IRC Research Core

 Injury Research Center Research Committee

Peter Layde, MD, MSc, Director, Research Committee
(414) 955-8210
playde@mcw.edu

Karen J. Brasel, MD, MPH, Co-Director, Research Core
(414) 805-8624
kbrasel@mcw.edu

Laura Cassidy, PhD, Core Faculty
(414) 266-6552
lcassidy@mcw.edu

Ann Christiansen, MPH, Assistant Director, IRC
(414) 955-7660
achristi@mcw.edu

Terri deRoon-Cassini, PhD, Core Faculty
(414) 805-8624
tcassini@mcw.edu

Clare Guse, MS, Core Biostatistician
(414) 955-8699
cguse@mcw.edu

Kevin Hamberger, PhD, Core Faculty
(414) 527-8458
kevinh@mcw.edu

Stephen Hargarten, MD, MPH, Director, IRC
(414) 805-6454
hargart@mcw.edu

Prakash Laud, PhD, Core Faculty
(414) 456-8781
laud@mcw.edu

Brooke Lerner, PhD, Core Faculty
(414) 805-0113
eblerner@mcw.edu

 Injury Research Center Funding Opportunities

How to Get Your Injury Research Funded

Injury is a major biosocial disease that is a burden across all ages in our society. It is the leading cause of death for Americans under the age of 44. It is a preventable disease and an area where multi-disciplinary teams including physicians and researchers can come together and make a real difference.

If you would like more information or would like to discuss any of the IRC's resources for developing grant proposals, please contact Ann Herbst or Mary Czinner.

 CDC Cycle 1 Funded Project - Quality of Life After Trauma

Project Director: Karen J. Brasel MD, MPH

Project Co-directors: John Weigelt MD, DVM and Andrea Winthrop MD

Institutions: Medical College of Wisconsin, Froedtert Hospital and Children's Hospital of Wisconsin

Categorization I: Acute Care
Categorization II: Major Project

Cost/ Year: $104,000 / year

Duration: Five Years

Keywords: injury, injury control, post-injury, quality of life, outcomes measures, trauma, utility, Functional Independence Measure (FIM) (WeeFIM), Quality of Well-being Index (QWB), SF-36, Child Health Questionnaire, acute care, and trauma outcomes

Abstract:
Long-term Objectives and Specific Aims:
This is a prospective study evaluating the functional outcome and health status after moderate to severe trauma. In addition to evaluating functional outcome and health status, their relationship to injury severity and types of injury will be evaluated as will the degree of social support experienced by the patient. The ability to use several sub-scale scores to derive a single utility value for health status will also be studied.

Research Design and Methods:
All patients with moderate to severe trauma will be surveyed 1, 3, 12, 18 and 24 months post-injury. Self-administered questionnaires will include two measures of generic quality of life and one functional outcome measure. Inclusion criteria include age 10 and older, with moderate or severe injury measured by the Injury Severity Score (ISS 9). Project duration is 5 years. Patient enrollment will continue for 3 years and followed for 2 years after enrollment. Study results will be used to determine the optimal time for measuring generic health status and functional recovery after trauma, and to derive a method of ascertaining a single value for quality of life useful in health services research.

 CDC Cycle 1 Funded Project - Risk Factors for Medical Injury

Project Director: Peter M. Layde, MD, MSc

Project Co-directors: Prakesh Laud, PhD and Karen Brasel, MD, MPH

Institutions: Medical College of Wisconsin, Froedtert Hospital and the Health Policy Institute

Categorization I: Prevention and Acute Care
Categorization II: Major Project
Categorization III: New

Cost / Year: $100,000 / year

Duration: Five Years

Keywords: Injury, medical injury, adverse events, patient safety, iatrogenic injuries, therapeutic misadventures, risk factors, medical error, injury prevention, and injury control

Abstract:
Long term Objectives and Specific Aims:
Concerns about patient safety are receiving unprecedented attention in the health policy arena and the lay press. A number of approaches (legal, epidemiologic/health services research, and managerial) have been used to address patient safety and medical injury. We believe that injury control science provides a coherent and systematic philosophical framework as well as valuable methodologic tools for researching and preventing medical injuries. Indeed, in light of the expansive scope of injury control, injuries arising from diagnostic or therapeutic healthcare interventions are a glaring omission from traditional injury control activity. To further the application of injury control science to medical injury and patient safety, we propose to conduct a case control study to identify risk factors for medical injury in hospitalized patients. This work is particularly important because it is the first comprehensive application of the Injury Control Model to the analytic study of medical injuries. The work we propose will lay the foundation for future work in this area by refining and evaluating epidemiologic methods for medical injuries. It will lay the groundwork for more in-depth studies and, ultimately, interventions to prevent medical injuries.

