bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intravenous Lipid Emulsion as Antidote: Experience in Hong Kong
Authors: Tse Cw , Chan Yc , Lau Fl 
Published: December 2017

Objective Intravenous lipid emulsion (ILE) is an emerging therapy in the field of toxicology. The purpose of this study was to report the accumulated local experience on using ILE in the management of patients suffering from poisoning by pharmaceutical agents other than local anaesthetics. Design Case series. Setting Local poison information centre. Methods Ten patients were identified from the database of Hong Kong Poison Information Centre. The patients were managed in 6 Hong Kong public hospitals during a 4-year study period (July 2008-June 2012). Results Nine of them presented with drug-induced cardiotoxicity, defined as either cardiac arrest (n=3) or hypotension refractory to other treatments (n=6). The overall survival rate is 30%. Possible adverse events from ILE included mild derangement of liver function, elevated amylase and hyperlipidaemia were observed. Conclusions About 30% of severe poison-induced cardiotoxicity treated with ILE can survive with no major adverse effects. The use of ILE remains to be a treatment option for lipid-soluble drug induced severe toxicity not responsive to standard resuscitation measures. (Hong Kong j. emerg.med. 2015;22:100-107)
Clinical use of Serial Mean Platelet Volume Measurement for Diagnosis of Non-ST Segment Elevation Myocardial Infarction in Patients Visiting Emergency Department with Acute Chest Pain
Authors: özcan Ks , Ekmekçi A , Güngör B , şener S , Osmonov D , Altay S , Aruğraslan E , çinar T , Sayar N , Orhan Al , Eren M 
Published: December 2017

Objective We aim to demonstrate diagnostic accuracy of serial MPV measuring and to assess its correlation with cardiac troponin I (cTnI) levels. Design Cross-sectional study. Methods Consecutive patients presenting to emergency department with new onset chest pain started in the last four hours without electrocardiographic ST segment and T wave changes, pathological q waves were included in study. Complete blood count and cTnI levels were studied on admission and six hours after presentation. Patients with cTnI levels higher than 0.06 ng/ml were diagnosed as non-ST elevation myocardial infarction (NSTEMI) and other patients were matched as the control group. Results NSTEMI group had significantly higher levels of MPV on admission and at the sixth hour. The increase in MPV was corraleted with elevation of cTnI levels. At six hours follow up, the increase in MPV levels predicted myocardial ischaemia (corrected r2=0.36; p=0.001) in linear regression analysis. The corresponding area under the receiver operating characteristic curve (ROC) for admission MPV, sixth hour MPV and increase in MPV levels in predicting myocardial ischaemia in patients with increased cTnI were 0.652, 0.727 and 0.896 respectively. If MPV threshold was selected as ≥0.10 fL during follow up, myocardial ischaemia was predicted with a sensitivity of 75% and specificity of 88%. Conclusions Elevation of MPV levels in patients with acute chest pain may be an indicator of myocardial ischaemia. Serial MPV measurement can be used to complement serial cTnI measurements to diagnose NSTEMI.
The use of the Airtraq® in Awake Tracheal Intubation: A Case Series
Authors: Tai FMT , Ho YL , Cheng BCP , Mui KSY , Chan MTV , Wong OF 
Published: December 2017

ObjectiveTo report the clinical experience in using the Airtraq® in awake tracheal intubation in patients with known or potential difficult airway, or unstable cervical spine.MethodsCase series study. Twenty patients with known or potential difficult airway, or unstable cervical spine who underwent elective operations and might require awake fibreoptic intubation were recruited. After standardised topical anaesthesia of the airway, awake intubation was performed using the Airtraq®. The duration of the intubation procedure, the intubation difficulty scale (IDS), the rate of successful placement of endotracheal tube and patient's satisfaction were recorded.ResultsFifteen out of the twenty patients were successfully intubated with the Airtraq® under awake condition leading to an overall success rate of 75%. Eleven of them were intubated in the first attempt. The mean duration of intubation was 1 min 33 s. Concerning the degree of difficulty of intubation using the Airtraq®, as evaluated with the IDS, 20% was ranked as easy and 80% was slightly difficult. Excessive secretion, patient gagging, inability to cooperate and inadequate view of larynx were the major reasons of failed intubation. Eighty percent of the patients considered the intubating procedure with the Airtraq® under awake condition acceptable. In general, patients felt mild pain and discomfort and were satisfied with the intubation process.ConclusionAirtraq® may be a useful alternative of flexible bronchoscope for awake intubation with low rate of minor complications in the elective operation setting. (Hong Kong j.emerg.med. 2015;22:248‐255)
The Academic Contribution of Emergency Departments in Taiwan: Data on Scientific Publications, 1992‐2011
Authors: Lee CH , Chaou CH 
Published: December 2017

