Douglas Moreland

Publications (2)4.32 Total impact

• Source

  Available from: Barry Willer

  Article: A proposal for an evidenced-based emergency department discharge form for mild traumatic brain injury.

  Michael Fung, Barry Willer, Douglas Moreland, John J Leddy
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  ABSTRACT: To examine and compare a sample of head injury care instruction forms available in hospital emergency departments (EDs) against evidence-based factors predictive of haemorrhage or traumatic lesions and to propose an easy-to-understand discharge instruction form for patients with concussion or mild traumatic brain injury (MTBI). Fifteen hospital discharge instruction forms were reviewed for inclusion of six factors known to be associated with the presence of haemorrhage after MTBI. ED instruction forms were also evaluated for readability. The 15 hospital ED instruction forms varied in what patients' caretakers were instructed to observe. Some but not all important factors associated with haemorrhage were included. The mean Flesch-Kincaid reading grade level of the discharge instruction forms was 8.2 with a mean Reading Ease score of 59.9%. EDs use discharge instruction forms listing signs and symptoms that are highly variable, confusing, not all evidence-based and often not easy to understand. This review proposes a discharge instruction form containing the six best evidence-based variables (according to the current literature) as being useful and understandable to patients and their families for home observation after MTBI.
  Brain Injury 09/2006; 20(9):889-94. · 1.36 Impact Factor
• Article: Validity of stereotactic frame localization during radiosurgery after one fixation pin removal.

  James T MacKenzie, Matthew B Podgorsak, Douglas Moreland
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  ABSTRACT: This study was designed to examine the effect on target localization of removing one fixation pin or post. A stereotactic frame was applied to a head phantom by using four fixation pins. Contiguous axial computerized tomography (CT) slices (1 mm thick) were obtained through the head phantom. Using clinical treatment planning software, a marker was identified and its coordinates were determined. The imaging procedure and point localization were repeated independently seven times in the control configuration, after four-pin fixation, to study reproducibility. Standard deviations in marker coordinates were 0.013, 0.046, and 0.039 mm along the x, y, and z axes, respectively, indicating excellent reproducibility. Each of the four pins was then removed separately, leaving three pins providing fixation to the skull. Imaging was repeated for each three-pin configuration. To simulate the forces at each pin-skull interface, a lever arm was connected to the head phantom allowing application of variable torque to the system. The CT scans were obtained for each torque strength and pin removal combination. Marker coordinates were compared with the control. In most cases, it was found that accurate target positioning could be achieved after removal of a single pin and/or post. When high torque was used, however, removal of a pin resulted in up to a 1.2-mm error. The findings may be significant for clinical practice, depending on the condition being treated.
  Journal of Neurosurgery 01/2003; 97(5 Suppl):539-41. · 2.96 Impact Factor