Digital Commons Network^™

Clinical Clearance Of The Cervical Spine In Blunt Trauma Patients Younger Than 3 Years: A Multi-Center Study Of The American Association For The Surgery Of Trauma., Rafael Pieretti-Vanmarcke, George C Velmahos, Michael L Nance, Saleem Islam, Richard A Falcone, Paul W Wales, Rebeccah L Brown, Barbara A Gaines, Christine Mckenna, Forrest O Moore, Pamela W Goslar, Kenji Inaba, Galinos Barmparas, Eric R Scaife, Ryan R Metzger, Douglas L Brockmeyer, Jeffrey S Upperman, Joaquin Estrada, David A Lanning, Sara K Rasmussen, Paul D Danielson, Michael P Hirsh, Heitor F X Consani, Steven Stylianos, Candace Pineda, Scott H Norwood, Steven W Bruch, Robert Drongowski, Robert Barraco, Michael Pasquale, Farheen Hussain, Erwin F Hirsch, P Daniel Mcneely, Mary E Fallat, David S Foley, Joseph A Iocono, Heather M Bennett, Kenneth Waxman, Kelly Kam, Lisa Bakhos, Laurie Petrovick, Yuchiao Chang, Peter T Masiakos

Michael D Pasquale MD, FACS, FCCM

BACKGROUND: Cervical spine clearance in the very young child is challenging. Radiographic imaging to diagnose cervical spine injuries (CSI) even in the absence of clinical findings is common, raising concerns about radiation exposure and imaging-related complications. We examined whether simple clinical criteria can be used to safely rule out CSI in patients younger than 3 years. METHODS: The trauma registries from 22 level I or II trauma centers were reviewed for the 10-year period (January 1995 to January 2005). Blunt trauma patients younger than 3 years were identified. The measured outcome was CSI. Independent predictors of CSI were identified by …

Gender Differences In Perceptions And Self-Reported Driving Behaviors Among Teenagers., Gavin Barr, Kathleen Kane, Robert Barraco, Timarie Rayburg, Lauren Demers, Chadd Kraus, Marna Greenberg, Valerie Rupp, Kimberly Hamilton, Bryan Kane

Bryan G Kane MD

BACKGROUND: The Centers for Disease Control reports that motor vehicle crashes (MVCs) are the leading cause of injury and death among U.S. teenagers, and disproportionately affect males. Among preventable causes of MVCs involving teenage drivers, distracted driving continues to be a serious public health problem. OBJECTIVES: To describe gender differences in teenage drivers' self-perceptions of safe driving behaviors, and self-reported risk behaviors and distractions while driving. METHODS: We prospectively surveyed teenage drivers from four high schools in Pennsylvania and New Jersey. Gender comparisons were made between self-reported perceptions and self-reported driving behaviors. Descriptive statistics and chi-squared testing were used in …

Gender Differences In Perceptions And Self-Reported Driving Behaviors Among Teenagers., Gavin Barr, Kathleen Kane, Robert Barraco, Timarie Rayburg, Lauren Demers, Chadd Kraus, Marna Greenberg, Valerie Rupp, Kimberly Hamilton, Bryan Kane

Kathleen E Kane MD

BACKGROUND: The Centers for Disease Control reports that motor vehicle crashes (MVCs) are the leading cause of injury and death among U.S. teenagers, and disproportionately affect males. Among preventable causes of MVCs involving teenage drivers, distracted driving continues to be a serious public health problem. OBJECTIVES: To describe gender differences in teenage drivers' self-perceptions of safe driving behaviors, and self-reported risk behaviors and distractions while driving. METHODS: We prospectively surveyed teenage drivers from four high schools in Pennsylvania and New Jersey. Gender comparisons were made between self-reported perceptions and self-reported driving behaviors. Descriptive statistics and chi-squared testing were used in …

