PURPOSESerum risk factors for the development of heart disease and diabetes are not routinely evaluated in teens. The intent of this study was to determine the prevalence of these risk factors in teens and evaluate the effectiveness of a two-part electronic education program (recurring electronic lifestyle education program [REEP]) on reducing risks.DATA SOURCESTeens (n = 170) were recruited from one urban and one rural high school in the mid-Atlantic in 2014. Following baseline data collection in February, REEP was initiated and data collection repeated at 12 weeks. Data were analyzed and students sent a report with results and recommendations.CONCLUSIONSOne or more serum and/or physical risk factors were found in the majority of students with low vitamin D and elevated body mass index (BMI) being the most common. Correlations existed between elevated BMI and elevated diastolic blood pressure, low vitamin D, and low high-density lipoprotein. All but one risk factor (BMI) improved at 12 weeks.IMPLICATIONS FOR PRACTICEThe majority of teens had one or more physical and/or serum risk factors. Using multiple electronic methods to deliver healthy lifestyle recommendations helps lower these risks. Also, Blackboard, an electronic learning platform, was found to be an effective data management and communication center.

01 May 2014·Journal of NeurosurgeryQ1 · MEDICINE

Predictors of outcome in civilian gunshot wounds to the head

Q1 · MEDICINE

Article

Author: Kufera, Joseph A. ; Naff, Neal J. ; Uscinski, Ronald H. ; Cooper, Carnell ; Malik, Jacek M. ; Chang, Louis ; Radley, Michael ; Kheder, Ashker ; Ahn, Edward S. ; Hadley, Jeffrey ; Aarabi, Bizhan ; Tofighi, Babak

ObjectCivilian gunshot wounds to the head (GSWH) are often deadly, but some patients with open cranial wounds need medical and surgical management and are potentially good candidates for acceptable functional recovery. The authors analyzed predictors of favorable clinical outcome (Glasgow Outcome Scale scores of 4 and 5) after GSWH over a 24-month period.MethodsThe authors posited 2 questions: First, what percentage of civilians with GSWH died in the state of Maryland in a given period of time? Second, what were the predictors of favorable outcome after GSWH? The authors examined demographic, clinical, imaging, and acute care data for 786 civilians who sustained GSWH. Univariate and logistic regression analyses were used to analyze the data.ResultsOf the 786 patients in this series, 712 (91%) died and 74 (9%) completed acute care in 9 trauma centers. Of the 69 patients admitted to one Maryland center, 46 (67%) eventually died. In 48 patients who were resuscitated, the Injury Severity Score was 26.2, Glasgow Coma Scale (GCS) score was 7.8, and an abnormal pupillary response (APR) to light was present in 41% of patients. Computed tomography indicated midline shift in 17%, obliteration of basal cisterns in 41.3%, intracranial hematomas in 34.8%, and intraventricular hemorrhage in 49% of cases. When analyzed for trajectory, 57.5% of bullet slugs crossed midcoronal, midsagittal, or both planes. Two subsets of admissions were studied: 27 patients (65%) who had poor outcome (25 patients who died and 2 who had severe disability) and 15 patients (35%) who had a favorable outcome when followed for a mean period of 40.6 months. Six patients were lost to follow-up.Univariate analysis indicated that admission GCS score (p < 0.001), missile trajectory (p < 0.001), surgery (p < 0.001), APR to light (p = 0.002), patency of basal cisterns (p = 0.01), age (p = 0.01), and intraventricular bleed (p = 0.03) had a significant relationship to outcome. Multivariable logistic regression analysis indicated that GCS score and patency of the basal cistern were significant determinants of outcome. Exclusion of GCS score from the regression models indicated missile trajectory and APR to light were significant in determining outcome.ConclusionsAdmission GCS score, trajectory of the missile track, APR to light, and patency of basal cisterns were significant determinants of outcome in civilian GSWH.

17 Apr 2012·Annals of Internal Medicine

A Multicenter, Randomized Trial

Review

Author: Gilligan, Christopher ; Chang, Audrey ; Cohen, Steven P. ; White, Ronald L. ; Pasquina, Paul F. ; Nguyen, Conner ; Larkin, Thomas M. ; Kurihara, Connie ; Larkin, Ralph ; Yaksh, Tony L. ; Griffith, Scott R. ; Morlando, Benny

BACKGROUNDPerineural inhibitors of tumor necrosis factor have recently generated intense interest as an alternative to epidural steroid injections for lumbosacral radiculopathy.OBJECTIVETo evaluate whether epidural steroids, etanercept, or saline better improves pain and function in adults with lumbosacral radiculopathy.DESIGNA multicenter, 3-group, randomized, placebo-controlled trial conducted from 2008 to 2011. Randomization was computer-generated and stratified by site. Pharmacists prepared the syringes. Patients, treating physicians, and nurses assessing outcomes were blinded to treatment assignment. (ClinicalTrials.gov registration number: NCT00733096)SETTINGMilitary and civilian treatment centers.PATIENTS84 adults with lumbosacral radiculopathy of less than 6 months' duration.INTERVENTION2 epidural injections of steroids, etanercept, or saline, mixed with bupivacaine and separated by 2 weeks.MEASUREMENTSThe primary outcome measure was leg pain 1 month after the second injection. All patients had 1-month follow-up visits; patients whose condition improved remained blinded for the 6-month study period.RESULTSThe group that received epidural steroids had greater reductions in the primary outcome measure than those who received saline (mean difference, -1.26 [95% CI, -2.79 to 0.27]; P = 0.11) or etanercept (mean difference, -1.01 [CI, -2.60 to 0.58]; P = 0.21). For back pain, smaller differences favoring steroids compared with saline (mean difference, -0.52 [CI, -1.85 to 0.81]; P = 0.44) and etanercept (mean difference, -0.92 [CI,-2.28 to 0.44]; P = 0.18) were observed. The largest differences were noted for functional capacity, in which etanercept fared worse than the other treatments: steroids vs. etanercept (mean difference, -16.16 [CI, -26.05 to -6.27]; P = 0.002), steroids vs. saline (mean difference, -5.87 [CI, -15.59 to 3.85]; P = 0.23), and etanercept vs. saline (mean difference, 10.29 [CI, 0.55 to 20.04]; P = 0.04). More patients treated with epidural steroids (75%) reported 50% or greater leg pain relief and a positive global perceived effect at 1 month than those who received saline (50%) or etanercept (42%) (P = 0.09).LIMITATIONShort-term follow-up, small sample size, and a possibly subtherapeutic dose of etanercept.CONCLUSIONEpidural steroid injections may provide modest short-term pain relief for some adults with lumbosacral radiculopathy, but larger studies with longer follow-up are needed to confirm their benefits.PRIMARY FUNDING SOURCEThe John P. Murtha Neuroscience and Pain Institute, International Spinal Intervention Society, and Center for Rehabilitation Sciences Research.

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