL-10 maintain vascular tone during endotoxin exposure. We conclude that IL-10 pretreatment prevents loss of vascular tone of isolated arterioles exposed to endotoxin.

Acetylcholine↗
PubMed2001

Newer diagnostic modalities for vascular injuries: the way we were, the way we are.

The article discusses the role of modalities in diagnosing vascular injuries starting with angiography and tracing the evolution of the use of color flow Doppler, CT, and CT angiography. It also addresses the controversy of minimal vascular injury and outlines vascular injuries that may be safely observed and followed-up. Finally, the evolution from angiography to the use of helical CT for the diagnosis of thoracic aortic injuries is reviewed in detail.

Angiography↗
PubMed2001

Multiinstitutional experience with the management of superior mesenteric artery injuries.

BACKGROUND: Superior mesenteric artery (SMA) injuries are rare and often lethal injuries incurring very high morbidity and mortality. The purposes of this study are to review a multiinstitutional experience with these injuries; to analyze Fullen's classification based on anatomic zone and ischemia grade for its predictive value; to correlate the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) for abdominal vascular injury with mortality; and to identify independent risk factors predictive of mortality, describing current trends for the management of this injury in America. DESIGN: We performed a retrospective multiinstitutional study of patients sustaining SMA injuries involving 34 trauma centers in the US over 10 years. Outcomes variables, both continuous and dichotomous, were analyzed initially with univariate methods. For the subsequent multivariate analysis, stepwise logistic regression was used to identify a set of risk factors significantly associated with mortality. RESULTS: There were 250 patients enrolled, with a mean Revised Trauma Score (RTS) of 6.44 and a mean Injury Severity Score (ISS) of 25. Surgical management consisted of ligation in 175 of 244 patients (72%), primary [corrected] repair in 53 of 244 patients (22%), autogenous grafts were used in 10 of 244 (4%), and prosthetic grafts of PTFE in 6 of 244 patients (2%). Overall mortality was 97 of 250 patients (39%). Mortality versus Fullen's zones: zone I, 39 of 51 (76.5%); zone II, 15 of 34 (44.1%); zone III, 11 of 40 (27.5%); and zone IV, 25 of 108 (23.1%). Mortality versus Fullen's ischemia grade: grade 1, 22 of 34 (64.7%). Mortality versus AAST-OIS for abdominal vascular injury: grade I, 9 of 55 (16.4%); grade II, 13 of 51 (25.5%); grade III, 8 of 20 (40%); grade IV, 37 of 69 (53.6%); and grade V, 17 of 19 (89.5%). Logistic regression analysis identified as independent risk factors for mortality the following: transfusion of greater than 10 units of packed RBCs, intraoperative acidosis, dysrhythmias, injury to Fullen's zone I or II, and multisystem organ failure. CONCLUSION: SMA injuries are highly lethal. Fullen's anatomic zones, ischemia grade, and AAST-OIS abdominal vascular injuries correlate well with mortality. Injuries to Fullen's zones I and II, Fullen's maximal ischemia grade, and AAST-OIS injury grades IV and V, high-intraoperative transfusion requirements, and presence of acidosis and disrhythmias are significant predictors of mortality. All of these predictive factors for mortality must be taken into account in the surgical management of these injuries.

Adolescent↗
PubMed2001

Penetrating esophageal injuries: multicenter study of the American Association for the Surgery of Trauma.

OBJECTIVE: The purpose of this study was to define the period of time after which delays in management incurred by investigations cause increased morbidity and mortality. The outcome study is intended to correlate time with death from esophageal causes, overall complications, esophageal related complications, and surgical intensive care unit length of stay. METHODS: This was a retrospective multicenter study involving 34 trauma centers in the United States, under the auspices of the American Association for the Surgery of Trauma Multi-institutional Trials Committee over a span of 10.5 years. Patients surviving to reach the operating room (OR) were divided into two groups: those that underwent diagnostic studies to identify their injuries (preoperative evaluation group) and those that went immediately to the OR (no preoperative evaluation group). Statistical methods included Fisher's exact test, Student's T test, and logistic regression analysis. RESULTS: The study involved 405 patients: 355 male patients (86.5%) and 50 female patients (13.5%). The mean Revised Trauma Score was 6.3, the mean Injury Severity Score was 28, and the mean time interval to the OR was 6.5 hours. There were associated injuries in 356 patients (88%), and an overall complication rate of 53.5%. Overall mortality was 78 of 405 (19%). Three hundred forty-six patients survived to reach the OR: 171 in the preoperative evaluation group and 175 in the no preoperative evaluation group. No statistically significant differences were noted in the two groups in the following parameters: number of patients, age, Injury Severity Score, admission blood pressure, anatomic location of injury (cervical or thoracic), surgical management (primary repair, resection and anastomosis, resection and diversion, flaps), number of associated injuries, and mortality. Average length of time to the OR was 13 hours in the preoperative evaluation group versus 1 hour in the no preoperative evaluation group (p < 0.001). Overall complications occurred in 134 in the preoperative evaluation group versus 87 in the no preoperative evaluation group (p < 0.001), and 74 (41%) esophageal related complications occurred in the preoperative evaluation group versus 32 (19%) in the no preoperative evaluation group (p = 0.003). Mean surgical intensive care unit length of stay was 11 days in the preoperative evaluation group versus 7 days in the no preoperative evaluation group (p = 0.012). Logistic regression analysis identified as independent risk factors for the development of esophageal related complications included time delays in preoperative evaluation (odds ratio, 3.13), American Association for the Surgery of Trauma Organ Injury Scale grade >2 (odds ratio, 2.62), and resection and diversion (odds ratio, 4.47). CONCLUSION: Esophageal injuries carry a high morbidity and mortality. Increased esophageal related morbidity occurs with the diagnostic workup and its inherent delay in operative repair of these injuries. For centers practicing selective management of penetrating neck injuries and transmediastinal gunshot wounds, rapid diagnosis and definitive repair should be made a high priority.

Adolescent↗