Gender Differences In Perceptions And Self-Reported Driving Behaviors Among Teenagers., Gavin Barr, Kathleen Kane, Robert Barraco, Timarie Rayburg, Lauren Demers, Chadd Kraus, Marna Greenberg, Valerie Rupp, Kimberly Hamilton, Bryan Kane

Marna R Greenberg DO, MPH, FACEP

BACKGROUND: The Centers for Disease Control reports that motor vehicle crashes (MVCs) are the leading cause of injury and death among U.S. teenagers, and disproportionately affect males. Among preventable causes of MVCs involving teenage drivers, distracted driving continues to be a serious public health problem. OBJECTIVES: To describe gender differences in teenage drivers' self-perceptions of safe driving behaviors, and self-reported risk behaviors and distractions while driving. METHODS: We prospectively surveyed teenage drivers from four high schools in Pennsylvania and New Jersey. Gender comparisons were made between self-reported perceptions and self-reported driving behaviors. Descriptive statistics and chi-squared testing were used in …

Gender Differences In Perceptions And Self-Reported Driving Behaviors Among Teenagers., Gavin Barr, Kathleen Kane, Robert Barraco, Timarie Rayburg, Lauren Demers, Chadd Kraus, Marna Greenberg, Valerie Rupp, Kimberly Hamilton, Bryan Kane

Robert D Barraco MD, MPH

BACKGROUND: The Centers for Disease Control reports that motor vehicle crashes (MVCs) are the leading cause of injury and death among U.S. teenagers, and disproportionately affect males. Among preventable causes of MVCs involving teenage drivers, distracted driving continues to be a serious public health problem. OBJECTIVES: To describe gender differences in teenage drivers' self-perceptions of safe driving behaviors, and self-reported risk behaviors and distractions while driving. METHODS: We prospectively surveyed teenage drivers from four high schools in Pennsylvania and New Jersey. Gender comparisons were made between self-reported perceptions and self-reported driving behaviors. Descriptive statistics and chi-squared testing were used in …

Sports Related Concussion: There Is No Such Thing As A Ding., Robert Barraco

Robert D Barraco MD, MPH

No abstract provided.

The Drs. John M. Jr. And Josephine J. Templeton Lecture, “Prevention Breakthroughs That Really Save Lives", Robert Barraco

Robert D Barraco MD, MPH

No abstract provided.

Evaluation And Management Of Geriatric Trauma: An Eastern Association For The Surgery Of Trauma Practice Management Guideline., James Forrest Calland, Angela M Ingraham, Niels Martin, Gary T Marshall, Carl I Schulman, Tristan Stapleton, Robert Barraco

Robert D Barraco MD, MPH

BACKGROUND: Aging patients constitute an increasing proportion of patients treated at trauma centers. Previous and existing guidelines addressing care of the injured elder have not adequately addressed emerging data regarding optimal means for undertaking triage decisions, correcting coagulopathy, and the limitations of supraphysiologic resuscitation. METHODS: More than 400 MEDLINE citations published between the years 2000 and 2008 were identified and screened. A total of 90 references were selected for the evidentiary table followed by consensus-based discussions regarding the level of evidence and the strength of recommendations that could be derived from the related findings of the individual studies. RESULTS: In …

Improving Outcomes For Elderly Trauma Patients, Robert Barraco, Francis Salerno, Catherine Glew

Robert D Barraco MD, MPH

No abstract provided.

The Aging Of Our Icu's Part Iii, Robert Barraco

Robert D Barraco MD, MPH

No abstract provided.

The Geriatric Trauma Team: The Cutting Edge Of Elder Trauma Care, Robert Barraco

Robert D Barraco MD, MPH

No abstract provided.

