The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) (Br J Surg 2003; 90: 157-165).
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Aged↗
Biomedical subjects
S J Nixon
Publications and source records attributed to S J Nixon.
Death after inserting Hickman line was probably avoidable.
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Adolescent↗
Chronic pain after laparoscopic and open mesh repair of groin hernia.
BACKGROUND: The aim of this study was to compare the incidence of chronic pain or discomfort after laparoscopic totally extraperitoneal (TEP) repair and open mesh repair of groin hernia, and to assess the impact of such pain on patients' physical activity. METHODS: A postal questionnaire was sent to patients who had TEP or open mesh repair of groin hernia between January 1998 and December 1999. The patients were asked about any persistent pain or discomfort in relation to the groin hernia repair and whether this pain or discomfort restricted their ability to undertake physical or sporting activity. RESULTS: Of the 560 available patients 454 (81.1 per cent) replied. Laparoscopic TEP repair was performed in 240 patients (52.9 per cent) and open mesh repair in 214 (47.1 per cent). Of the 454 patients, 136 (30.0 per cent) reported chronic groin pain or discomfort, which was significantly more common after open repair than after laparoscopic repair (38.3 versus 22.5 per cent; P < 0.01). Chronic groin pain or discomfort restricted daily physical or sporting activity in 18.1 per cent of the patients. The patients who had open repair complained of significantly more restriction of daily physical activity than patients who underwent laparoscopic repair (walking, P < 0.05; lifting a bag of groceries, P < 0.01). CONCLUSION: Chronic pain or discomfort was reported by 30.0 per cent of patients after groin hernia repair and was significantly more common after open mesh repair than after laparoscopic TEP repair. It restricted physical or sporting activities in 18.1 per cent of the patients and significantly more so after open mesh repair.
Adult↗
Surgical audit activity may improve long-term survival in cancer patients: an observation from "Trends in Cancer Survival in Scotland 1971-1995".
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Humans↗
Estrogen replacement therapy: a perspective on cognitive impact.
Studies suggest that use of estrogen replacement therapy (ERT) after menopause may be beneficial toward preservation of cognitive functioning. However, potentially confounding variables such as alcohol consumption are typically not systematically considered. The purpose of this study was to determine whether ERT users and nonusers differ with regard to memory and concentration ability when potential confounds are eliminated. Alcohol consumption was included as an independent variable so that ERT by alcohol interactions could be examined. One-hundred-sixty-two postmenopausal women participated in the study and were classified as moderate drinkers or teetotalers. Logical Memory (Wechsler Memory Scale-Revised), Digit Span (Wechsler Adult Intelligence Scale-Revised) and the Cognitive Symptom Checklist-Memory subscale were administered. No main effects of ERT were found. However, ERT by alcohol interactions among some Digit Span Forward variables were observed. We conclude that confounding variables such as alcohol consumption, may be at least partly responsible for observed differences in cognition commonly attributed to ERT.
Cognition↗
Television exposure in children after a terrorist incident.
This study examined the influence of bomb-related television viewing in the context of physical and emotional exposure on posttraumatic stress symptoms--intrusion, avoidance, and arousal--in middle school students following the 1995 Oklahoma City bombing. Over 2,000 middle school students in Oklahoma City were surveyed 7 weeks after the incident. The primary outcome measures were the total posttraumatic stress symptom score and symptom cluster scores at the time of assessment. Bomb-related television viewing in the aftermath of the disaster was extensive. Both emotional and television exposure were associated with posttraumatic stress at 7 weeks. Among children with no physical or emotional exposure, the degree of television exposure was directly related to posttraumatic stress symptomatology. These findings suggest that television viewing in the aftermath of a disaster may make a small contribution to subsequent posttraumatic stress symptomatology in children or that increased television viewing may be a sign of current distress and that it should be monitored. Future research should examine further whether early symptoms predict increased television viewing and/or whether television viewing predicts subsequent symptoms.
Child↗
Predictors of post-traumatic stress symptoms in Oklahoma City: exposure, social support, peri-traumatic responses.
Eighty-five adults seeking mental health assistance six months after the Oklahoma City bombing were assessed to determine which of three groups of variables (exposure, peri-traumatic responses, and social support) predicted development of post-traumatic stress disorder (PTSD) symptoms. Variables most highly associated with subsequent PTSD symptoms included having been injured (among exposure variables), feeling nervous or afraid (peri-traumatic responses), and responding that counseling helped (support variables). Combining primary predictors in the three areas, PTSD symptoms were more likely to occur in those reporting counseling to help and those feeling nervous or afraid at the time of the bombing. Implications of these findings are discussed for behavioral health administrators and clinicians planning service delivery to groups of victims seeking mental health intervention after terrorist attacks and other disasters.