IntroductionThis study aimed to evaluate the academic contribution of emergency departments (EDs) in Taiwan by analysing scientific publications during the past 20 years.MethodsThis was an observational study. All data were collected from the 2010 Journal Citation Reports (JCR) and the SciVerse Scopus database. Three groups of publications were enrolled: (1) publications from Taiwan EDs in emergency medicine (EM) journals; (2) publications from Taiwan EDs in non‐EM journals; (3) publications from Taiwan who were not affiliated with EDs in EM journals. We collected data regarding the name and category of the journal, the publication year, the publication type, and the number of citations for further analysis.ResultsA total of 475 publications affiliated with Taiwan EDs appeared in EM journals and 735 appeared in non‐EM journals. A total of 389 publications in EM journals affiliated with departments other than EM. The number of publications showed an increasing trend (all p‐value <0.001). The number of publications from Taiwan EDs in EM and non‐EM journals changed in opposite directions since 2008. Researches from Taiwan EDs were published in 68 categories of journals in addition to EM. Publications in non‐EM journals were more frequently cited than were the publications in EM journals.conclusionsDuring the past 20 years, the academic contribution of EDs in Taiwan has increased substantially. The bidirectional change in publication numbers since 2008 constitutes a milestone in the development of EM in Taiwan, and improvements are evident in the quality, quantity, and breadth of research. (Hong Kong j.emerg.med. 2016;23:28‐34)
Does the Bed Frame Deflection Occur along with Mattress Deflection during In‐Hospital Cardiopulmonary Resuscitation? an Experiment Using Mechanical Devices
Authors: Oh JH , Kim CW , Kim SE , Lee DH 
Published: December 2017

ObjectivesWhen we perform chest compression on a patient on a bed, the mattress and bed frame can be depressed together with the patient's chest. This study was conducted to assess whether bed frame deflection occurred during chest compressions.MethodsWe designed a firm bed (“bed like the ground,” BLG) to assess the bed frame deflection in the Stryker Trauma Stretcher (STS) and the ER stretcher cart (ER‐SC). The STS included a soft mattress and the ER‐SC a hard mattress. We performed 50 continuous chest compressions on the Resusci Anne Skill Reporter with CPRmeter in each experiment. The experiments were done in four settings. Test 1 included the BLG; test 2 included a mattress and backboard on each bed; test 3 included the mattress of each bed and a backboard on the BLG; and test 4 included the mattress of each bed on the BLG. We calculated the mattress and bed frame deflections using the gaps of compression depths between the values measured by Resusci Anne and CPRmeter.ResultsThe mattress deflections of the STS and ER‐SC mattress were determined to be 11.2 and 0.67 mm, respectively. The bed frame deflection for the STS and ER‐SC were 0.95 and 5.17 mm, respectively.ConclusionThe study confirms that bed frame deflection will occur when we perform chest compressions on the manikin lying on a bed. Additionally, the bed frame deflections differ depending on the type of bed. (Hong Kong j.emerg.med. 2016;23:35‐41)
Clinical Practice and Risk Factors for Immediate Complications of Endotracheal Intubation by Intensive Care Unit Doctors in a Regional Hospital in Hong Kong
Authors: Cham EYK , Wong OF , Yip KH 
Published: December 2017