Clinical Clearance Of The Cervical Spine In Blunt Trauma Patients Younger Than 3 Years: A Multi-Center Study Of The American Association For The Surgery Of Trauma., Rafael Pieretti-Vanmarcke, George C Velmahos, Michael L Nance, Saleem Islam, Richard A Falcone, Paul W Wales, Rebeccah L Brown, Barbara A Gaines, Christine Mckenna, Forrest O Moore, Pamela W Goslar, Kenji Inaba, Galinos Barmparas, Eric R Scaife, Ryan R Metzger, Douglas L Brockmeyer, Jeffrey S Upperman, Joaquin Estrada, David A Lanning, Sara K Rasmussen, Paul D Danielson, Michael P Hirsh, Heitor F X Consani, Steven Stylianos, Candace Pineda, Scott H Norwood, Steven W Bruch, Robert Drongowski, Robert Barraco, Michael Pasquale, Farheen Hussain, Erwin F Hirsch, P Daniel Mcneely, Mary E Fallat, David S Foley, Joseph A Iocono, Heather M Bennett, Kenneth Waxman, Kelly Kam, Lisa Bakhos, Laurie Petrovick, Yuchiao Chang, Peter T Masiakos

Robert D Barraco MD, MPH

BACKGROUND: Cervical spine clearance in the very young child is challenging. Radiographic imaging to diagnose cervical spine injuries (CSI) even in the absence of clinical findings is common, raising concerns about radiation exposure and imaging-related complications. We examined whether simple clinical criteria can be used to safely rule out CSI in patients younger than 3 years. METHODS: The trauma registries from 22 level I or II trauma centers were reviewed for the 10-year period (January 1995 to January 2005). Blunt trauma patients younger than 3 years were identified. The measured outcome was CSI. Independent predictors of CSI were identified by …

Admissions To A Trauma Service From Nursing Facilities, Catherine Glew, Robert Barraco

Robert D Barraco MD, MPH

No abstract provided.

Evaluation And Management Of Mild Traumatic Brain Injury: An Eastern Association For The Surgery Of Trauma Practice Management Guideline, Ronald Barbosa, Randeep Jawa, Jennifer Watters, Jennifer Knight, Andrew Kerwin, Eleanor Winston, Robert Barraco, Brian Tucker, James Bardes, Susan Rowell

Robert D Barraco MD, MPH

BACKGROUND: An estimated 1.1 million people sustain a mild traumatic brain injury (MTBI) annually in the United States. The natural history of MTBI remains poorly characterized, and its optimal clinical management is unclear. The Eastern Association for the Surgery of Trauma had previously published a set of practice management guidelines for MTBI in 2001. The purpose of this review was to update these guidelines to reflect the literature published since that time.

METHODS: The PubMed and Cochrane Library databases were searched for articles related to MTBI published between 1998 and 2011. Selected older references were also examined.

RESULTS: A total …

Nutrition Support, Robert Barraco

Robert D Barraco MD, MPH

No abstract provided.

Child Passenger Safety: An Evidence-Based Review, Robert Barraco, J Cheng, W Bromberg, R Falcone, Jeffrey Hammond, F Lui, Rovinder Sandhu, David Scaff

Robert D Barraco MD, MPH

No abstract provided.

Practice Management Guidelines For The Diagnosis And Management Of Injury In The Pregnant Patient: The East Practice Management Guidelines Work Group, Robert Barraco, William Chiu, Thomas Clancy, John Como, James Ebert, L Hess, William Hoff, Michele Holevar, J Quirk, Bruce J Simon, Patrice Weiss

Robert D Barraco MD, MPH

Trauma during pregnancy has presented very unique challenges over the centuries. From the first report of Ambrose Pare of a gunshot wound to the uterus in the 1600s to the present, there have existed controversies and inconsistencies in diagnosis, management, prognostics, and outcome. Anxiety is heightened by the addition of another, smaller patient. Trauma affects 7% of all pregnancies and requires admission in 4 of 1000 pregnancies. The incidence increases with advancing gestational age. Just over half of trauma during pregnancy occurs in the third trimester. Motor vehicle crashes comprise 50% of these traumas, and falls and assaults account for …

Geriatric Psychology, Robert Barraco

Robert D Barraco MD, MPH

No abstract provided.

Triage Of The Trauma Patient, Robert Barraco, William Chiu

Robert D Barraco MD, MPH

No abstract provided.

