bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differences in Attitude towards Cadaveric Organ Donation: Observations in a Multiracial Malaysian Society
Authors: Loch A , Hilmi IN , Mazam Z , Pillay Y , Choon DSK 
Published: December 2017

BackgroundWillingness to donate organs is affected by socio‐cultural and religious values. The Malaysian society is made up of three ethnic groups: Malay, Chinese, and Indian, with Islam, Buddhism and Hinduism as their religions respectively. This study examined the knowledge and perception towards organ donation for each group.MethodsThis study was conducted at University Malaya Medical Centre, Kuala Lumpur, Malaysia. Relatives of patients awaiting treatment at the emergency department answered a questionnaire on knowledge and attitude on organ transplantation.ResultsA total of 904 questionnaires were completed; 90.6% would accept organs, 43.6% would donate, and 4.0% carried donor cards. The reasons for reluctance to donate included: fear of organs being used for research (18.8%), desire to be buried whole (18.0%), fear of less active treatment if patient is known to be a donor (12.8%). Malays were less willing to accept organs from a different race (63.5%) compared to Chinese (83.3%) and Indians (83.8%) (OR=0.35, 95%CI: 0.23‐0.54 and OR=0.34, 95%CI: 0.22‐0.51 respectively) and also less likely to donate organs (29.8%) as compared to Chinese (42.1%) and Indians (63.2%) (OR=0.57, 95%CI 0.40‐0.83 and OR=0.24, 95%CI 0.17‐0.35 respectively). Malays were less willing to donate organs to another race compared to Chinese or Indians (OR=0.48, 95%CI 0.33‐0.70 and OR=0.22, 95%CI 0.15‐0.31 respectively). Only 34.7% of Muslims are aware of fatwa supporting organ donation.ConclusionsThe awareness of organ donation was low. Clear differences exist among ethnic groups. Cultural‐religious attitudes and lack of trust in the medical systems were reasons for reluctance to donation. Identifying socio‐cultural barriers and reassuring donors regarding medical care are required.
Caffeic Acid Phenethyl Ester Decreases Oxidative Stress Index in Blunt Spinal Cord Injury in Rats
Authors: Kavakli H Sahin , Alici O , Koca C , Ilhan A , Isik B 
Published: December 2017

ObjectiveThe aim of this study was to investigate the total oxidant status and total antioxidant status of caffeic acid phenethyl ester and methylprednisolone in blunt spinal cord injury in rats.MethodsTwenty‐four adult Wistar albino rats were randomised into three groups. Spinal cord injury was performed by the weight‐drop model. Group 1 underwent laminectomy followed by spinal cord injury and received no medication (control group). Group 2 underwent laminectomy followed by spinal cord injury and received caffeic acid phenethyl ester (10 µmol/kg) by intraperitoneal injection. Group 3 underwent laminectomy followed by spinal cord injury and received methylprednisolone (30 mg/kg) by intraperitoneal injection. Twenty‐four hours later, all rats were sacrified and after that total oxidant status, total antioxidant status and oxidative stress index levels were determined in spinal cord tissues and the obtained results were compared.ResultsThe highest total antioxidant status level was observed in the caffeic acid phenethyl ester group and the highest total oxidant status level was observed in the control group. Oxidative stress index levels in the control group were statistically higher than the caffeic acid phenethyl ester and methylprednisolone groups (p<0.01).ConclusionBased on our results, it is concluded that caffeic acid phenethyl ester might be a promising neuroprotective agent after spinal cord injury via its antioxidant effects.
A Case of Risperidone‐Associated Neuroleptic Malignant Syndrome in a Patient Receiving Long‐Term Haloperidol Treatment
Authors: Wee JCP , Wong E , Annathurai A 
Published: December 2017

We report a case of risperidone‐associated neuroleptic malignant syndrome. A 53‐year‐old gentleman with mental retardation, psychosis and hypertension who was on long term haloperidol, lorazepam and atenolol treatment presented to the Department of Emergency Medicine of the Singapore General Hospital with hyperthermia, generalised rigidity, impaired consciousness and diaphoresis five weeks after adding on risperidone. Biochemical investigations revealed hyponatremia, raised creatine kinase levels and myoglobinuria. Chest X‐ray showed consolidative changes in the right upper and middle zones and left middle zone. He was diagnosed as neuroleptic malignant syndrome with rhabdomyolysis, and aspiration pneumonia. He was discharged well after 13 days.
Daytime versus Night Time Intentional Drug Overdose: The Outcome is Different
Authors: Lee KL , Ng HW , Tse ML , Lau FL 
Published: December 2017