Research Design and Methods:
The primary aim of this project is to quantify the association of specific hypothesized risk factors with the occurrence of medical injury: demographic characteristics (age, sex, insurance status); severity of underlying illness or injury; co-morbidities; number and nature of healthcare interventions; and specific diagnostic and therapeutic interventions. A secondary aim is to refine, demonstrate, and evaluate methods for conducting hospital-based analytic research of medical injury, including case definitions an control selection criteria, severity of illness assessment and classification of medical interventions.

 CDC Cycle 1 Funded Project - Clinical Biomechanics of Penetrating Brain Injury

Project Director: Thomas Gennarelli, MD

Project Co-director: Frank Pintar, PhD

Institutions: Medical College of Wisconsin, Medical College of Wisconsin Biomechanics Laboratory, Zablocki VA Medical Center, Froedtert Hospital

Categorization I: Acute Care
Categorization II: Major Project
Categorization III: New

Cost / Year: $100,000 / year

Duration: Five Years

Keywords: penetrating head injury, TBI, head injury, brain injury, cranium, gunshot wounds, computer finite element models

Abstract:
Long term Objectives and Specific Aims:
As treatment methods of penetrating wounds to the head became more advanced and duration of time to treatment became shorter, these wounds warrant further study. Aspects to the survivability of gunshot wounds to the cranium include the type of weapon, projectile and the location of trauma. The physical simulant models have the advantage of direct filming of high-speed projectiles using the latest high-speed digital videography (18,000-40,000 f/s). The approach in this grant is two-fold: to better understand survivability, a series of physical models and computer finite element models that will characterize and quantify the mechanics associated with wounding energy will be created. High-velocity projectiles through the brain impart tremendous pressures within the tissues, inducing strains that may or may not produce permanent damage to the structures. The pressures in and immediately around the wounding track are known to cause damage. The potential for a larger wounded area due to secondary pressures has not been thoroughly examined. The specific hypothesis is that the penetrating traumatic brain injury wound energy is directly related to the magnitude of pressure wave distributions within the cranial vault that occurs during the traumatic event and that additional wounded areas may occur if the secondary pressures reach damaging magnitudes. The specific objectives are linked to both short-term and long-term patient outcome. For the short-term, the principal issues are the determinants of initial survivability. It is anticipated that these determinants will include the wounding energy and missile trajectory.

Research Design and Methods:
Computer models of these variables that predict not only initial survivability, but also specific areas where the brain is damaged will be developed. Patients who survive penetrating traumatic brain injury often require treatment for various combinations of motor, sensory, cognitive or behavioral impairments. Using advanced imaging techniques; tools for visualizing the patient-specific tissue damage to assist the clinician in the continued treatment of these patients will be developed.

 CDC Cycle 1 Funded Project - An Analysis of Violence-related Fatalities and Injuries in Wisconsin

Project Director: Stephen W. Hargarten, MD, MPH

Project Co-director: Carrie Nie MPH

Institutions: Medical College of Wisconsin

Categorization I: Prevention
Categorization II: Major Project
Categorization III: New

Cost / Year: $100,000 / year

Duration: Five Years

Keywords: firearms, violence, suicide, homicide, injury, surveillance systems

Abstract:
Long term Objectives and Specific Aims:
Homicides and suicides are a significant public health problem, accounting for approximately 48,400 deaths in 1998 in the United States. The proposed project will investigate trends and epidemiological patterns of intentional injury fatalities and non-fatal intentional injuries in Wisconsin using a comprehensive statewide Violence Fatality Reporting System. This system, a linked information system of medical examiners/coroners, law enforcement agencies and crime lab data, will include all Wisconsin homicides and suicides. We will also examine trends in violence-related injuries in collaboration with the Wisconsin Department of Health and Family Services using the statewide hospitalization discharge data set and a statewide emergency department data set. This combined morbidity and mortality data set will enable us to examine the spectrum of violent events and describe and contrast emerging trends and characteristics for these deaths and non-fatal events.