Select Readiness: Assessing The Clinical Learning Environment Of A Regional Branch Medical Campus, Margaret A. Hadinger Edd, Ms, Erica T. Mahady Ma, Edward Norris Md, Fapm, J Alan Otsuki Md, Mba

Edward R Norris MD, FAPA, FAPM

No abstract provided.

A Survey Of Complementary And Alternative Medicine Knowledge Among Health Educators In The United States, Ping Johnson, Jennifer Priestley, Roy Johnson

Jennifer L. Priestley

Background: Complementary and alternative medicine (CAM) is popular among U.S. health care consumers, but no study has examined how much health educators know about CAM. Purpose: To examine the knowledge of basic CAM concepts and common CAM therapies among health educators in the U.S. Methods: An online survey was conducted among 1,299 health educators with valid e-mails on a professional listserv. The response rate was 39%. The 16-item CAM knowledge scale yielded a Cronbach's alpha of .71. Results: Participating health educators were most knowledgeable about chiropractic and massage therapy, familiar with the general definition of CAM, understood whether acupuncture is …

Medical Schools Can Cooperate: A New Joint Venture To Provide Medical Education In The Northern Rivers Region Of New South Wales, Sue Page, Hudson Birden, Judith Hudson, Jill Thistlethwaite, Chris Roberts, Ian Wilson, John Bushnell, John Hogg, Ben Freedman, Neville Yeomans

Ian G Wilson

The medical schools at the University of Western Sydney, University of Wollongong and University of Sydney have developed a joint program for training medical students through placements of up to 40 weeks on the New South Wales North Coast.

The new partnership agency - the North Coast Medical Education Collaboration - builds on the experience of regional doctors and their academic partners.

A steering comm ittee has identified the availability and support requireme nts of local practitioners to provide training, and has undertaken a comparative mapping of learning objectives and assessments from the courses of the three universities.

The goals …

The Disavowed Curriculum: Understanding Student's Reasoning In Professionally Challenging Situations, Shiphra Ginsburg, Glenn Regehr, Lorelei Lingard

Lorelei Lingard

CONTEXT: Understanding students' perceptions of and responses to lapses in professionalism is important to shaping students' professional development. OBJECTIVE: Utilize realistic, standardized professional dilemmas to obtain insight into students' reasoning and motivations in "real time." DESIGN: Qualitative study using 5 videotaped scenarios (each depicting a student placed in a situation which requires action in response to a professional dilemma) and individual interviews, in which students were questioned about what they would do next and why. SETTING: University of Toronto. PARTICIPANTS: Eighteen fourth-year medical students; participation voluntary and anonymous. MAIN OUTCOME MEASURE: A model to explain students' reasoning in the face …

Look Who’S Talking: Teaching And Learning Using The Genre Of Medical Case Presentations, Marlee Spafford, Catherine Schryer, Marcellina Mian, Lorelei Lingard

Lorelei Lingard

In a pediatric teaching hospital, the authors examined 16 novice medical case presentations that were classified as instances of a hybrid apprenticeship genre. In contrast to strict school and workplace genres, an apprenticeship genre results from the sometimes competing activity systems of student education and patient care. The authors examined these novice case presentations for the amount and patterns of time devoted to student learning and expert teaching, the difficulties created for participants, the sometimes misunderstood implicit messages delivered by experts, and the opportunities to address educational objectives. This study offers professional communication researchers a model that combines quantitative and …

Tensions Influencing Operating Room Team Function: Does Institutional Context Make A Difference?, Lorelei Lingard, Stacey Garwood, Dan Poenaru

Lorelei Lingard

BACKGROUND: A recent study of operating room (OR) team communication in a large, urban hospital described recurrent tension catalysts and a preliminary theory of team members' interpretive processes. To determine to what extent these findings were transferable to other institutional contexts, we conducted a validation study in 2 small, academic hospitals in a mid-size city. METHODS: Eight focus groups and 8 interviews were conducted with 6 general surgeons, 22 OR nurses, 5 anaesthesiologists and 10 trainees. Observations of 10 surgeons and their team members were conducted over 4 months. Data were analysed by applying thematic codes derived from previous research …

