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Biomedical subjects

P S Gainer

Publications and source records attributed to P S Gainer.

11 recordsLinked to original sources
PubMed1999

Update on trauma system development in the United States.

BACKGROUND: Two previous reports, in 1987 and 1993, have tracked trauma system development in the United States. This report updates the current status of trauma systems in the United States. METHODS: All state emergency medical service directors (including the District of Columbia) were surveyed regarding the existence of trauma systems in their states, including the presence of eight essential criteria of trauma system development that have been the focus of the two previous studies. Data were analyzed and compared with results previously published in the two reports. RESULTS: Five states met all eight essential development criteria, 28 states met six or seven criteria, and another 10 states met between one and five criteria. In the 1993 study, 18 states met six or more criteria. In 1987, 22 states reported meeting four or more criteria. CONCLUSION: There has been significant progress, when compared with 1987 and 1993 evaluations in the number of states reporting the presence of trauma systems and meeting six or more key criteria. Recent progress may be due to federal assistance for trauma system development available from 1991 until 1995.

Data Collection↗
PubMed1993

A youth violence prevention program. Description and preliminary evaluation.

PROBLEM STATEMENT: In response to growing violence, primary prevention programs have been launched, but scientific rationale and credible evaluations have been lacking. METHODS: Fifth and seventh-grade students in three inner-city schools (n = 135) participated in a violence prevention program. Controls consisted of students from the same schools and grades during the following school year (n = 115). Students were taught social problem-solving skills and risk factors for violence. Multivariate analyses were performed on posttest measures while controlling for base-line differences. RESULTS: Program participants were much less likely to define social problems in adversarial ways, were less likely to provide violent solutions in hypothetical conflict situations, listed more negative consequences to using violence, and were less inclined to legitimatize violence. Risk factor knowledge also was significantly increased. No increase was shown in the students' abilities to identify viable nonviolent solutions. CONCLUSIONS: The program produced immediate influences on knowledge and some attitudes and social skills shown to be related to aggressive behavior.

Aggression↗
PubMed1993

Weapon carrying among inner-city junior high school students: defensive behavior vs aggressive delinquency.

OBJECTIVES: The purpose of this study was to estimate associations between beliefs and experiences hypothesized to be related to weapon carrying among youths. METHODS: Students in two inner-city junior high schools completed anonymous questionnaires. Logistic regression models were fit for having ever carried a weapon for protection or use in a fight and were stratified by sex and weapon type. RESULTS: Among males, 47% had carried knives and 25% had carried guns. Key risk factors for knife carrying were being threatened with a knife, getting into fights, and disbelief that having a weapon increases the carrier's risk of injury. Gun carrying was associated with having been arrested, knowing more victims of violence, starting fights, and being willing to justify shooting someone. Among females, 37% had carried a knife; knowing many victims of violence and being willing to justify shooting someone predicted knife carrying. CONCLUSIONS: Knife carrying was associated with aggressiveness but did not appear to be related to serious delinquency. Gun carrying within this nonrandom sample appeared to be a component of highly aggressive delinquency rather than a purely defensive behavior.

Adolescent↗
PubMed1992

Epidemiologic changes in gunshot wounds in Washington, DC, 1983-1990.

The purpose of this study was to examine temporal patterns in gunshot wound admission rates and wound profiles from 1983 through 1990 at a level I trauma center in Washington, DC. Data on trauma admissions were collected at the time of admission. Records were reviewed to identify patients admitted for gunshot wounds from assaults. Data on the number and location of entrance gunshot wounds, survival, complications, length of stay in the intensive care unit, and total inpatient days were recorded. Admissions due to gunshot wounds grew at an exponential rate beginning in 1987 and reached a level from 1989 through 1990 three times higher than the preepidemic rate. The mean number of entrance gunshot wounds per patient grew from 1.44 before the epidemic to 2.04 from 1988 through 1990. Multiple thoracic wounds became relatively more common from 1988 through 1990. This increase was partially responsible for reversing a downward trend in patient mortality. Temporal changes in admission rates and wound profiles were consistent with the city's epidemic of drug-related violence and with a shift in weaponry toward high-capacity, semiautomatic handguns.

Adult↗
PubMed1988

The effect of medical direction on trauma triage.

Effective field triage of trauma victims requires identification of patients at risk of dying and their rapid transport to hospitals capable of treating severe injuries. Identification of these patients at the accident scene can be difficult since prehospital personnel receive little training in structured triage decision making. The role of the physician in routine triage is disputed and his/her value has not been documented. This study explored the severity of injury of three groups of trauma patients triaged by different guidelines to a Level I urban trauma center. Results showed that with physician input in the triage process, patients chosen for helicopter transport to the trauma center had a significantly higher median level of injury severity than patients triaged to the trauma center without physician involvement. The results have implications for controlling overtriage of patients to trauma centers.

Emergency Medical Services↗
PubMed1988

The impact of Patrick v. Burget on peer review.

In analyzing the effect of Patrick v. Burget upon peer review, the authors conclude that the decision was not "an atom bomb" and that physicians who wish to work for changes in state law to ensure the availability of the state action exemption for peer review actions will find substantial guidance in the decision.

Economic Competition↗
PubMed1986

A progress report on the trauma score in predicting a fatal outcome.

Advances in prehospital care have increased the number of trauma patients arriving in extremis in the emergency room. In-hospital resuscitation focuses on an aggressive team approach, raising the specter that some patients who have little chance of survival may receive protracted, but futile, resuscitation efforts. This study examined the physiologic severity on admission and associated costs for resuscitation efforts of severely injured trauma patients who died within 48 hours post admission. The data suggest that a Trauma Score less than or equal to 3 is valuable in identifying patients for whom prolonged resuscitation is futile. The decision to discontinue resuscitation, however, must include consideration of other relevant clinical data.

Costs and Cost Analysis↗
PubMed1985

Application of the trauma score in the prehospital setting.

The Trauma Score (TS) is a physiologic measure of injury severity that correlates with patient outcome. Application of the TS has shown that it is useful for patient triage, for predicting patient outcome, and as a means of normalizing for case mix when comparing prehospital care and transport modalities. Our study explored the interrater reliability of assessments of TS variables that were made by emergency medical technicians and paramedics during the prehospital phase. Results showed that 95.3% of the assessments made by prehospital personnel agreed with those made by a highly-trained nurse observer, despite slight variations in assessment techniques. The results have implications for prehospital field use of the TS.

Diagnosis-Related Groups↗
PubMed1984

The Trauma Score as applied to penetrating trauma.

The Trauma Score is a simple physiological measure of injury severity that has been shown to have a high correlation with mortality for blunt trauma patients. In this study, the Trauma Score was evaluated on two subsets of penetrating trauma patients. Results showed that the Trauma Score had a relative information gain of 0.83 and 0.87, an excellent rating in comparison with a possible perfect rating of 1.0. The Score had modest numbers of false negatives (13/64 for the design set, and 3/380 for the test set) and a low number of false positives (5/380 for the design set, and 3/380 for the test set). The Trauma Score is thus an accurate predictor of mortality for both blunt and penetrating trauma patients.

Evaluation Studies as Topic↗