Background Endotracheal intubation in critically ill patients is often challenging and is associated with a high complication rate. Intensive Care Unit (ICU) doctors are often responsible for emergency intubation but local data about their experience is lacking. Objective To describe the ICU team's practice of endotracheal intubation in critically ill patients in a regional hospital; to evaluate the incidence of immediate complications; and to identify risk factors for complications and predictors for successful intubation. Design Retrospective, observational study Patients All patients who received endotracheal intubation by the ICU team of the study centre between the 1st July 2013 and 31st December 2013. Results Complete data from 325 endotracheal intubations were analyzed. The commonest diagnosis was pneumonia (41.5%) and the mostly frequently cited indication for endotracheal intubation was respiratory failure (50.8%). Complications occurred in 25.5% of all intubations including 4 cases of cardiac arrest after the procedure. Haemodynamic alterations (hypotension and hypertension occurred in 9.2% and 7.4% respectively) were the most common complications. Overall, 96.6% of intubations were successful on the first two attempts. Logistic regression analyses showed that reduced mouth opening was a significant risk factor for immediate complications (odds ratio [OR] 15.98, 95% confidence interval [CI]: 2.71 to 94.41, P=0.006). Cormack-Lehane laryngoscope grading below 2b (OR 0.2, 95% CI: 0.07-0.59, P=0.003) and operator with more than 6 months of formal anaesthetic training (OR 7.06, 95% CI: 1.63 to 30.62, P=0.009) were independent predictors for successful intubation. Conclusion The ICU team achieves a high successful rate of emergency endotracheal intubation. High rates of anticipated and unanticipated difficult airway are encountered. Reduced mouth opening is a significant risk factor for complications occurrence. Cormack-Lehane laryngoscopic grading below 2b and intubation performer with more than 6 months of formal anaesthetic training are significant independent predictors for successful intubation. (Hong Kong j.emerg.med. 2016;23:135-144)
The Effect of Telephone Advice on Cardiopulmonary Resuscitation (CPR) on the Rate of Bystander CPR in Out-of-Hospital Cardiopulmonary Arrest in a Typical Urban Area
Authors: Moriwaki Y , Tahara Y , Kosuge T , Suzuki N 
Published: December 2017

Introduction The frequency of telephone advice for cardiopulmonary resuscitation (T-CPR) and its effect are unclear. We have few data concerning how many persons who are willing to perform CPR under the setting of the T-CPR system. Most of these data were from action reports in the pre-hospital EMS records. Methods: This study was a population-based observational case series of out-of-hospital cardiopulmonary arrest (OHCPA). The primary outcome was the acceptability of a bystander to perform CPR according to T-CPR. In our emergency department, one medical doctor interviewed the bystanders regarding T-CPR and CPR; this doctor was devoted to obtaining information from the patients. Results Of the 803 patients in, T-CPR advice was provided in 47% and CPR was actually performed in 47% independent of T-CPR guidance. Of the 373 cases in which lay persons received T-CPR, 95% provided CPR. Dispatchers could more easily provide T-CPR to family members compared with friends and passengers. Twenty-one percent of callers made emergency calls after consulting with others (indirect call). In non-traumatic victims who underwent bystander CPR, 43% experienced the return of spontaneous circulation, and 5% were discharged with a mild disorder or no neurological abnormality. Conclusions We conclude that 95% of bystanders are willing to perform CPR under the T-CPR system, but we cannot conclude that bystander CPR may not affect the survival rate. These findings indicate that bystanders should be guided with T-CPR. (Hong Kong j.emerg. med. 2016;23:220-226)
The 100 Top-Cited Articles Published in Emergency Medicine Journals: A Bibliometric Analysis
Authors: Shao JF , Zheng XT 
Published: December 2017

Background The number of citations that an article has received can reflect its importance in a specialty. The purpose of this study was to analyse the characteristics of top-cited articles published in 24 emergency medicine (EM) journals in the Thomson Reuters Web of Science (WoS). Method WoS were used to identify the 100 top-cited articles published in EM journals. Basic information, including title, authors, country of origin (based on the first author), institution, publication year, journal name, language, document type, citation times and impact factor, was collected and analysed. Results The 100 top-cited articles in EM journals, cited from 175 to 530 times, were published between 1979 and 2010, with most articles published between 2001 and 2005. All articles were written in English, and the United States contributed the most. The articles were distributed in seven different EM journals, led by Annals of Emergency Medicine with 45 articles. Resuscitation medicine was the most discussed topic. Conclusion The bibliometric analysis on the 100 top-cited articles in EM journals from WoS demonstrates some significant points, which can have important implications for researchers in evaluating and orienting their research.
Benefits of Visual Feedback on Cardiopulmonary Resuscitation Training: A Non‐Randomised Manikin Study with Bystanders
Authors: Abelairas‐Gómez C , Gili‐Roig C , López‐García S , Palacios‐Aguilar J , Romo‐Pérez V , Barcala‐Furelos R 
Published: December 2017

