Brief Motivational Intervention to Increase Self-reported Safety Belt Use among Emergency Department Patients

Objectives:  Brief motivational interventions have shown promise in reducing harmful behaviors. The authors tested an intervention to increase safety belt use (SBU) among emergency department (ED) patients.
Methods:  From February 2006 to May 2006, the authors conducted a randomized trial of adult ED patients at a teaching hospital in Boston. ED patients were systematically sampled for self-reported SBU. Those with SBU other than "always" were asked to participate. At baseline, participants answered a 9-item series of situational SBU questions, each scored on a 5-point Likert scale. SBU was defined as a continuous variable (9-item average) and as a dichotomous variable (response of "always" across all items). Participants were randomized to an intervention or a control group. The intervention group received a 5- to 7-minute intervention, adapted from classic motivational interviewing techniques, by a trained interventionist. Participants completed a 3-month follow-up phone survey to determine changes from baseline SBU. Continuous and dichotomous SBU were analyzed via analysis of covariance and chi-square testing.
Results:  Of 432 eligible patients, 292 enrolled (mean age 35 years, standard deviation [SD] ±11 years; 61% male). At baseline, the intervention and control groups had similar mean (±SD) SBU scores (2.8 [±1.1] vs. 2.6 [±1.1], p = 0.31) and SBU prevalence (each 0%). At 3 months, 81% completed follow-up. The intervention group had significantly greater improvement in mean (±SD) SBU scores than controls (0.76 [±0.91] vs. 0.34 [±0.88], p < 0.001). Also, SBU prevalence of "always" was higher for the intervention group than controls (14.4% vs. 5.9%, p = 0.03).
Conclusions:  Participants receiving a brief motivational intervention reported higher SBU at follow-up compared to controls. An ED-based intervention may be useful to increase SBU.     

Therapeutic efficacy of three silver dressings in an infected animal model

The organic salt AgNO3 has been available as a topical armamentarium to the medical arena for centuries and for burns for the past 60 years. Thirty-five (1968) years later, Charles Fox introduced and popularized a new topical agent known as silver sulfadiazine. More recently, several new slow-release silver dressings came to the forefront. Acticoat (Smith & Nephew, Largo, FL) Silverlon (Argentum, Lakemont, GA) & Silvasorb (Medline Industries, Inc, Mundelein, IL). Because the standard of care is to change dressings daily, our study focused in on weekly dressing changes as a cost-containment issue. Sprague-Dawley rats received a standard contact burn (20% TBSA). On day 3, the wound was excised and infected with Pseudomonas aeruginosa and Staphylococcus aureus at 5.0 x 10 cfu/ml. The animals were divided into four groups (n = 5 each group): untreated control, Acticoat group, Silvasorb group, and Silverlon group. The dressings remained on the wounds for 10 days when the wounds were quantitatively assessed. Mean wound counts of the control ranged from 1.2 x 10(5) to 6.5 x 10(5) for P. aeruginosa and S. aureus, respectively. Acticoat dressing counts for both organisms were 0 and 1.8 x 10(3) (median alpha); Silvasorb was 0 and 6.3 x 10(3) and Silverlon was 1.5 x 10(4) x 7.4 x 10(4) (median), Acticoat and Silvasorb were both significantly lower (P < .05) than the control for P. aeruginosa, and Acticoat was significantly lower (P < .05) than the control for S. aureus. Although counts for Silvasorb (M) appear significantly lower than the controls for S. aureus, the numbers were not sufficient to be significant. However, Silverlon did achieve a slight significance. These preliminary data suggest that weekly dressing changes with these new silver dressings are feasible and economically and medically congruous.     

A dog and a "happy person" visit nursing home residents

Recent recognition of the importance of the human-animal bond has led to the proliferation of programs designed to improve the lives of nursing home residents through the use of animals. Because human-human interaction in the nursing home setting is often of an obligatory nature, we wondered if a visit from a nonjudgmental, outgoing, enthusiastic young adult ("a happy person") could elicit the same positive influence as a visit from a nonjudgmental dog. The purpose of this study was to determine if elderly residents of a midwestern nursing home had a preference for the type of visitor (dog vs. person) when both visits were nonobligatory and nonjudgmental. Behaviors were evaluated to determine if one visitor was more likely to influence prosocial behaviors (moving closer, patting, smiling). Six residents were visited by both the dog and the happy person: 5 of 6 completed the final interview. Residents were equally likely to smile at and move closer to both visitors. Residents were more likely to pat the dog. Three residents liked both visits equally: 1 preferred the dog, and 1 preferred the happy person. These data suggest that nonobligatory visits to nursing home residents from a happy person may be as beneficial to the resident as visits from a dog.     