Introduction In drug overdose, it is generally perceived that the dosage can predict the clinical outcome. Are the dosages of intentional drug overdosing the same between day and night? If so, are these overdoses followed by similar clinical outcomes? Answers to these two questions might affect resource allocation and clinical judgment. The present study was performed to establish whether daytime patients and night time patients report similar drug doses, and see which group of patients would have a higher incidence of severe outcomes. Method A retrospective observational study on intentional drug overdose was performed. The reported numbers of total tablets ingested and the incidences of major outcomes, in terms of death and intensive care unit admissions, were compared between daytime and night time. Results A total of 400 patients were included. The reported number of ingested tablets in daytime had no statistical difference with that at night time. The numbers of severe outcomes had no differences between the patients presenting to the emergency department at daytime or night time. Yet overdosing at night time was more likely associated with severe outcomes. Conclusions We advise a higher index of suspicion at the emergency department on the reliability of the dosages reported by patients who overdose during night time. The larger number of severe outcomes may also be related to more toxic drug exposures in the night time. More resources in the community could be allocated to self-harm prevention at night time.
Oral Mucosal Irritating Plant Ingestion in Hong Kong: Epidemiology and Its Clinical Presentation
Authors: Pang CT , Ng HW , Lau FL 
Published: December 2017

Objective To study the local epidemiology and clinical presentation after ingestion of oral mucosal irritating plants. Methodology Cases presenting with immediate oral mucosal irritation after plant product ingestion from July 2005 to June 2009 were retrieved from the Hong Kong Poison Information Centre's clinical database. Their clinical features and management were reviewed. Results Thirty cases were retrieved and analysed, including 14 males and 16 females. Poisoning occurred all year round with no seasonal predilection. Vomiting and dysphagia were the two most common symptoms other than immediate oral mucosal irritation. Half of the cases could be managed with symptomatic treatment and discharged after a few hours of observation. Six patients presented with angioedema and were managed initially with the use of intravenous steroid, antihistamine and with or without adrenaline. Urgent airway assessment with laryngoscope was performed in 3 patients. No patient required endotracheal intubation. Conclusion Oral mucosal irritating plant ingestion is not uncommon in Hong Kong. Its clinical feature can mimic angioedema on presentation. Immediate and localized oral mucosal symptoms after plant product ingestion are the key to diagnosis.
Superior Mesenteric Artery Syndrome Leading to Acute Gastric Dilatation in a Woman with Bulimia
Authors: Park YS , Kim JS , Hwang JY 
Published: December 2017

Superior mesenteric artery (SMA) syndrome is a rare clinical disease defined as compression of the third part of the duodenum between the aorta and the SMA. Severe complications of SMA syndrome include acute gastric dilatation which is uncommon but potentially fatal and requires immediate intervention. This report describes a 29‐year‐old woman with SMA syndrome complicated by acute gastric dilatation. It was diagnosed by computerized tomography. The patient had a history of treatment of bulimia nervosa but defaulted 3 months ago. She presented with severe abdominal distension and extreme abdominal pain due to massive gastric dilatation after an eating binge. Gastric decompression was successful with a modified gastric lavage tube with additional large holes at the tip.
A Retrospective Survey on the Clinical Presentation of Ketamine Abusers in a Hong Kong Emergency Department
Authors: Lee HKH , Ng HW , Tse ML , Lau FL 
Published: December 2017

