Randomized trials have demonstrated reduced morbidity and mortality with stroke unit care; howeve... more Randomized trials have demonstrated reduced morbidity and mortality with stroke unit care; however, the effect on length of stay, and hence the economic benefit, is less well-defined. In 2001, a multidisciplinary stroke unit was opened at our institution. We observed whether a stroke unit reduces length of stay and in-hospital case fatality when compared to admission to a general neurology/medical ward. A retrospective study of 2 cohorts in the Foothills Medical Center in Calgary was conducted using administrative databases. We compared a cohort of stroke patients managed on general neurology/medical wards before 2001, with a similar cohort of stroke patients managed on a stroke unit after 2003. The length of stay was dichotomized after being centered to 7 days and the Charlson Index was dichotomized for analysis. Multivariable logistic regression was used to compare the length of stay and case fatality in 2 cohorts, adjusted for age, gender, and patient comorbid conditions defined by the Charlson Index. Average length of stay for patients on a stroke unit (n=2461) was 15 days vs 19 days for patients managed on general neurology/medical wards (n=1567). The proportion of patients with length of stay >7 days on general neurology/medical wards was 53.8% vs 44.4% on the stroke unit (difference 9.4%; P<0.0001). The adjusted odds of a length of stay >7 days was reduced by 30%…
On average, lightning causes more casualties annually in the United States than any other storm-r... more On average, lightning causes more casualties annually in the United States than any other storm-related phenomenon except floods. Although 90% of those injured survive, they may have permanent sequelae and disability. Many of these people incur injuries or are killed by lightning because of misinformation and inappropriate behavior during thunderstorms. A few simple precautions can reduce lightning injury risk. To standardize recommended actions during thunderstorms, the Lightning Safety Group (LSG), composed of lightning experts from many lightning-related backgrounds, met at the American Meteorological Society meeting Phoenix, AZ, in January 1998 to collectively address personal lightning safety. This paper is a summary of the recommendations developed by the LSG.
Prior to1989 no known support group existed for victims of lightning or electrical shock injury a... more Prior to1989 no known support group existed for victims of lightning or electrical shock injury and their families. A lightning strike survivor of twenty years, Steve Marshburn, recognized the need both from his personal experience and after meeting two other survivors. With his wife and psychologist, he formed Lightning Strike and Electric Shock Survivors International. The organization has grown nearly one hundredfold from the thirteen who attended the first annual meeting. The support group serves people from around the world, has produced a number of publications, participated in research about these injuries and has become active in prevention activities. This paper will describe some of the factors that have led to such success for the organization.
T he Llanos basin lies east of the Eastern Cordillera in northeastern Colombia. Basin development... more T he Llanos basin lies east of the Eastern Cordillera in northeastern Colombia. Basin development commenced with a Triassic-Jurassic synrift megasequence related to the separation of North and South America in the Caribbean. Basin development continued in the Cretaceous as a back-arc megasequence behind the Andean subduction zone. Marine deposition was abruptly terminated during the early Maastrichtian due to final
Abstract:Online teaching and learning is the current push in education. While much,research has b... more Abstract:Online teaching and learning is the current push in education. While much,research has been done on the numbers, there is still a perception that online learning is substandard. This interpretive study looks at the learner perceptions as they participate in masters’ level courses on the web. Themes of schedule, geography, and family responsibility, as well as interaction, communication, and time
Online teaching and learning is the current push in education. While much research has been done ... more Online teaching and learning is the current push in education. While much research has been done on the numbers, there is still a perception that online learning is substandard. This interpretive study looks at the learner perceptions as they participate in masters' level courses on the web. Themes of schedule, geography, and family responsibility, as well as interaction, communication, and
The use of cardiopulmonary resuscitation for hospitalized patients who are not expected to surviv... more The use of cardiopulmonary resuscitation for hospitalized patients who are not expected to survive to discharge is considered medically inappropriate. In this population, addressing resuscitation options early in the hospitalization has important medical, ethical, and economic ramifications for patients and their families. We studied the distribution, timing, and outcome of resuscitation decisions through a retrospective review of the hospital records of 239 patients who expired on an inpatient internal medicine service in a large teaching hospital. Patients were classified into those for whom attempts were made to restore spontaneous circulation (Full Code) and those for whom attempts were not made to restore spontaneous circulation (Do Not Resuscitate). Data were collected on discharge diagnosis, resuscitation status changes, length of survival for patients resuscitated, and placement of order not to resuscitate (DNR) in length of stay. Resuscitation orders were found more often to communicate the impending demise of the patient, rather than a decision about cardiopulmonary resuscitation alone. The results suggest that even in patients for whom cardiopulmonary resuscitation would be considered medically inappropriate, resuscitation discussions and subsequent orders are often not initiated until close to midway into a patient’s hospitalization. Particularly now with the adoption of The Patient Self-Determination Act, and the emerging population of patients who do not want to be resuscitated but who may not be terminally ill, physicians need to engage patients and families in earlier discussions about resuscitation in order to distinguish those patients for whom resuscitation could be life-saving from those for whom it could be medically futile.
