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Biomedical subjects

Robert Woolard

Publications and source records attributed to Robert Woolard.

13 recordsLinked to original sources
PubMed2006

Portable advanced medical simulation for new emergency department testing and orientation.

OBJECTIVES: Efforts to mitigate unexpected problems during transition of an active emergency department (ED) to a new physical plant are imperative to ensure effective health care delivery and patient safety. The authors used advanced medical simulation (SIM) to evaluate the capacity of a new ED for emergent resuscitative processes and assist facility orientation before opening day. METHODS: Operational readiness testing and orientation to the new ED of a large academic center were arranged through a Transportable Enhanced Simulation Technologies for Pre-Implementation Limited Operations Testing (TESTPILOT) project. Using a portable life-sized computerized manikin, the project required participants to perform assorted patient care interventions on-site. Cardiac arrest, multitrauma, uroseptic shock, and pediatric toxicology scenarios elicited the dynamics of real-life ED activities. Debriefings and surveys assessed participants' perceptions of the new facility's clinical readiness and identified areas needing administrative attention. Subjective utility of SIM orientation was compared with that of standard facility orientation. RESULTS: Fourteen ED clinicians and five SIM facilitators participated over two sessions. The new facility received mean (+/- SD) and median five-point Likert scale scores of 4.4 (+/- 0.8) and 5 for ability of clinical staff to perform resuscitations. The respective scores for ability of simulated scenarios to prepare staff for new ED function were 4.6 (+/- 0.5) and 5, compared with 4.2 (+/- 1.0) and 4 for non-SIM orientation (p = 0.22; not significant). Problems with equipment location, inadequate procedural surfaces, and insufficient orientation were discovered and rapidly corrected. CONCLUSIONS: Transportable SIM was used to evaluate the clinical functions of a new ED. Significant operational issues identified by participants were corrected before opening of the facility. Limited comparison did not reveal SIM enhancement of orientation.

Attitude of Health Personnel↗
PubMed2005

Emergency department brief motivational interventions for alcohol with motor vehicle crash patients.

STUDY OBJECTIVE: This study compares the effect of a brief motivational intervention for alcohol plus a booster given to emergency department (ED) patients with subcritical injuries from a motor vehicle crash with the effect of brief motivational intervention for alcohol plus a booster in patients treated for non-motor vehicle crash-related injuries. METHODS: A randomized controlled trial (n=539) was conducted at an urban Level I trauma center of brief intervention (1 ED session of brief intervention), brief motivational intervention for alcohol plus a booster (1 ED session plus booster session), or standard care for injured ED patients with an alcohol use problem who were being discharged home. At 12 months, alcohol-related negative consequences and injuries were measured. We performed a secondary analysis comparing motor vehicle crash-injured patients and non-motor vehicle crash-injured patients in the study sample. RESULTS: Subcritically injured ED patients with harmful or hazardous alcohol use who received brief motivational intervention for alcohol plus a booster had fewer alcohol-related negative consequences and alcohol-related injuries than those receiving brief intervention or standard care at 12-month follow-up (previously reported). A secondary analysis of this result showed that motor vehicle crash patients (n=133) given brief motivational intervention for alcohol plus a booster (n=34) had fewer alcohol-related injuries than those receiving standard care (n=46; P =.001). Moreover, there were no significant differences in alcohol-related injuries among the non-motor vehicle crash-injured patients who received brief intervention or standard care. CONCLUSION: Brief motivational intervention for alcohol plus a booster is a useful intervention for subcritically injured ED patients with harmful or hazardous alcohol use. Its effects may be moderated by the cause of injury.

Accidents, Traffic↗
PubMed2003

Physicians' attitudes regarding reporting alcohol-impaired drivers.

Our objective was to examine attitudes on reporting alcohol-impaired drivers by physicians of different specialties who are most likely to treat motor vehicle crash (MVC) patients. Specific objectives included examining 1) degree of comfort with reporting to police or Department of Motor Vehicles (DMV), 2) variability in attitudes across specialties surveyed, 3) perceived barriers to reporting, and 4) general attitudes on treating alcoholism. Physicians reported that they felt more comfortable with reporting to a medical review board of DMV than to police in all three of the case examples, which included treating a patient who is a clinically diagnosed alcohol-impaired MVC driver (66% DMV report, 36% police report), MVC driver at legal limit of blood alcohol concentration (63% DMV report, 32% police report), and an MVC driver with a very high blood alcohol concentration (81% DMV report, 53% police report). There was no difference between specialties in comfort with reporting, though emergency medicine physicians were less likely to screen and refer patients for counseling. The primary reasons given for not reporting an alcohol-impaired driver were physician-patient confidentiality and perceived threat of civil action by patients.

Alcoholic Intoxication↗
PubMed2003

Marijuana use and prior injury among injured problem drinkers.

OBJECTIVES: The purpose of this paper is to better understand marijuana use among injured problem drinkers in the emergency department (ED). The specific objectives are: 1) to assess the prevalence of marijuana use; 2) to identify factors associated with marijuana use; 3) to determine whether prior injury is associated with marijuana use; and 4) to determine whether marijuana-using problem drinkers want to change behaviors. METHODS: The authors conducted a post-hoc analysis on data obtained prospectively. Subjects had injury and problem drinking: either measurable alcohol level (blood alcohol concentration, BAC), report of drinking, or an Alcohol Use Disorders Identification Test (AUDIT) score of > or =8. The study was conducted on weekend nights; 3,776 injured ED patients were screened, 383 refused, 578 were enrolled, and 433 had complete data. RESULTS: Of the 433 subjects, 48.3% reported using marijuana in the three months prior. Marijuana-using problem drinkers had more hazardous drinking, higher AUDIT scores (14.0 vs. 11.4, p < 0.001), and higher risk-taking scores (12.4 vs. 10.1, p < 0.001). More used other drugs (69.7% vs. 30.3%, p < 0.001). In regression analyses, marijuana use remained an independent predictor of prior injury (OR = 2.16, 95% CI = 1.25 to 3.75), particularly prior alcohol-related (OR = 2.26, 95% CI = 1.45 to 3.53) and motor-vehicle-related (OR = 1.69, 95% CI = 1.03 to 2.79) injury. Readiness-to-change scores were similar (4.14 vs. 4.22, p = 0.21) between users and nonusers. CONCLUSIONS: Marijuana use among injured problem drinkers is prevalent. Their risk of prior injury is increased. Counseling for alcohol and injury should address marijuana use.