ObjectiveKetamine is one of the commonest abusing agents in Hong Kong. Our study aims to identify their clinical pattern of presentations to emergency departments.MethodThis is a retrospective survey study. The studied group was ketamine abusers being referred to us from a source out of emergency department (ED). Control group was randomly selected from patients attending our ED. The electronic records of the ketamine abusers and the controls in the past 3 years (1st April 2004‐31st March 2007) were reviewed and analysed.ResultTotal 91 subjects (48 in ketamine group, 43 in control group) were included. The mean age of ketamine abusers and control group are 21 and 22.2 year‐old respectively. Most of them (97.9%) did not declare their background of ketamine abuse. The mean 3‐year attendance rate for the ketamine group was 2.38 and for control group was 0.91, with a difference of 1.47 (95% CI 0.54‐2.41, p=0.003). Most of their illnesses were diagnosed as epigastric pain (25%), followed by upper respiratory tract infection (18.8%), head injury (10.4%) and urinary tract infection (10.4%). Significantly higher number of ketamine abusers presented with epigastric pain compared with control group (odds ratio 143, p<0.001).ConclusionMost teenage ketamine abusers do not declare their background of drug abuse when they present to emergency departments. They tend to have a higher frequency of attendances. Most of their presenting problems are related to gastrointestinal system.
Evaluation of the Appropriateness of Acute Hospitalisations in Hong Kong
Authors: Leung LP , Cheng YW , Fan KL 
Published: December 2017

Objective To test the validity of the Hong Kong version of Appropriateness Evaluation Protocol and estimate the prevalence of inappropriate acute hospitalisations in Hong Kong. Methods A retrospective chart review of two hundred randomly selected patients admitted to the specialty of Internal Medicine and General Surgery via the Accident & Emergency department of 2 regional hospitals in 2008. Comparison between the Hong Kong version of Appropriateness Evaluation Protocol and the consensus of an expert panel on appropriateness of admissions was made. The extent of agreement between the reviewer using the protocol and the expert panel was measured. Results The kappa coefficient for agreement was 0.73 (95% confidence interval: 0.63-0.83). The prevalence of inappropriate acute hospitalisations was 29%. Conclusions The Hong Kong version of Appropriateness Evaluation Protocol is a valid tool for assessing the appropriateness of acute hospitalisations.
Effects of Erdosteine in Experimental Sepsis Model in Rats
Authors: Kavakli H Sahin , Alici O , Koca C , Altintas ND , Aydin M 
Published: December 2017

Objective Erdosteine is a mucolytic agent that is known to possess antioxidant effects. This study investigated the effects of erdosteine on endothelin-1 (ET-1) levels and oxidative stress parameters superoxide dismutase (SOD) and malondialdehyde (MDA) in a rat sepsis model. Methods Four groups of Wistar albino rats (n=8 per group) were randomly allocated to the following groups: sham (group 1), sepsis (group 2), erdosteine control (group 3) and a sepsis group pretreated with erdosteine (group 4). Sepsis was induced using E. Coli ATCC 25922 inoculation. Serum ET-1, liver tissue SOD and MDA levels were determined in all groups. Results ET-1 levels were significantly higher in group 2 compared to groups 1, 3 and 4 (p<0.001, p=0.002 and p<0.001, respectively). Similarly, MDA levels in groups 1, 3 and 4 were significantly lower relative to group 2 (p<0.001, p=0.022 and p=0.010, respectively). Additionally, SOD activities in these same three groups were found to be significantly higher than those in group 2 (p<0.001, p=0.004 and p=0.028, respectively). Conclusion In conclusion, erdosteine decreases ET-1 levels and ameliorates oxidative stress parameters induced by sepsis in an experimental rat model of sepsis.
Prognostic Value of Avr Lead and the Well-Known Risk Factors in Acute St-Segment Elevated Myocardial Infarction
Authors: Eren SH , Aktas C , Korkmaz I , Karcioglu O , Coskun A , Guven FM Kukul 
Published: December 2017

Objective The present study was designed to analyse the effect of ST segment changes in aVR lead and the well-known risk factors in ST-segment elevated myocardial infarction (STEMI) patients. Materials and Methods A total of 250 patients who were admitted between 2009 and 2010 with STEMI and ≥1 mm ST-segment elevation in aVR lead were enrolled in the study. The patients were followed for life-threatening events like acute pulmonary oedema, atrial fibrillation, AV block, ventricular tachycardia, length of stay in hospital and death. Results Among the enrolled patients, 222 were discharged and 28 died. Pulmonary oedema and mortality rates were significantly higher in patients with ST-segment elevation in aVR lead (both p=0.001). Conclusions There is a correlation of ST-segment elevation in aVR lead with poor outcome in STEMI. Therefore aVR lead must be analysed as well as the other leads and well-known risk factors while it estimates the prognosis.
Epidemiological Survey and Mspss Scores of 260 Suicide Attempters Presenting to Two Emergency Departments in Turkey
Authors: Cevik Y , Kelleci M , Golbasi Z , Caykoylu A , Das M 
Published: December 2017

