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Biomedical subjects

T J Mader

Publications and source records attributed to T J Mader.

At least 19 recordsLinked to original sources
PubMed2001

Social services referral of adolescent trauma patients admitted following alcohol-related injury.

Alcohol screening of severely injured patients should be universal. Hospitalization following alcohol-related injury provides an opportunity for intervention to reduce recidivism. This study examines the frequency of social services referral of an alcohol positive cohort of adolescent trauma patients. This was a retrospective analysis of data collected from 1994 through 1998 by the National Pediatric Trauma Registry. All patients between the ages of 12 and 17 who had a blood alcohol level (BAL) measured were analyzed. Patients receiving referral to the department of social services, family counseling, or addiction services, and those receiving any substance abuse education intervention were considered a positive referral. There were 6006 children age 12 to 17 included in the database during this five-year period, 751 of whom had a BAL measured. Of those screened, 15.5% were positive. Sixty-eight (59%) of the BAL positive patients were referred for intervention through social services. The only statistically significant predictor of referral was whether or not the patient was the operator of a vehicle involved in the motor vehicle collision. Nearly half of the adolescents in this study, who screened positive for alcohol, received no social services support.

Accidents, Traffic↗
PubMed2001

Adequacy of pain assessment and pain relief and correlation of patient satisfaction in 68 ED fast-track patients.

INTRODUCTION: The new standards of the joint commission on accreditation of healthcare organizations specify the patient's right to appropriate assessment and management of pain. With this impetus, we looked at our own practice to see how well we assess and manage patients with pain. METHODS: Patients who presented with minor nonemergent pain were interviewed on arrival, and then again before discharge, with use of a structured questionnaire. A total of 68 completed pain surveys were analyzed. RESULTS: With use of a visual analog scale, patients rated their pain on arrival and at discharge; they also rated pain they were willing to accept when it was time for discharge. Sixty percent of the patients went home with more pain than they were willing to accept. Fifty-one percent of the patients were offered something for pain, and only half of them said the pain relief was adequate. The median time from arrival to administration of pain medication was 104 minutes. Surprisingly, the median patient satisfaction rating for overall care was "very good." DISCUSSION: This survey revealed that acute pain conditions are underevaluated and undertreated in one fast-track setting, suggesting that ED staff need more education about the management of acute pain. It also showed that relying on patient satisfaction surveys as surrogate markers for how well we manage pain is erroneous.

Acute Disease↗
PubMed1999

Aminophylline in undifferentiated out-of-hospital asystolic cardiac arrest.

PRIMARY OBJECTIVE: To determine if the introduction of intravenous aminophylline, a nonspecific adenosine receptor antagonist, into the resuscitation algorithm of asystole will increase return of spontaneous circulation when used in undifferentiated prehospital cardiac arrest. METHODS: An urban, prehospital, prospective, randomized, double-blind, placebo-controlled trial of nonpregnant normothermic adults suffering nontraumatic out-of-hospital asystolic cardiac arrest. Subjects were treated in accordance with published advanced cardiac life support guidelines and standard pharmacotherapy. They were randomly assigned to receive either placebo or aminophylline along with the initial boluses of atropine and epinephrine. Cardiac rhythms and carotid pulses were monitored throughout the resuscitation. RESULTS: Eighty-two patients were entered into the trial. Forty-five patients were assigned to the placebo group and 37 received aminophylline. Nine of 45 controls (20%; 95% CI 10-35%) achieved return of spontaneous circulation compared to ten of 37 (27%; 95% CI 14-44%) in the aminophylline group. CONCLUSIONS: We were not able to show a statistically significant improvement in return of spontaneous circulation when aminophylline was given during the early resuscitation phase of undifferentiated asystolic cardiac arrest in the prehospital setting with this sample size.

Aged↗
PubMed1999

Academic emergency physicians' perception of patient charges resulting from routine ED care.