Adult↗
Laparoscopic total extraperitoneal hernia repair: mesh fixation is unnecessary.
BACKGROUND: Inguinal hernia repair contributes significantly to the general surgeon's workload. Since the evolution of laparoscopic inguinal hernia repair, the total extraperitoneal (TEP) repair is the technique most commonly employed by laparoscopic surgeons. This technique involves the placement of a polypropylene mesh in the preperitoneal space. The issue of fixation of this mesh remains unresolved. Surgeons have previously fixed this mesh in place using laparoscopic stapling devices, suturing techniques, or, more recently, polycyanoacrylate adhesives. However, stapling the mesh not only increases the time and expense of the procedure but can cause specific complications such as nerve entrapment syndromes and osteitis pubis. PATIENTS AND METHODS: We report a series of 89 total extraperitoneal laparoscopic repairs in 80 consecutive patients using no means of mechanical or adhesive mesh fixation, irrespective of the size of the hernial defect. RESULTS: Follow-up revealed no increase in morbidity or hernia recurrence. CONCLUSION: Our experience suggests that mechanically fixing the mesh in the preperitoneal space is unnecessary. Not fixing the mesh avoids possible complications and is not associated with any increased risk of hernia recurrence.
Adult↗
A comparison of substance use between female inmates and female substance misusers in treatment.
Recent literature documents extensive substance misuse histories among US female prison inmates. The primary purpose of the present study was to determine whether histories of personal and familial substance misuse distinguished female inmates from substance misusers in treatment. After accounting for drug-related offences, we hypothesized that the inmates would have more extensive histories of personal and familial substance misuse and that they would have initiated substance use at an earlier age. Contrary to our expectations, the two samples were similar on many measures of alcohol and drug use. Similarly, differences in family histories of substance misuse were not in the predicted direction. As hypothesized, however, the inmates did report earlier age at onset of drinking. Of particular clinical relevance was the finding that, despite similar alcohol consumption levels, inmates reported fewer alcohol-related adverse medical, legal, and psychosocial consequences than did the treatment sample.
Adult↗
Is Intranet technology the low cost, quick fix solution for Scotland's clinical information technology chaos? Results of a pilot study.
For health care professional staff immediate access to recent clinical documents is seen as the first priority for developments in Information Technology. Large amounts of clinical data are held on computer systems to which staff have little or no access. A pilot study has been undertaken to evaluate the use of Intranet technology, electronically extracting large volumes of data from various feeder systems in real time and allowing access via standard Internet browsers. Over 700,000 reports have been successfully transferred from three differing sources with more than 2000 new records added per week. Intranet technology would seem to be a low cost solution, capable of rapid implementation, that could overcome the most important bottleneck in clinical computing.
Cost Control↗
Characteristics of American-Indian clients seeking inpatient treatment for substance abuse.
OBJECTIVE: The current study was conducted as a preliminary examination of substance use and some of its correlates in nonreservation-residing American Indians. METHOD: A group of 522 American-Indian (AI) subjects (473 men) were compared with two sets of geographic controls: (1) an equal number of African Americans (AA) and (2) an equal number of European Americans (EA). All received treatment in the same facilities over the same time period. RESULTS: Contrary to expectations, the ethnic/racial groups were remarkably similar on a number of alcohol use variables, including the amount consumed in the 6 months prior to treatment and the number of previous treatments. Among those self-reporting as problem drinkers, there were group differences in the age of first drink (AA mean = 13.54, AI mean = 12.24 and EA mean = 11.71) and first drunk (AA mean = 15.80, AI mean = 14.23 and EA mean = 14.08) and the number of alcohol-related problems (AA mean = 7.52, AI mean = 8.49 and EA mean = 8.46). On these measures, AI and EA subjects did not differ whereas AA subjects reported a later age of onset and fewer negative consequences. EA and AI male subjects reported marijuana as their most frequently used "other" drug, whereas AA male subjects listed stimulants as their primary drugs. Regardless of ethnic/racial group, women did not differ on their drug(s) of choice, reporting stimulants as the most frequently abused drug (after accounting for alcohol use). CONCLUSIONS: This preliminary study is remarkable for the observed similarities among groups. Future studies using more rigorous sampling are needed to provide clarification of this preliminary study.
Adult↗
Neuropsychological deficits in sober alcoholics: influences of chronicity and recent alcohol consumption.