Introduction The aim of this study was to determine the epidemiological characteristics of suicide attempt cases who were admitted to the emergency departments and to determine their level of social support and related factors by using multidimensional scale of perceived social support (MSPSS). Methods This study was conducted simultaneously in two different centres between February 23 and June 31, 2009. Totally 260 suicidal cases who were admitted to the emergency departments were included in the study after obtaining the consents. Related derived data were collected with a questionnaire. The questionnaire determined epidemiological characteristics of suicide attempters by using MSPSS derived data. The data were analysed with percentage, mean, t test, ANOVA, and Scheffe test. Results About 70% of all cases were female and 63.1% of them were between 16 and 25 years of age. The main causes leading to suicide attempts were family problems (41.9%), financial problems (11.2%), and peer suicide attempts (5.4%). Drug use was the most common suicide method both in males and females. The MSPSS score was 52.47±17.81 (mean±SD, range=12-84). While being a member of a broken family, being widow/divorced, previously diagnosed mental disorder affected social support scores negatively, being a student or having a high level of education affected scores positively. Conclusion Family problems, financial problems, 16-25 age group, female sex, being divorced/widowed, being a member of broken family, chronic physical and psychological problems, and lower level of perceived social support are main characteristics associated with suicide attempts. (Hong Kong j.emerg.med. 2011;18:412-420)
FARES Method to Reduce Acute Anterior Shoulder Dislocation: A Case Series and an Efficacy Analysis
Authors: Tsoi LCH , Wong MCK 
Published: December 2017

ObjectiveAnterior shoulder dislocation is a common large joint dislocation. There is no standard method for reduction. A new technique (FARES method) was introduced by a Greek group in late 2009.DesignCase series analysis.SettingAn emergency department.MethodsA survey was conducted from April to June 2010 in the emergency department primarily to collect data on the methods of reduction of anterior shoulder dislocation and their efficacies.ResultsNine cases of anterior shoulder dislocation were documented. All 9 cases were reduced successfully regardless of the reduction methods used. FARES method was found to be popular in the studying emergency department. Six out of the 9 cases were using the FARES method at their first attempt (the rest two case using Spaso; one using traction‐counter traction). No pre‐medication was needed in all FARES' cases. In all 6 cases using the FARES method, the shoulder could be reduced within 2 minutes.ConclusionsOur experience concords with overseas' in which the FARES method is efficacious and fast.
Direct Observation as a Focused Teaching Tool for Doctors Newly Posted to the Emergency Department
Authors: Tan ECC , Tiah L , Chong WCC 
Published: December 2017

Introduction The emergency department (ED) is a high risk working environment with clinical and operational protocols in place to attenuate the risks for doctors new to the ED. We implemented a structured direct observation program for new ED doctors who were not Emergency Medicine trainees. Method An ED consultant observed each new ED doctor directly over two weeks without intervention in the clinical encounters. A structured form documented the doctor's performance in pre-defined areas relevant to patient care as well as mastery of operational procedures. Individual strengths and weaknesses were noted. Feedback was provided at the end of each session. After two weeks, the doctors completed a survey form with questions pertaining to their perceived level of competence in areas related to patient care and their experience with the direct observation program. Results There was an overall improvement in their perceived levels of competence in most areas pertaining to patient care. Most felt that this program was useful. Only a minority found it stressful. None felt that it was a waste of time. Conclusion Implementation of direct observation as a focused teaching tool is well received by both junior doctors and Emergency physicians. It provides early insight and feedback into the strengths and weaknesses of the junior doctors and helps new ED doctors to adapt quickly to the work process of the ED.
The Minimum Clinically Significant Difference in Acute Nontraumatic Thoracoabdominal Pain in Adult Emergency Department Patients in Turkey
Authors: Degerli V , Karcioglu O , Larkin GL , Karaduman S , Korkmaz T , Tunc MA 
Published: December 2017