IntroductionCardiopulmonary resuscitation (CPR) is vital for the survival of people who has suffered a cardiac arrest. In order to achieve a good quality CPR performance, rescuer needs a good training which could be gotten with the use of feedback devices. The aim of this study was to compare the use of visual feedback device in CPR training to learning without feedback.MethodsNinety‐nine subjects without basic life support knowledge participating in the study were divided into three groups. All of them carried out two tests: 2 minutes of CPR with compressions and ventilations. First two groups received trainings on CPR between the tests (experimental groups): one group with instructor‐led training and the other one with visual feedback device. The third group did not receive any training between the tests (control group).ResultsIn the first test no differences among the three groups were found. The experimental groups improved their scores in the last test. The number of correct chest compressions by hand position and depth, and the number of correct rescue breaths was increased. The experimental group with visual feedback CPR training achieved better scores of quality CPR in the second test than the instructor‐led training group.ConclusionsThe visual feedback and instruction‐led training have positive effects on the quality CPR. The use of visual feedback during learning has greater benefits than instruction‐led training in the three variables analysed.
Increased cerebrospinal fluid albumin and immunoglobulin A fractions forecast cortical atrophy and longitudinal functional deterioration in relapsing-remitting multiple sclerosis
Authors: Kroth Julia , Ciolac Dumitru , Fleischer Vinzenz , Koirala Nabin , Krämer Julia , Muthuraman Muthuraman , Luessi Felix , Bittner Stefan , Gonzalez-Escamilla Gabriel , Zipp Frauke , Meuth Sven G. , Groppa Sergiu 
Published: December 2017

Background: Currently, no unequivocal predictors of disease evolution exist in patients with multiple sclerosis (MS). Cortical atrophy measurements are, however, closely associated with cumulative disability. Objective: Here, we aim to forecast longitudinal magnetic resonance imaging (MRI)-driven cortical atrophy and clinical disability from cerebrospinal fluid (CSF) markers. Methods: We analyzed CSF fractions of albumin and immunoglobulins (Ig) A, G, and M and their CSF to serum quotients. Results: Widespread atrophy was highly associated with increased baseline CSF concentrations and quotients of albumin and IgA. Patients with increased CSFIgA and CSFIgM showed higher functional disability at follow-up. Conclusion: CSF markers of blood–brain barrier integrity and specific immune response forecast emerging gray matter pathology and disease progression in MS.
Narratives of health and illness: Arts-based research capturing the lived experience of dementia
Authors: Moss Hilary , O’Neill Desmond 
Published: December 2017

Introduction This paper presents three artists’ residencies in a geriatric medicine unit in a teaching hospital. The aim of the residencies was creation of new work of high artistic quality reflecting the lived experience of the person with dementia and greater understanding of service user experience of living with dementia. This paper also explores arts-based research methodologies in a medical setting. Method Arts-based research and narrative enquiry were the method used in this study. Artists had extensive access to service users with dementia, family carers and clinical team. Projects were created through collaboration between clinical staff, arts and health director, artist, patients and family carers. Each performance was accompanied by a public seminar discussing dementia. Evaluations were undertaken following each residency. The process of creating artistic responses to dementia is outlined, presented and discussed. Results The artworks were well received with repeat performances and exhibitions requested. Evaluations of each residency indicated increased understanding of dementia. The narratives within the artworks aided learning about dementia. The results are a new chamber music composition, a series of visual artworks created collaboratively between visual artist and patients and family carers and a dance film inspired by a dancer’s residency, all created through narrative enquiry. Discussion and conclusion: These projects support the role of arts-based research as creative process and qualitative research method which contributes to illuminating and exploring the lived experience of dementia. The arts act as a reflective tool for learning and understanding a complex health condition, as well as creating opportunities for increased understanding and public awareness of dementia. Issues arising in arts-based research in medical settings are highlighted, including ethical issues, the importance of service user narrative and multidisciplinary collaboration in arts and health practice and research.
Utilizing evidence-based assessment instruments to detect well-being and distress in English- and Spanish-speaking caregivers of individuals affected by dementia
Authors: Burke Shanna L , Burgess Aaron , Cadet Tamara 
Published: December 2017