Randomized trials have demonstrated reduced morbidity and mortality with stroke unit care; howeve... more Randomized trials have demonstrated reduced morbidity and mortality with stroke unit care; however, the effect on length of stay, and hence the economic benefit, is less well-defined. In 2001, a multidisciplinary stroke unit was opened at our institution. We observed whether a stroke unit reduces length of stay and in-hospital case fatality when compared to admission to a general neurology/medical ward. A retrospective study of 2 cohorts in the Foothills Medical Center in Calgary was conducted using administrative databases. We compared a cohort of stroke patients managed on general neurology/medical wards before 2001, with a similar cohort of stroke patients managed on a stroke unit after 2003. The length of stay was dichotomized after being centered to 7 days and the Charlson Index was dichotomized for analysis. Multivariable logistic regression was used to compare the length of stay and case fatality in 2 cohorts, adjusted for age, gender, and patient comorbid conditions defined by the Charlson Index. Average length of stay for patients on a stroke unit (n=2461) was 15 days vs 19 days for patients managed on general neurology/medical wards (n=1567). The proportion of patients with length of stay >7 days on general neurology/medical wards was 53.8% vs 44.4% on the stroke unit (difference 9.4%; P<0.0001). The adjusted odds of a length of stay >7 days was reduced by 30%…
On average, lightning causes more casualties annually in the United States than any other storm-r... more On average, lightning causes more casualties annually in the United States than any other storm-related phenomenon except floods. Although 90% of those injured survive, they may have permanent sequelae and disability. Many of these people incur injuries or are killed by lightning because of misinformation and inappropriate behavior during thunderstorms. A few simple precautions can reduce lightning injury risk. To standardize recommended actions during thunderstorms, the Lightning Safety Group (LSG), composed of lightning experts from many lightning-related backgrounds, met at the American Meteorological Society meeting Phoenix, AZ, in January 1998 to collectively address personal lightning safety. This paper is a summary of the recommendations developed by the LSG.
Prior to1989 no known support group existed for victims of lightning or electrical shock injury a... more Prior to1989 no known support group existed for victims of lightning or electrical shock injury and their families. A lightning strike survivor of twenty years, Steve Marshburn, recognized the need both from his personal experience and after meeting two other survivors. With his wife and psychologist, he formed Lightning Strike and Electric Shock Survivors International. The organization has grown nearly one hundredfold from the thirteen who attended the first annual meeting. The support group serves people from around the world, has produced a number of publications, participated in research about these injuries and has become active in prevention activities. This paper will describe some of the factors that have led to such success for the organization.
T he Llanos basin lies east of the Eastern Cordillera in northeastern Colombia. Basin development... more T he Llanos basin lies east of the Eastern Cordillera in northeastern Colombia. Basin development commenced with a Triassic-Jurassic synrift megasequence related to the separation of North and South America in the Caribbean. Basin development continued in the Cretaceous as a back-arc megasequence behind the Andean subduction zone. Marine deposition was abruptly terminated during the early Maastrichtian due to final
Abstract:Online teaching and learning is the current push in education. While much,research has b... more Abstract:Online teaching and learning is the current push in education. While much,research has been done on the numbers, there is still a perception that online learning is substandard. This interpretive study looks at the learner perceptions as they participate in masters’ level courses on the web. Themes of schedule, geography, and family responsibility, as well as interaction, communication, and time
Online teaching and learning is the current push in education. While much research has been done ... more Online teaching and learning is the current push in education. While much research has been done on the numbers, there is still a perception that online learning is substandard. This interpretive study looks at the learner perceptions as they participate in masters' level courses on the web. Themes of schedule, geography, and family responsibility, as well as interaction, communication, and
The use of cardiopulmonary resuscitation for hospitalized patients who are not expected to surviv... more The use of cardiopulmonary resuscitation for hospitalized patients who are not expected to survive to discharge is considered medically inappropriate. In this population, addressing resuscitation options early in the hospitalization has important medical, ethical, and economic ramifications for patients and their families. We studied the distribution, timing, and outcome of resuscitation decisions through a retrospective review of the hospital records of 239 patients who expired on an inpatient internal medicine service in a large teaching hospital. Patients were classified into those for whom attempts were made to restore spontaneous circulation (Full Code) and those for whom attempts were not made to restore spontaneous circulation (Do Not Resuscitate). Data were collected on discharge diagnosis, resuscitation status changes, length of survival for patients resuscitated, and placement of order not to resuscitate (DNR) in length of stay. Resuscitation orders were found more often to communicate the impending demise of the patient, rather than a decision about cardiopulmonary resuscitation alone. The results suggest that even in patients for whom cardiopulmonary resuscitation would be considered medically inappropriate, resuscitation discussions and subsequent orders are often not initiated until close to midway into a patient’s hospitalization. Particularly now with the adoption of The Patient Self-Determination Act, and the emerging population of patients who do not want to be resuscitated but who may not be terminally ill, physicians need to engage patients and families in earlier discussions about resuscitation in order to distinguish those patients for whom resuscitation could be life-saving from those for whom it could be medically futile.
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Papers by Mary Cooper