Non-helmeted motorcyclists: a burden to society? A study using the National Trauma Data Bank

INTRODUCTION: Helmet laws remain controversial. Opponents believe negative findings are a result of biased statistical analyses that fail to account for the impact of alcohol and drugs. In this study, we evaluated the effect that helmet use had upon injury severity, outcome controlling for alcohol or drug use, resource utilization, and financial burden using the National Trauma Data Bank (NTDB). METHODS: Two groups of patients, helmeted and non-helmeted motorcyclists, were identified using the NTDB over an 8-year period. Group differences were compared using nonparametric Wilcoxon tests for continuous variables and Fisher's exact test for dichotomous outcomes. To evaluate the effect that alcohol or drug use had on mortality, logistic regression models were created. RESULTS: A total of 9,769 patients were identified by the NTDB of which 6756 (69.2%) were helmeted and 3013 (30.8%) were non-helmeted. Helmet use was associated with lower injury severity, mortality, and resource utilization. Non-helmeted motorcyclists accrued greater hospital charges and were significantly less likely to have health insurance. When controlling for alcohol or drug use, mortality continued to be significantly associated with non-helmet use. CONCLUSION: Non-helmeted motorcyclists have worse outcomes than their helmeted counterparts independent of the use of alcohol or drugs. Furthermore, they monopolize more hospital resources, incur higher hospital charges, and as non-helmeted motorcyclists frequently do not have insurance, reimbursement in this group of patients is poor. Thus, the burden of caring for these patients is transmitted to society as a whole.     

The gastric cardia: to be or not to be?

The origin and biologic significance of cardiac gastric mucosa are controversial. Traditionally, it has been considered native mucosa and part of normal foregut development. It has been recently suggested that cardiac mucosa is present only as a metaplastic response to gastroesophageal reflux disease and therefore always abnormal. We evaluated the esophagogastric junction in 100 pediatric autopsy samples to determine the existence, characteristics, and length of pure cardiac mucosa at different ages. No patient had a history of gastroesophageal reflux disease. Cardiac mucosa immediately distal and contiguous to the esophageal squamous mucosa was identified in all 100 samples, varying in length from 0.1 to 3 mm; the mean length was 1 mm. There was an inverse correlation between patient age and length of cardiac mucosa; gender had no influence on measured length. Three patients had mild to moderate histologic esophagitis; two had gastritis. No metaplastic features or Helicobacter pylori were identified. These findings support the concept that there is a normal, variably narrow developmental zone at the esophagogastric junction covered by cardiac mucosa and is present at birth. When cardiac type mucosa is found in biopsy material, it does not necessarily represent evidence of a mucosal metaplastic response to gastroesophageal reflux disease.     

Free radicals and antioxidant therapy in clinical practice: to be or not to be?

Free radicals and antioxidant therapy have attracted a great deal of attention in recent years. Current research reveals the potential applications of antioxidants in prevention or control of disease. However, controversy still exists due to lack of well controlled clinical trials and definitive conclusion on efficacy/safety. This article highlights the debatable issues related to this. Based on the available literature and clinician's experience, recommendation on antioxidant usage is mentioned at the end. There is a need to assimilate the known available information with extensive research to establish a positive role of antioxidant therapy in clinical practice and to use an evidence-based approach for summarizing data, drawing conclusions and making recommendations about antioxidant usage and efficacy. A substantial gap still exists between the claims and the efficacy/safety in this area of research.     

Pneumocephalus after Pancoast's tumor surgery: to be or not to be conservative?

We report a case of a 62-year-old man affected by Pancoast's tumor who developed pneumocephalus 17 days after right upper lobectomy with en bloc resection of the first three ribs and C8-D1 branches of the brachial plexus. The patient complained of aphasia, disorientation and sphincterial release. A chest and brain-CT scan showed a right apical pneumothorax associated with a massive pneumocephalus of the ventricles and of the subarachnoidal spaces. A pneumoperitoneum was also seen. The patient was treated using pleural drainages, Trendelenburg's position and antibiotic therapy. Clinical and radiological remission was achieved after 12 days of additional hospital stay.     

So,you want to be a leader?

Every physician is a leader. We often lead teams of people, whether it is in an ambulatory clinic, the ICU, or the operating room. We have responsibility for our patients, and need to ensure our colleagues, advanced practice providers, and support teams are doing their jobs correctly. On a small scale, it is a physician in a solo practice or a surgeon in an operating room. On a larger scale it can be an academic chair or a dean. This article serves as a primer for those who will journey down the path of becoming a leader. Starting with a brief historical background of modern leadership theory, and a discussion on managing versus leading, we will then touch on what we believe are the key steps required to become a successful leader. We have drilled this down to four steps: 1) know yourself, 2) know others, 3) reality test your skill set, and finally, 4) become a servant leader. Numerous vignettes are written to help illustrate some of the lessons that should be learned when embarking on this journey.