What Healthcare Students Do With What They Don't Know: The Socializing Power Of 'Uncertainty' In The Case Presentation, Marlee Spafford, Catherine Schryer, Lorelei Lingard, Patricia Hrynchak

Lorelei Lingard

Healthcare students learn to manage clinical uncertainty amid the tensions that emerge between clinical omniscience and the 'truth for now' realities of the knowledge explosion in healthcare. The case presentation provides a portal to viewing the practitioner's ability to manage uncertainty. We examined the communicative features of uncertainty in 31 novice optometry case presentations and considered how these features contributed to the development of professional identity in optometry students. We also reflected on how these features compared with our earlier study of medical students' case presentations. Optometry students, like their counterparts in medicine, displayed a novice rhetoric of uncertainty that …

Forming Professional Identities On The Health Care Team: Discursive Constructions Of The 'Other' In The Operating Room, Lorelei Lingard, R. Reznick, I. Devito, S. Espin

Lorelei Lingard

BACKGROUND: Inter-professional health care teams represent the nucleus of both patient care and the clinical education of novices. Both activities depend upon the'talk' that team members use to interact with one another. This study explored team members' interpretations of tense team communications in the operating room (OR). METHODS: The study was conducted using 52 team members divided into 14 focus groups. Team members comprised 13 surgeons, 19 nurses, nine anaesthetists and 11 trainees. Both uni-disciplinary (n = 11) and multi-disciplinary (n = 3) formats were employed. All groups discussed three communication scenarios, derived from prior ethnographic research. Discussions were audio-recorded …

Junior Faculty Experiences With Informal Mentoring, Karen Leslie, Lorelei Lingard, Sarah Whyte

Lorelei Lingard

Mentoring is one way in which new faculty can acquire the skills needed for a successful academic career. Little is known about how informal mentoring is operationalized in an academic setting. This study had two main objectives: (1) to determine if junior faculty identify as having an informal mentor(s) and to describe their informal mentoring relationships; and (2) to identify the areas in which these faculty seek career assistance and advice. The study employed a grounded theory approach. Subjects were recruited from the clinical teaching faculty and were 3-7 years into their first faculty position. Theoretical sampling was employed in …

Clinical Oversight: Conceptualizing The Relationship Between Supervision And Safety, Tara Kennedy, Lorelei Lingard, G. Baker, Lisa Kitchen, Glenn Regehr

Lorelei Lingard

BACKGROUND: Concern about the link between clinical supervision and safe, quality health care has led to widespread increases in the supervision of medical trainees. The effects of increased supervision on patient care and trainee education are not known, primarily because the current multifacted and poorly operationalized concept of clinical supervision limits the potential for evaluation.

OBJECTIVE: To develop a conceptual model of clinical supervision to inform and guide policy and research.

DESIGN, SETTING, AND PARTICIPANTS: Observational fieldwork and interviews were conducted in the Emergency Department and General Internal Medicine in-patient teaching wards of two academic health sciences centers associated with …

Teaching The Balancing Act: Integrating Patient And Professional Agendas In Optometry, Marlee Spafford, Lorelei Lingard, Catherine Schryer, Patricia Hrynchak

Lorelei Lingard

PURPOSE: We observed novice case presentations to identify the opportunities optometry students have to learn about balancing patient and professional agendas. METHODS: Eight optometry students and 6 faculty optometrists were audio-recorded during 31 case presentations. Four students and 4 optometrists from the field observations were interviewed. We analyzed the data using a grounded theory method. RESULTS: Students encountered patient and professional agendas that were both compatible (these instances typically involved appointment purpose and treatment options) and incompatible (these instances typically involved patient consent and 'guideline adherence). CONCLUSIONS: Ideally through explicit instruction, optometrists facilitated the student's ability to negotiate these tensions …