Research Design and Methods:
The project has three essential elements: 1) The first component of the project will analyze the linked information to answer several questions including: What are the changes in suicide and homicide rates and patterns over time: associated with methodology used, victim (homicide and suicide) and perpetrator (homicide suspect) characteristics and relationships including criminal records, urban/suburban/rural circumstances and locations, changes related to implementation of new policies that address perpetrators/victim, environment, and weapon availability? 2) We will also evaluate system data completeness, consistency and accuracy. 3) By linking the intentional injury deaths with non-fatal hospital discharges and emergency department admissions, additional important questions can be addressed. These include the relationship of the method of attempted suicide (e.g. drugs, firearms, other categories) to age, sex, urban/rural location of residence, hospital mortality, length of stay, hospital charges and costs and age/cause specific case fatality ratios.

 CDC Cycle 1 Funded Project - Psychological Factors Associated with Effective Adjustment Following Traumatic Brain Injury

Project Director: Mark Rusch, PhD

Project Co-directors: Brad Grunert, PhD and James Wallace, MD, PhD

Institutions: Medical College of Wisconsin

Categorization I: Rehabilitation
Categorization II: Medium Project
Categorization III: New

Cost / Year: $23,000 / year

Duration: Three Years

Key Words: acute stress disorder, recovery, psychological adjustment, injuries, traumatic injuries, social support, self-efficacy, depression and PTSD

Abstract:
Long term Objectives and Specific Aims:
This is a prospective cohort study that investigates the psychological adjustment of individuals who suffered traumatic physical injuries. It examines the influence of subject, trauma, and injury variables on psychological well being after injury with specific emphasis on six subject factors: causal attributions, self-efficacy, spiritual/religious values, perceived level of social support, anger and personal coping resources. Outcome data include measures of the intensity of post-traumatic stress disorder (PTSD) and depression symptoms. Changes in pre- and post-injury use will also be examined.

Research Design and Methods:
One hundred and fifteen subjects will be interviewed within 2-14 days post injury and in follow-up at 1,3 and 6 months. Inclusion criteria include age 18 and older, current diagnosis of traumatic injury from accidents, and non-assaults resulting in soft tissue, internal and orthopedic injuries that require inpatient medical care longer than 48 hours. Project duration is 3 years. Study results will be used to improve early psychological intervention with trauma patients to prevent the development of long-term PTSD and depressive symptomatology.

 CDC Cycle 1 Funded Project - Injury Fatalities of U.S. International Travelers

Project Director: Halim Hennes, MD, MS

Project Co-directors: Leslie M. Cortes MHS and Stephen W. Hargarten, MD, MPH

Institutions: Medical College of Wisconsin

Categorization I: Prevention
Categorization II: Medium Project
Categorization II: New

Cost / Year: $20,000 / year

Duration: Three Years

Keywords: injuries, international injury, travel, travel medicine, surveillance, injury prevention, injury control and international health

Abstract:
Long term Objectives and Specific Aims:
The first objective and specific aim of this study is to quantify and examine patterns of regional and country specific injury deaths among travelers controlling for age, economic development of destination country and duration of stay in destination country. This will be achieved by 1) collecting available years of data from the U.S. State Department Passport Office, 2) examining and linking appropriate international travel denominator sources, 3) calculating injury-mortality rates by cause, region, country and level of economic development, 4) performing age and gender adjustment and 5) assessing how economic development affects traveler's injury mortality rates. The second objective and aim of this study will examine how risk is associated with travel exposure by comparing traveler injury mortality rates with those of US Citizens residing in the US and those of residents of travelers' region or country of destination.

Research Design and Methods:
This will be the first longitudinal analysis, which examines trends of U.S. international travelers due to injury. This type of analysis will have several advantages, such as, increased power, identification of emerging patterns, and an ability to undertake a more detailed analysis of risk factors. Death reports from the US Passport Office will be utilized for data abstraction of the reports filed by US counselor Officers around the world for years 1998, 2000, 2002. Two main hypotheses will be tested. Proportionate mortality rations will be applied to measure the risk from injury fatality to U.S. travelers versus the risk of injury mortality to residents of the destination country.