This project was undertaken to assess academic emergency physicians' awareness of emergency department charges for routine care. A 60-item worksheet requiring estimates of patient charges for selected emergency department services, supplies, medications, and composite scenarios was used. The study was conducted at a university-affiliated academic emergency department and included 20 emergency medicine attendings and 20 emergency medicine residents. The questionnaires were distributed to the participants, independently completed, and immediately returned without discussion or consultation. All 40 surveys were analyzed. Answers were scored correct if the estimate was no more than 20% above or below the actual charge. The attending physicians scored an average of 19% of the items correctly, and the residents scored an average of 18% correctly. The average absolute error for attendings and residents were 89% and 105%, respectively. The proportion of those overestimating and underestimating each category were virtually identical in the 2 groups. We conclude from this study that emergency medicine attending physicians and residents do not have a good appreciation of patient charges for routine emergency care.

Academic Medical Centers↗
PubMed1999

Do patients with acute medical conditions have the capacity to give informed consent for emergency medicine research?

OBJECTIVE: Because of stress and illness, conscious emergency medicine (EM) patients may be temporarily cognitively impaired and thus incapable of participating in the informed consent process for acute care research. This pilot study sought to assess the mental capacity of ED patients during their evaluation and treatment for acute myocardial infarction (AMI). METHODS: A prospective observational design at a university tertiary referral center. EM patients with AMI from November 1996 to February 1997 were enrolled. While usual care was delivered, patients were administered three subtests of the Wechsler Adult Intelligence Scale-Revised (WAIS-R) test. Subtest scaled scores range from 1 to 19, with abnormal being less than 5. Demographic, historical, and environmental parameters were recorded. Patients assessed how serious they perceived their conditions; and rated their degrees of pain, nausea, breathlessness, and anxiety on 10-cm visual analog scales (VASs). Testing was repeated prior to hospital discharge. RESULTS: Twenty-five patients were enrolled. Of these, two (8%) were suspected by their emergency physicians to have insufficient capacity to give informed consent. However, five (20%) scored less than 5 on all of the WAIS-R subtests (kappa = 0.5) and eight (32%) scored less than 5 on at least one of the subtests (kappa = 0.3). The initial median Digit Span, Comprehension, and Similarities subtest scores were 7, 5, and 6. By discharge, these improved to 8, 7, and 8, respectively. CONCLUSIONS: This pilot study suggests that some patients with AMI may have difficulty processing information necessary to give informed consent for acute care research. Routine clinical evaluation may not detect this cognitive defect.

Acute Disease↗
PubMed1997

Emergency medicine research consent form readability assessment.

STUDY OBJECTIVE: To determine the level of education necessary to understand informed consent documents used to enroll subjects in emergency medicine research. METHODS: The directors of 96 accredited emergency medicine residency programs were asked to provide copies of research consent forms approved for patient enrollment at their facilities. A computer program was used to evaluate the readability of the documents submitted. The consent forms were stratified by degree of risk to the subject and compared with the use of ANOVA and the Kruskal-Wallis test. RESULTS: Ninety-four informed consent documents were received from 45 program directors. After exclusion of 6 forms, 88 were analyzed using the software program RightWriter 5.0. The mean readability index (years of education needed to understand the content) was 10. The length and complexity of the consent forms increased as risk to the subject increased (P = .03). CONCLUSION: Informed consent documents used in emergency medicine research may be too complex for the average patient to understand. A positive correlation exists between protocol risk and consent from complexity.

Clinical Protocols↗
PubMed1997

Adenosine receptor antagonism in refractory asystolic cardiac arrest: results of a human pilot study.