Adult↗
PubMed2003

Alcohol use and related harm among older adolescents treated in an emergency department: the importance of alcohol status and college status.

OBJECTIVE: Patients treated in an urban emergency department were studied to determine if college status, gender and having alcohol as a reason for medical treatment were related to alcohol use and related problem behaviors. METHOD: Patients ages 18-19 years (N = 250; 55% men) who had or had not been drinking alcohol prior to the event that precipitated their medical treatment were assessed on their alcohol use, alcohol-related problems and drug use. RESULTS: There were high levels of alcohol use, tobacco use and other drug use in the sample, regardless of the reason for medical treatment. Analyses consistently showed that patients treated for alcohol-related reasons had more severe drinking patterns and problems than patients who were alcohol negative. Patients not enrolled in college showed similar patterns of alcohol consumption as their college-attending peers, but bad more severe alcohol-related behaviors and problems. Few gender differences were found and no interactions were found between gender, alcohol status and college status. CONCLUSIONS: Findings indicate that older adolescents who receive medical treatment for alcohol use are not inexperienced drinkers. Furthermore, in this convenience sample, college students did not appear to be at greater risk for substance use or problems. Findings underscore the potential usefulness of alcohol intervention programs for alcohol-involved medical patients, and the need to attend to the alcohol and drug use of nonstudent populations.

Adolescent↗
PubMed2003

Rhode Island Disaster Initiative.

In summary, RIDI is a multi-year research project to identify and develop solutions to some of the challenges posed by disaster response, with a focus on WMD incidents. September 11, 2001, changed the RIDI timeline with increased pressure to produce tangible results and recommendations rapidly. Phase 1 was an effort to identify problems and potential solutions through vulnerability assessment, literature review and expert panel discussion. Many disaster response "solutions" may fail because of a rush to use untested equipment or processes. RIDI is working cooperatively with other Rhode Island disaster experts to avoid these failures. Informed by Phase 1, RIDI Phase 2 will carefully and progressively test potential "solutions" during research trial disaster drills. Only after research can RIDI identify best practices in disaster response. As RIDI progresses to Phase 3, the demonstration project phase, specific improvements are expected in Rhode Island's readiness for disaster. A main feature of Phase 3 is use of a RIDI demonstration vehicle to bring identified solutions to the scene as requested by Rhode Island EMS agencies. Together with others working to improve Rhode Island readiness for disaster threats, RIDI hopes to improve the outcome for patients and providers in Rhode Island as they face the current disaster threats.

Computer Systems↗
PubMed2002

Potential biases in case detection of alcohol involvement among adolescents in an emergency department.

OBJECTIVE: To determine the factors associated with physician decisions to test for alcohol involvement in adolescents treated in an emergency department (ED) and to examine patient and event characteristics associated with being identified as alcohol positive, either by testing or by clinical examination. METHODS: Medical chart reviews were conducted for all adolescent patients (n = 9,660; age range, 13-19 y) treated over a 1-year period in a Level I regional trauma center/ED. RESULTS: Among all 9,660 patients in the ED, 298 (3.1%) were identified as alcohol positive by test or clinical examination. Of the 9,660 patients, 464 (4.8%) were tested for alcohol, and 49% of these had alcohol-positive test results. Physicians were more likely to order alcohol tests when patients were male, older, injured, and treated during the overnight shift or on weekends. Testing was most common for suicide attempts, motor vehicle crashes, assaults, and intoxication. Patients being treated for an illness or for occupational or athletic injuries were rarely tested. A large proportion of alcohol-related treatment was for intoxicated, uninjured patients, whose profile was different (ie, younger, more often female, with higher blood alcohol concentrations, and admission distributed more evenly across ED shifts). CONCLUSIONS: Case detection rates for alcohol involvement may be biased and inflated when based on physician decisions to test for alcohol use. Rates based on comprehensive chart reviews and clinical examination may be better estimates but are also subject to methodologic limitations. Universal screening would yield the most accurate estimates of alcohol prevalence and would provide more accurate guidance to physicians regarding when to test for alcohol use. Universal screening as a clinical standard would help to identify more adolescents who might benefit from additional alcohol use intervention.

Adolescent↗
PubMed2002

Predictors of motivation to change after medical treatment for drinking-related events in adolescents.

Characteristics associated with intention to change drinking were examined in 254 adolescents treated in an emergency department for alcohol. Younger age, living at home, lower baseline level of drinking and drinking problems, greater depression, having penalties for breaking family drinking rules, higher injury severity, being frightened, and being admitted to the hospital predicted greater intention to change drinking at the time of the event. Baseline characteristics related to being in the action stage of change 3 months later were younger age; lower drinking; having penalties for breaking family drinking rules; injury severity; and number of anticipated consequences, including being in trouble with parents. This study has implications for brief interventions that capitalize on potential teachable moments with problem-drinking adolescents.

Adolescent↗