Objective The purpose of this study was to examine the most effective and available English and Spanish language caregiver assessments for providers and caregivers. Methods Assessments were included if they screened for caregiving-related concerns, including stress, depression, and caregiving burden and could be administered directly to caregivers in person or online. Results Eighteen assessments are designed to assess caregiver burden, distress, depression, and grief. Six did not have psychometric data to support efficacy but are widely used in clinical and research settings. Six were validated in Spanish, and one other is available in Spanish but not validated. Conclusion As many as 80% of care recipients are cared for in the home by family members who act as informal caregivers. Caregivers of persons with dementia may experience depression symptoms, high caregiver burden, and feelings of being constrained. Due to the lack of psychometric evidence available, the validity of some assessments is questionable.
Assessing apathy in long-term care residents with dementia: Who should be the rater?
Authors: Jao Ying-Ling , Williams Kristine , Mogle Jacqueline , Behrens Liza , McDermott Caroline 
Published: December 2017

Background Apathy is prominent in persons with dementia and apathy assessment is challenging. It remains unclear who should conduct apathy assessments in long-term care settings for residents with moderate to advanced dementia. The Apathy Evaluation Scale (AES) is a widely used instrument and its use for long-term care residents with dementia needs to be further established. This study explored the relationship among apathy assessments conducted by family and clinical caregivers using the original AES (AES-18) and the nursing home version (AES-10). Methods This study used a cross-sectional, descriptive design and enrolled 15 quartets of participants recruited from long-term care settings. Each quartet consisted of one resident with dementia, one family member, one certified nursing assistant, and one licensed practical nurse or activity staff. Family, certified nursing assistants, and licensed practical nurses/activity staff rated the resident’s apathy level on the AES independently. Bivariate Pearson correlation coefficients were used for analysis. Results The results revealed that ratings conducted by certified nursing assistants and licensed practical nurses/activity staff were moderately correlated for the AES-18 and the result approached statistical significance (r = 0.47, p = .08). None of the other AES ratings among family, certified nursing assistants, and licensed practical nurses/activity staff were significantly correlated. Discussion Family and clinical caregivers were incongruent on their AES ratings of apathy. It remains undetermined which rater provides the most valid AES rating for residents with dementia. Findings from this study further highlight challenges in rating apathy in this population. Future research is needed to determine best practices for accurate apathy assessment for residents with dementia in long-term care.
Uterus unicornis and pregnancy in two feline littermates
Authors: Brookshire Wilson C , Shivley Jacob , Woodruff Kimberly , Cooley Jim 
Published: December 2017

Case series summary A queen, tom and four 1-year-old female offspring presented for routine neuter. Two of the littermates (cats 1 and 2) were diagnosed with a uterine abnormality during surgery. The left uterine horn of both cats appeared as a thin, solid, cord-like structure, whereas the right uterine horn of both cats appeared to have intermittent bulges consistent with pregnancy. The two other littermates, queen and tom were reproductively normal. The uteruses of the affected cats were nearly identical with a gross and histopathologic diagnosis of uterus unicornis with concurrent pregnancy. Ovaries were present, bilaterally. An oviduct was present only on the single normally developed and pregnant uterine horn in both cats. At a postoperative follow-up evaluation, abdominal ultrasound was performed on the two cats with uterine abnormalities. Cat 1 was ultrasonographically within normal limits. Cat 2 was diagnosed with ipsilateral renal agenesis on the same side as the absent uterine horn. Relevance and novel information The complexity of uterus unicornis and renal aplasia is demonstrated by this unique presentation of five related cats for ovariohysterectomy. This report raises questions regarding the genetic, environmental, hormonal or other underlying causes of this anatomic abnormality in cats that may spur additional research. This is the first publication describing uterus unicornis in gravid feline littermates, with one of the cats having ipsilateral renal agenesis. This is also the first publication to describe oviduct agenesis on the affected uterine horn in feline uterus unicornis.