Approach to decreasing emergency department ambulance diversion hours

Analysis between two local Emergency Departments (EDs) suggested an oscillatory phenomenon for ambulance diversion: When one hospital went on diversion it led to a disproportionate flow of ambulance traffic to a neighboring facility that subsequently was forced to go on divert. We hypothesized if one hospital could avoid diversion status, the need for diversion could be averted in the neighboring facility. ED A secured additional resources and made a commitment to no diversion for 1 week. No changes in operations occurred in hospital B. We found no differences in ambulance runs or ED census at either facility comparing the week before, during, and after the trial. There was a dramatic decline in diversion hours from 19.7 to 1.4 and 27.7 to 0 at hospitals A and B, respectively, during the trial period (p < 0.05) compared to the weeks before and after. We conclude that reciprocating effects can be decreased with one institution's commitment to avoid diversion, thus decreasing the need for diversion at a neighboring facility.     

Quantification of training in obstetrical ultrasound: a study of family practice residents.

This study was done to determine how rapidly physicians in training could become competent in performing obstetrical ultrasound for the purposes of routine evaluations (i.e., the standard examination as defined by AIUM). The scan measurements and results of organ surveys of 12 family medicine residents were compared with the results obtained by faculty members experienced in obstetrical ultrasound. Residents rapidly became proficient in biometry. The mean menstrual age calculated from BPD, AC, HC, and FL differed from faculty values by 0.381 weeks after residents had performed 40 supervised scans. Organ survey success rates demonstrated similar high concordance between resident and faculty scans.     

Advanced life support cardiac arrest scenario test evaluation

BACKGROUND: The cardiac arrest scenario test (CASTest) is a central component of the assessment strategy on the Advanced Life Support Course. The aim of this study was to establish equivalence between the four different CASTest scenarios and investigate the impact of profession, candidate order and course centre on the pass rate. MATERIALS AND METHODS: This was a cluster randomised study. CASTest scenarios were randomly allocated to candidates stratified by course centre. Candidate demographics and performance were recorded on the criterion referenced check list along with the final assessment outcome (pass/fail). Differences in pass rates according scenario; profession, course centre and candidate order were examined by Chi-squared and multiple logistic regression. RESULTS: Two thousand, four hundred and forty-nine assessments from 65 course centres were evaluated. There was no difference in pass rate between scenarios (average pass rate 74.4%). Pass rates according to course centre varied widely (40-93%, P<0.0001) as did professional group (42-100%, P<0.0001). The order that candidates took the test did not influence the pass rate. CONCLUSION: The CASTest assessment scenarios used during ALS testing appear equivalent in terms of difficulty. In contrast, the professional background of the candidate and centre at which the assessment is performed do significantly influence the likelihood of passing the assessment. Further evaluation of the reasons for differences between course centres is required.     

Follicular lymphoma lacking the t(14;18)(q32;q21): identification of two disease subtypes

The clinical and pathological features, including karyotype data and BCL2 protein expression pattern, of follicular lymphoma without a t(14;18)(q32;q21) have not been well defined. We have identified and conducted a detailed analysis of 50 cases with follicular lymphoma who lack the t(14;18). Fluorescent in situ hybridization (FISH) analysis was used to exclude cases with a cryptic IGH/BCL2 rearrangement. BCL2 protein expression level was assessed by immunohistochemistry. The karyotypes were assessed for recurrent sites of structural rearrangement, duplications and deletions on a band-by-band basis, and compared with a large cohort of cases with t(14;18). A distinct pattern of chromosomal alterations was identified in the cases without t(14;18). BCL2 protein overexpression was detected in 33% of 49 tested cases. In this minority, the karyotypes frequently showed increased copies of chromosome 18. The majority of cases (67%) did not show BCL2 overexpression and were characterized prominently by the presence of t(3;14)(q27;q32), implying a role for BCL6. Follicular lymphomas that lack a t(14;18) were segregated into two subgroups with distinct cytogenetic, phenotypic and possibly clinical features: one with BCL2 protein overexpression not related to an IGH/BCL2 rearrangement and a second without BCL2 overexpression. Objective identification of BCL2 expression level as well as BCL2 and BCL6 status by cytogenetic or FISH analysis has potential clinical utility and may yield insights into alternative genetic mechanisms associated with B-cell lymphomas with a follicular growth pattern.