PRIMARY OBJECTIVE: To determine if adenosine receptor antagonism has any beneficial impact on victims of asystolic cardiac arrest and whether or not it warrants further clinical study as a treatment for cardiac asystole. MATERIALS AND METHODS: A 6-month prospective, randomized, double-blinded, placebo-controlled trial, set in an urban emergency medical services system, in adults with nontraumatic asystolic out-of-hospital cardiac arrest. Patients in whom standard advanced cardiac life support pharmacotherapy failed were randomized to receive placebo or aminophylline, a nonspecific competitive adenosine receptor antagonist. Rhythms were recorded before and after intervention. RESULTS: Twenty-two patients were appropriately entered into the trial. Eight patients served as controls and 14 patients received aminophylline. The groups were similar in all measured parameters except for initial rhythm. None of the patients in the placebo group responded to the intervention. Half of the patients in the treatment group had return of organized cardiac electrical activity. CONCLUSION: Our results suggest that adenosine receptor antagonism may have a role in the treatment of cardiac asystole. Further clinical studies to validate these findings and clarify the appropriate use of adenosine receptor antagonists in cardiac asystole may be justified.

Adult↗
PubMed1994

Reducing the pain of local anesthetic infiltration: warming and buffering have a synergistic effect.

STUDY OBJECTIVE: To compare room-temperature unbuffered lidocaine, warm lidocaine, buffered lidocaine, and warm buffered lidocaine to determine which of the four solutions is least painful during infiltration. DESIGN: Randomized, controlled, double-blinded, volunteer study. TYPE OF PARTICIPANT: Thirty-two young healthy adults. MAIN RESULTS: Each subject received four subcutaneous injections of 1% lidocaine: room-temperature unbuffered, warm, buffered, and warm buffered. After each injection, participants recorded their perception of pain associated with infiltration of the solution on a visual analog scale. Mean pain scores for the four solutions were determined and analyzed. The mean perceived pain score for the warm buffered solution was significantly lower than for any of the other solutions (versus warm: P = .0005; versus buffered: P = .0028; versus room temperature: P = .0001). There was no statistically significant difference between either the warm solution or buffered solution and the room-temperature unbuffered lidocaine. The difference in mean pain score for the warm buffered solution, compared with those for the warm, buffered, and room-temperature solutions, suggests that warming and buffering have a synergistic effect. CONCLUSION: Skin infiltration with warm buffered lidocaine is significantly less painful than infiltration with room-temperature unbuffered lidocaine, warm lidocaine, or buffered lidocaine.

Adult↗
PubMed1992

Acute pancreatitis in children.

Acute pancreatitis in childhood is not a rare condition, and it should be considered in all children presenting with acute abdominal complaints. A complete history should be obtained, with emphasis on recent trauma or infection, current medications, and the presence of any chronic diseases. After a thorough physical examination, simple ancillary studies including noninvasive imaging techniques will confirm the clinical suspicion. Appropriate aggressive treatment, instituted early, will help to reduce the associated morbidity and mortality. Most children with acute pancreatitis will recover with conservative management and suffer no significant long-term sequelae.

Acute Disease↗
PubMed1990

Avulsion of the rectus femoris tendon: an unusual type of pelvic fracture.

We present the case of a 15-year-old boy evaluated in the emergency department after sustaining an acute hip injury during track and field practice. Pelvic radiograph demonstrated an avulsion fracture of the anterior inferior iliac spine. Review of the literature reveals this to be a well recognized, yet unusual and interesting injury.

Adolescent↗
PubMed1990

Child abuse reporting in South Carolina, 1975-1987.

Child abuse continues to be a tremendous medical and social problem in South Carolina. Hundreds of children are injured each year and some are killed. Many injuries and deaths could have been prevented with timely intervention. Unfortunately the vast resources available in the fight against child abuse are of little value if primary health providers fail to notify the appropriate agencies. Improvements in education, detection, reporting and intervention are the only effective means of reducing the morbidity and mortality associated with child abuse and helping to eradicate it from society.

Child↗
PubMed1989

Acute pancreatitis in a five-year-old male.

Acute pancreatitis should be considered in all children presenting with acute abdominal complaints. A complete history should be obtained with emphasis on recent trauma, infections, current medications, and the presence of any systemic diseases. Simple laboratory studies and non-invasive imaging techniques can usually confirm the clinical suspicion. Most cases of interstitial pancreatitis resolve uneventfully but hemorrhagic pancreatitis carries a significant mortality risk.

Acute Disease↗