BACKGROUND: The relationships between severity of neuropsychological (NP) deficits and quantity and duration of alcoholic drinking remain controversial. Eckardt et al. (1998) proposed that NP deficits can be observed only if chronicity of alcohol abuse equals or exceeds 10 years. In this study we tested the hypothesis of Eckardt et al. and reexamined the relationship of NP performance and alcohol consumption. METHODS: One hundred sixty-two alcoholics and 165 controls completed a NP test battery at least 3 weeks after the alcoholics attained sobriety. Chronicity varied from 4 to 9 years for 55 alcoholics and from 10 to 33 years for the remaining 107. RESULTS: Compared to controls, both groups of alcoholics were impaired on the Shipley Vocabulary and Abstraction tests and on two versions of the Digit Symbol test, but there was no difference between the two alcoholic groups on any measure. Regression analyses that controlled for age and education showed that chronicity predicted less than 0.5% of the variance on NP measures. By contrast, a measure of recent alcohol consumption, the Quantity-Frequency Index, contributed significantly (approximately 5% of the variance) to the prediction of alcoholics' NP performance. CONCLUSIONS: These data provide weak support for a dose effect relationship between degree of NP impairment and level of alcoholic drinking in the past 6 months but no evidence for an influence of chronicity.
Adult↗
Blunted stress cortisol response in abstinent alcoholic and polysubstance-abusing men.
BACKGROUND: This study tested cortisol responses to a psychological stressor in controls (CT) versus patients who were diagnosed as alcohol dependent (AD) or alcohol and stimulant dependent (ADSD) by DSM-IV criteria and who were abstinent for 3 to 4 weeks from alcohol and illicit drugs. Alcohol increases cortisol secretion acutely and during withdrawal. However, there is little information about abnormalities of hypothalamic-pituitary-adrenocortical (HPA) reactivity in recovering alcoholics. METHODS: Accordingly, we tested HPA function in the laboratory between 7:00 and 9:30 AM on control versus stress days. Stress consisted of a 20-min public speaking challenge with preparation and delivery of two short speeches, ostensibly evaluated for quality of delivery, whereas control involved relaxing for the same period. Cortisol was measured in saliva collected at baseline, stress or control, and recovery period, and also at home at 9:00 PM on one of the two days. RESULTS: The three groups did not differ in diurnal patterns of cortisol secretion on the rest day and 9:00 PM sample, which indicated that AD and ADSD patients had intact diurnal HPA regulation at rest. During speech stress, the CT subjects showed the expected cortisol increase (p < 0.0001), whereas neither AD nor ADSD patients responded significantly. Cortisol values were not accounted for by covariates such as depression, posttraumatic stress disorder, glucose metabolism, or anthropometric or demographic characteristics. CONCLUSIONS: The apparent stress hyporesponsiveness of the AD and ADSD patients suggests a persistent disruption of HPA function, perhaps due to incomplete recovery from prior abuse, or to a preexisting alteration in neural systems that regulate HPA responses to stress.
Adult↗
Deaths following hernia surgery: room for improvement.
BACKGROUND: Abdominal wall herniae are common and may well lead to death. The aim of this study was to examine the deaths of patients with an inguinal, femoral or incisional hernia to identify aspects of management which could be improved upon. METHOD: Data collected by the Scottish Audit of Surgical Mortality 1994-1997 was analysed by interrogation of the database for all deaths on a surgical ward or within 30 days of surgery where the principle diagnosis was inguinal, fermoral or incisional hernia. RESULTS: There were 133 deaths out of 31,525 operations over the 4-year period. Mortality was highest among femoral hernia operations in women (37 deaths/1184 operations; 3.1%) and 59% of femoral hernia surgery was performed outwith normal working hours. The 133 patients were elderly (mean age 79 years) and unfit, but less than half the operations involved consultant anaesthetists or consultant surgeons. Delay in referral contributed to death in 15/133 patients and adverse factors in management, particularly in the perioperative period, caused the death of 2 patients and contributed to the death of a further 29/133. CONCLUSIONS: Herniae carry a significant mortality in elderly, unfit patients who require close attention to perioperative management. These patients should be anaesthetised and operated upon by consultant staff during the normal working day.
Adult↗
An overview of women seeking substance abuse treatment in Oklahoma.
Current studies of neurocognitive function in alcoholics are generally restricted to a relatively small subsample of persons seeking treatment. Subjects are typically excluded from study if reporting signs or symptoms of possibly confounding disorders such as comorbid psychiatric disorders, medical, or neurologic disorders. Thus, the question arises as to whether those individuals who actually participate in these reported studies are representative of the larger population of unselected persons. Studies of women are particularly subject to this concern due to higher rates of comorbid medical and psychiatric disorders in women. The current study was directed to contrasting treatment-seeking women who either were or were not selected for a laboratory study of neurocognitive function. Specifically, we compared subgroups of women identified on the basis of the presence of an alcohol use disorder and/or being selected for study. A total of 638 women were available for comparison. Contrary to anticipated concerns, analysis of basic demographic, alcohol and drug use, and affective/cognitive measures revealed considerable similarities among the groups. Consistent with other literature, the large majority of these women reported a family history of alcohol use disorders. They also reported a preference for stimulants as opposed to other illicit substances as evidenced in self-report of their most frequently used drug in the six months prior to treatment (excluding alcohol). These findings suggest that current selection procedures, although necessarily biasing samples in response to specific questions, do not result in samples that are significantly different from the majority of treatment-seeking women, at least on the basis of demographic and affective variables. Furthermore, as described herein, these findings have specific indications for primary care assessment and treatment referral.