ObjectivesTo determine the minimum clinically significant difference (MCSD) in visual analog scale (VAS) pain scores for acute non‐traumatic thoracoabdominal pain (TAP) in the emergency department (ED) and to determine its association with sociodemographic features, location and duration of pain.MethodsAn observational survey of adult ED patients with TAP lasting less than 48 hours was conducted over a six‐week period. Demographic information and the duration and location of pain were recorded. Patients indicated their pain level on a 100‐mm VAS at baseline and at 20, 40, and 60 minutes thereafter. Subjects were also asked to rate their pain as ‘much less’, ‘a little less’, ‘about the same’, ‘a little more’, or ‘much more’ at the 20‐, 40‐, and 60‐minute time points. MCSD was calculated as the difference between the subsequent and preceding VAS scores if a patient reported pain as ‘a little less’ or ‘a little more’.ResultsData was available for 306 of the 374 patients with TAP who presented during the study period. For pain comparisons (n=428) categorised as ‘a little less’ or ‘a little more’, the MCSD was 24.2 mm (95% CI 22.6‐25.7 mm). The MCSD value was not significantly different among the factors of gender, age, level of education, duration, or location of pain.ConclusionsThe MCSD of ED patients with nontraumatic thoracoabominal pain in Turkey is 24.2 mm. The MCSD is not affected by gender, age, level of education, location, or duration of pain.
Critical Thinking Dispositions of Emergency Nurses in Turkey: A Cross‐Sectional Study
Authors: Kaya H , Yalniz N 
Published: December 2017

IntroductionThis cross‐sectional descriptive study was conducted to determine the critical thinking dispositions of emergency nurses and any influencing factors related to critical thinking. The study is considered to respond to this need and contribute to the relevant literature.MethodThe study was conducted with the participation of 248 emergency nurses. The study data were collected using an information form covering characteristics of the nurses and the California Critical Thinking Disposition Inventory. The data were analyzed using independent‐samples t test, independent‐samples one‐way variance analysis (F‐test), and Pearson correlation test.ResultsThe critical thinking dispositions of the emergency nurses in the study group were found to be at medium level (246.76±23.24). It was found that the female emergency nurses had higher levels of critical thinking dispositions than that of male nurses. The emergency nurses with graduate degrees had higher levels of critical thinking dispositions than that of the nurses with other educational levels. It was demonstrated that age, marital status, experience, or participation in in‐service emergency training and certificate program did not affect the critical thinking dispositions of the nurses.ConclusionThe results of the study reveal that the emergency nurses who are required to make quick and correct decisions. They need to develop their critical thinking skills and further studies should be conducted with more representative sample group.
The Effect of Animation‐Assisted Informed Consent Using Tablet Personal Computer for Contrast‐Enhanced Computed‐Tomography in Emergency Department
Authors: Hong JY , Kim CW , Noh H , Lee DH , Kim SE , Lee SJ 
Published: December 2017

IntroductionInformed consent is essential patient's right even in overcrowded emergency department (ED). We compared the effect of animation‐assisted informed consent using tablet PC with the standard informed consent for contrast‐enhanced computed‐tomography (CT) in ED.MethodsWe included 150 patients scheduled to undergo contrast‐enhanced CT in ED from November 2010 through January 2011. Participants were randomised to either animation‐assisted information (AAI) (n=75) or standard verbal information (SVI) group (n=75). AAI was provided by tablet personal computer (PC); and SVI by clinicians. All participants completed 10‐point scale questionnaires after the CT scan. The questionnaires included two main categories – understanding and satisfaction of informed consent.ResultsParticipants in the AAI group had a better understanding of purpose (8.95±1.48 vs. 8.32±1.88, p=0.026) and methods (8.93±1.43 vs. 8.37±1.83, p=0.048) of CT scans compared to participants in the SVI group. Every score in satisfaction categories was significantly higher in the AAI group. In the SVI group, relatively low‐educated participants had a lower score in understanding when compared with university‐educated participants (7.53±2.28 vs. 8.52±1.40, p=0.029). Regardless of education level, understanding score was high in the AAI group (8.73±1.27 vs. 8.57±1.50, p=0.71).ConclusionsParticipants receiving animation assisted informed consent with tablet PC shows a higher degree of understanding and satisfaction compared with patients receiving standard verbal informed consent. Particularly in patients with lower education, animation‐assisted informed consent may be better for understanding of contrast‐enhanced CT.