Qualitative Research on Trauma Surgery: Getting Beyond the Numbers

Qualitative research methods have a unique role to play in surgical research, revealing important contextual details about the causes and impact of surgical illnesses and treatment. The utility of qualitative methods is illustrated through results of a research study of young, black male victims of interpersonal violence. Narrative analysis of in-depth interviews with 48 survivors of penetrating violence revealed the impact of these patients perceptions of post-injury care on their pain, the central role of fear of death in their injury experience, and the transforming role providers can play in addressing patient fears of death. The study provides support for the notion that qualitative methods can be a useful approach to understanding marginalized individuals who become our patients after injury. Furthermore, potential applications of multimethod approaches to surgical research (qualitative research methods in combination with quantitative methods) for the study of trainee experiences, patient satisfaction, and racial disparities are recommended.     

Medically eligible women who do not use HAART: the importance of abuse, drug use, and race

OBJECTIVES: We investigated the prevalence and characteristics of HIV-positive women who do not report highly active antiretroviral therapy (HAART) use. METHODS: We analyzed HAART use among 1165 HIV-positive participants in the Women's Interagency HIV Study. RESULTS: Between October 1, 2000, and March 31, 2001, 254 women with clinical indications for HAART reported not using it, 635 reported HAART use, and 276 had no clinical indications. In multivariate analysis, using crack/cocaine/heroin and a history of abuse decreased the likelihood of using HAART, whereas being White increased it. CONCLUSIONS: One of 4 women for whom HAART was indicated reported not using HAART. Childhood sexual abuse prevention, more intensive abuse treatment, and continuing drug treatment may enhance HIV disease treatment of women.     

A cross-sectional survey of clinicians performing periodontal surgical crown lengthening

The aim of this study was to conduct a survey of surgical crown lengthening practice performed by dental specialists and general dental practitioners using a cross-sectional questionnaire. One hundred general dental practitioners and 100 specialists from each of the following specialties: prosthodontics, periodontics, restorative dentistry and surgical dentistry. There were fewer surgical dentists performing surgical crown lengthening than the other specialists. The specialists in periodontics were significantly more likely to perform surgical crown lengthening than not. The respondents predominantly considered that periodontal surgical crown lengthening is within the remit of periodontics. 33% of the respondents performing more than 50 PSCL procedures in one year thought that the gingival margin was stable after three months. 33% thought that it was stable after six months and 33% declined to state a post-operative marginal stability time period.     

Effects of alcohol and drug use on inpatient and residential treatment among youth with severe emotional disturbance in Medicaid-funded behavioral health care plans

This study examined the use of alcohol and recreational drugs among 875 youth with severe emotional disturbance (SED) enrolled in Medicaid-funded behavioral health care plans, and whether co-occurring SED and substance use affected the subsequent likelihood of receiving inpatient and/or residential treatment. Youth at five sites nationwide were interviewed about their use of drugs and alcohol, while interviews with their caregivers elicited information about youths' service utilization, degree of functional impairment, and a series of demographic and environmental variables. Results indicated that half of the youth (52%) reported lifetime use of alcohol, street drugs, or over-the-counter medications for recreational purposes, while 18% reported use in the past 30 days. Among those reporting recent use, 32% reported using drugs only, 34% alcohol only, and 33% reported use of both drugs and alcohol. In multivariate logistic regression analyses, the effect of recent use was stronger than that of lifetime use; however, the largest effect occurred for those reporting recent use of both drugs and alcohol, versus either alone, or none. Differences remained significant when controlling for managed care versus fee for service enrollment as well as child, family, and environmental characteristics including study site. These results mirror those of prior studies that found an association between substance use and greater likelihood of inpatient services, even in managed care settings.     

Exposure to Perfluorooctane Sulfonate during Pregnancy in Rat and Mouse: Maternal and Prenatal Evaluations

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Disruption of P-selectin signaling modulates cell trafficking and results in improved outcomes after mouse warm intestinal ischemia and reperfusion injury

BACKGROUND: This study analyzes the role of T lymphocytes and neutrophils (PMN) in intestinal ischemia and reperfusion injury (IRI) using either P-selectin blockade or elimination. METHODS: Using a model of severe mouse warm intestinal IRI, the following groups were performed: group 1: wild type C57BL6 no treatment; group 2: wild type treated with r-PSGL1-Ig; group 3: C57BL6 genetically deficient in P-selectin. Survival was assessed at day 7; intestine was assayed for histopathology, apoptosis, myeloperoxidase (MPO), inflammatory cytokines, hemoxygenase-1 (HO-1), and CD3 lymphocytes. Standard statistical comparison was undertaken. RESULTS: The survival was significantly (P < 0.01) improved in the treatment groups: group 1, 50%; group 2, 90%; group 3, 100%. Graded histopathology and crypt apoptosis were improved in groups 2 and 3. MPO and CD3 positive cells were significantly reduced in groups 2 and 3. A significant reduction in inflammatory/Th1-type cytokines was seen in groups 2 and 3 as compared to group 1. Conversely, a significant increase in Th2-type cytokines and HO-1 production was seen selectively in groups 2 and 3. CONCLUSIONS: This study demonstrates the importance of P-selectin signaling in warm, murine intestinal IRI in that either the blockade of or the genetic deficiency in P-selectin confers a survival advantage and reduction in tissue injury/inflammation. The mechanism involves a reduction of PMN and CD3 T cell infiltration and an alteration in the cytokine microenvironment in favor of a Th2 profile. These data implicate T lymphocyte as an important regulatory cell in this inflammatory process.