Adult↗
Psychiatric disorders among survivors of the Oklahoma City bombing.
CONTEXT: Disasters expose unselected populations to traumatic events and can be used to study the mental health effects. The Oklahoma City, Okla, bombing is particularly significant for the study of mental health sequelae of trauma because its extreme magnitude and scope have been predicted to render profound psychiatric effects on survivors. OBJECTIVE: To measure the psychiatric impact of the bombing of the Alfred P. Murrah Federal Building in Oklahoma City on survivors of the direct blast, specifically examining rates of posttraumatic stress disorder (PTSD), diagnostic comorbidity, functional impairment, and predictors of postdisaster psychopathology. DESIGN, SETTING, AND PARTICIPANTS: Of 255 eligible adult survivors selected from a confidential registry, 182 (71%) were assessed systematically by interviews approximately 6 months after the disaster, between August and December 1995. MAIN OUTCOME MEASURES: Diagnosis of 8 psychiatric disorders, demographic data, level of functioning, treatment, exposure to the event, involvement of family and friends, and physical injuries, as ascertained by the Diagnostic Interview Schedule/Disaster Supplement. RESULTS: Forty-five percent of the subjects had a postdisaster psychiatric disorder and 34.3% had PTSD. Predictors included disaster exposure, female sex (for any postdisaster diagnosis, 55% vs 34% for men; chi2 = 8.27; P=.004), and predisaster psychiatric disorder (for PTSD, 45% vs 26% for those without predisaster disorder; chi2 = 6.86; P=.009). Onset of PTSD was swift, with 76% reporting same-day onset. The relatively uncommon avoidance and numbing symptoms virtually dictated the diagnosis of PTSD (94% meeting avoidance and numbing criteria had full PTSD diagnosis) and were further associated with psychiatric comorbidity, functional impairment, and treatment received. Intrusive reexperience and hyperarousal symptoms were nearly universal, but by themselves were generally unassociated with other psychopathology or impairment in functioning. CONCLUSIONS: Our data suggest that a focus on avoidance and numbing symptoms could have provided an effective screening procedure for PTSD and could have identified most psychiatric cases early in the acute postdisaster period. Psychiatric comorbidity further identified those with functional disability and treatment need. The nearly universal yet distressing intrusive reexperience and hyperarousal symptoms in the majority of nonpsychiatrically ill persons may be addressed by nonmedical interventions of reassurance and support.
Adaptation, Psychological↗
Posttraumatic stress responses in bereaved children after the Oklahoma City bombing.
OBJECTIVE: To investigate the responses of middle and high school students exposed to the 1995 Oklahoma City bombing across a spectrum of loss. METHOD: A questionnaire measuring exposure, personal consequences, initial response, and current posttraumatic stress and other symptoms was administered to 3,218 students 7 weeks after the explosion. RESULTS: More than one third of the sample knew someone killed in the explosion. Bereaved youths were more likely than nonbereaved peers to report immediate symptoms of arousal and fear, changes in their home and school environment, and posttraumatic stress symptoms. Retrospective measures of initial arousal and fear predicted posttraumatic stress symptoms at 7 weeks. CONCLUSIONS: The results support the literature addressing the role of initial response in posttraumatic stress symptom development. The study raises concern about the impact of television, and traumatized youths' reactivity to it, in the aftermath of disaster.
Adolescent↗
Clinical needs assessment of middle and high school students following the 1995 Oklahoma City bombing.
OBJECTIVE: This clinical assessment was designed to identify middle and high school students in need of formal evaluation for posttraumatic response symptoms following the 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City. METHOD: A clinical needs assessment instrument was developed and administered to grade 6 through 12 students 7 weeks after the bombing (N = 3,218). RESULTS: More than 40% of the students reported knowing someone injured, and more than one-third reported knowing someone killed in the blast. Posttraumatic stress symptoms at 7 weeks significantly correlated with gender, exposure through knowing someone injured or killed, and bomb-related television viewing. CONCLUSIONS: This study documents the intensity of community exposure to the bombing and the lingering symptoms of stress. The assessment was used in planning for clinical service delivery, training professional responders, and supporting funding requests.
Adolescent↗