 CDC Cycle 2 Funded Project - A Randomized Trial of Evidence-Driven, Community-Based Injury Prevention Coalitions

Principal Investigator: Peter Layde, MD, MSc Co-Investigators: Ann Christiansen, MPH, Clare Guse, MS, Prakash Laud, PhD
Background and Significance

A significant challenge for the field of injury prevention and control is translating research findings into effective community-based prevention programs, policies, and practices. The National Center for Injury Prevention and Control believes that dissemination research can overcome this challenge by providing insight into the methods, structures, and processes needed to disseminate, translate, and integrate injury prevention and control research into everyday practice. The application of theoretical advances into applied programs is often a disconnect between researchers and communities. Researchers may have detailed information on the burden and scope of various injuries and on interventions that have been demonstrated to be effective in controlled studies. They lack, however, the knowledge or expertise in community priorities and means of implementing interventions in specific communities. Community-based coalitions interested in injury prevention frequently have detailed knowledge of community priorities and how to accomplish work within their community but may lack information on the magnitude and scope of various injuries in their community and on effective programs and policies that they can implement to reduce the burden. One result of this disconnect between researchers and communities is that community organizations and coalitions end up implementing ineffective injury prevention interventions or, perhaps even more frequently, not implementing any injury prevention interventions.

The proposed study builds on a model program developed and piloted by the IRC-MCW that bridges the gap between injury prevention and control research and the implementation of evidence-driven, community-based programs, policies, and practices through the use of an "enabling system." An enabling system links community coalitions with researchers by establishing an infrastructure of support through technical assistance, best practices guides, and direct consultation in all aspects of coalition development and management, as well as development, implementation, and assessment of the impact of a program, policy, or practice. This study proposes to implement and rigorously evaluate the use and impact of an enabling system on reducing the burden of injuries.

Specific Aims
We propose a randomized community trial of two components of our Injury Prevention Coalitions model;
1) provision of evidence on injury burden and effective interventions to local communities and
2) enabling system support of the coalition building process and injury prevention prioritization and intervention implementation. We hypothesize that enabling system support will be more effective at reducing injuries in a community than the provision of evidence alone.

The specific aims for this proposal are:
1) Identification of counties interested in developing community-based coalitions to implement injury prevention;
2) Randomized assignment of communities into three groups: 1) control, 2) evidence intervention only, and 3) evidence intervention plus enabling system support.
3) Analyze implementation of injury prevention programs, policies, and practices in control, evidence only, and evidence plus enabling communities.
4) Measure outcomes variables of emergency department visits and inpatient hospitalizations for targeted injuries in control, evidence only, and evidence plus enabling communities.

Methods
Preliminary sample size determination suggests that we will have sufficient power to detect increases in injury occurrence on the order of 10% - 15% for common injury outcomes with randomization of three communities into each of the intervention groups. Because of the scope and nature of this project it would only be feasible as a large research project.

 CDC Cycle 2 Funded Project - Intimate Partner Violence (IPV) Project

Healthcare can change from within: a sustainable model for intimate partner violence prevention
Primary Investigator: Kevin Hamberger, PhD

Intimate partner violence (IPV) is a major cause of illness, injury, and death for women. Victims frequently seek healthcare from their primary care physicians. Physicians are trusted helpers, and the healthcare setting is ideal for providing secondary and primary IPV prevention services. However, healthcare settings often fail to communicate values supporting abuse victims, and healthcare providers frequently fail to address IPV as a health issue, identify IPV victims, or offer appropriate primary and secondary prevention services. Further, there is little empirical support for primary care physicians to screen for IPV, identify victims and provide prevention and intervention services. The primary question that is yet unanswered by the current state of knowledge of physician screening and provision of primary and secondary IPV prevention services is what impact the provision of these services has on the lives of women patients who receive them. For example, do women who receive such services feel safer? Do they experience less violence? Do they have better knowledge of community services designed to help them, and do they access these services? Do they experience better health status and fewer medical and psychological symptoms? The Healthcare Can Change From Within model has been developed and implemented with grant support from the Healthier Wisconsin Partnership Program (HWPP) to accomplish change within the healthcare system that leads to more integrated, institutionalized, and appropriate provision of routine, primary and secondary prevention services to end IPV in the lives of women patients.

The primary objective of the proposed study is to provide a rigorous evaluation of the Healthcare Can Change From Within model. Specific aims include:

1) to evaluate patients identified as IPV victims to determine changes in violence and abuse, feelings of safety and community support, and access to relevant community services. The study will also evaluate long-term changes in quality of life and health status.

2) to compare the long-term outcomes described above for women identified and cared for in two primary care clinics that have adopted the Healthcare Can Change From Within model with women from two primary care clinics serving demographically similar patients that have not adopted the model but provide what we will hereafter call usual care.

Contact Us

Medical College of WI
Injury Research Center

8701 Watertown Plank Rd.
Milwaukee, WI 53226-0509

(414) 955-7670
(414) 955-6470 (fax)

irc@mcw.edu

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Milwaukee, WI 53226
(414) 955-8296
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