bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of lignocaine 1% injection and adrenaline‐cocaine gel for local anaesthesia in repair of lacerations
Authors: Dart Cameron J 
Published: August 2010

AbstractObjectiveTo compare adrenaline‐cocaine gel (adrenaline 1:1000 [0.5ml], cocaine 12%[1ml]) with injectable lignocaine 1% solution in efficacy, side effects and safety, cosmetic and patient acceptability in the repair of dermal lacerations on patients who attend the emergency department.DesignRandomised, prospective, single‐blinded clinical trial.SettingRural base hospital emergency department.ParticipantsPatients presenting to the emergency department aged six years and over with dermal lacerations to face, scalp, trunk and limbs, excluding areas below knee or with end‐artery blood supply. Those patients with altered mental state were also excluded.InterventionPatients with lacerations were randomly assigned to local anaesthesia with either topical adrenaline‐cocaine gel or injection of lignocaine 1% solution. Patients were then asked to rate the pain on application of either adrenaline‐cocaine gel or lignocaine 1% solution. The emergency doctor who performed the local anaesthesia then sutured in the usual way. A blinded observer recorded pain response using verbal and visual indicators.MeasurementNinety patients participated in the trial: 49 randomised to lignocaine 1% solution and 41 to adrenaline‐cocaine gel. A total of 924 skin punctures were recorded and measured.ConclusionAdrenaline‐cocaine gel compared favourably with lignocaine 1% solution efficacy, side effects and cosmetic results. It was less painful on application than lignocaine 1%. Adrenaline‐cocaine gel may be considered as an alternative for anaesthesia in the repair of selected dermal lacerations.
Time analysis of assessment and admission procedures for elderly patients in a Sydney emergency department
Authors: Chan Adam , Caplehorn John , Mather Andrew , Sprivulis Peter 
Published: August 2010

AbstractObjectiveTo identify factors influencing the time taken to either admit or discharge elderly patients from an emergency department.DesignA cohort of patients aged 60 years and over was followed by an independent team of investigators until discharge from the emergency department.SettingThe study took place over one week in the winter of 1995 in the St George Hospital Emergency Department, Sydney, a 600 bed teaching hospital.Main outcome measuresThe time spent waiting for medical attention, time taken to prepare the patient for admission or departure home and time spent waiting for transfer to a ward or home.ResultsThe waiting times for less urgent cases did not meet the current NSW Health Department targets. Emergency department staff specialists and registrars took less time to prepare patients for admission compared with residents and interns (two hours vs three hours). While elderly patients generally had to wait long periods in the emergency department for a ward bed, there were significant differences in the waiting times for different specialties; average times were 4.8 hours for a surgical, 8.8 hours for a medical, and 27.2 hours for an aged care bed.ConclusionMore medical staff may be required to reduce waiting times for less urgent cases. The time taken to ready patients for admission would be reduced if there were a higher proportion of senior medical staff. There is a need for improved availability of ward beds, particularly medical and aged care beds, for patients admitted through the emergency department.
Factors influencing resuscitation decisions in the emergency department
Authors: Biegler Paul , Thomson Graeme 
Published: August 2010

AbstractObjectiveTo determine the factors considered most important by emergency physicians when deciding to institute or withhold resuscitation in a hypothetical patient with a life‐threatening illness.MethodA self‐administered questionnaire containing a clinical scenario was posted to all Victorian emergency physicians in April 1997. Respondents were asked to decide between intubation and no active treatment, to rate the importance of various factors in making this decision and to rate the likelihood of altering the decision given hypothetical changes in the scenario.ResultsThe response rate was 67% (46/69). Of those choosing intubation (89%), most would have changed the decision if the patient had dementia, was permanently bed‐bound or was totally dependent for activities of daily living. Decisions were most influenced by reversibility of the illness, the patient's functional state and the perceived quality of life.ConclusionEmergency physicians consider many factors when deciding whether or not to actively resuscitate patients. Further study of the decision making process is recommended.
Incidence of recall of emergency intubation: a preliminary report
Authors: Smith Brendon , Bishop Rod 
Published: August 2010

AbstractObjectiveTo determine the incidence of recall of intubation performed during resuscitation as part of emergency care.MethodPatients intubated as an emergency procedure during prehospital, emergency department and inpatient care were identified in a prospective manner over a six month period from the admission register and interviewed after recovery during their hospital stay.ResultsA total of 34 patients with a variety of conditions were able to be assessed. Recall of intubation occurred in two patients, neither of whom considered the experience unpleasant. Both were intubated for respiratory failure. One was obtunded and given no induction agent, the other had a Glasgow Coma Scale score of 14 and was given a moderate dose of thiopentone and midazolam.ConclusionThis is a preliminary report which finds a low incidence of recall of intubation performed during resuscitation. The methodological difficulties in controlling for all relevant variables are discussed.
Angio‐oedema and ACE inhibitors: an association which is still not well recognised
Authors: O'Donnell Daniel 
Published: August 2010

AbstractThe angiotensin‐converting enzyme inhibitors are associated with angio‐oedema Three cases are recorded here which document the frequent delay in recognition of this association, the variability in time of onset after exposure to the drug, the variable severity of attack and the potential fatality of such an attack.
Rapiscope™—a portable fibre optic device to establish endotracheal tube position
Authors: Petroianu Georg , Werth Wolf , Subotic Svetozar , Maleck Wolfgang , Bergler Wolfgang , Ruefer Roderich 
Published: August 2010

AbstractClinical methods to determine endotracheal tube position are unreliable. The Oesophageal Detector Device and capnometry allow a quick and reliable assessment of tube position (oesophageal vs airway), but neither can differentiate between a tracheal or bronchial tube position. The Rapiscope™ (Cook Critical Care, Bloomington, USA) is a battery powered, ultralight fibrescope designed to visualise upper airway anatomy and to confirm the endotracheal tube position. The Cook Airway Exchange Catheter™ is designed to be used with the Rapiscope™ and to protect the fibre optic.During experiments with intubated minipigs, an additional, identical tube was inserted into the oesophagus. Anaesthetists and medical students were asked to determine the position of one of the tubes (randomly chosen after disconnection of the pig from the ventilator) using the Rapiscope™ with and without the Cook Airway Exchange Catheter. The decision (tracheal or oesophageal) was then confirmed with the Oesophageal Detector Device and subsequently, whether tracheal or bronchial, was checked with a conventional endoscope. The time needed to determine the tube position was recorded.Using the Rapiscope™ either alone or with the Cook Airway Exchange Catheter it was not possible, in most cases, to determine the correct tube position. The failure in establishing tube position was caused by the ‘foggy’ optic. The visibility could not be improved by using the Cook Airway Exchange Catheter or by oxygen insufflation. Consequently, the use of the Rapiscope™ cannot be recommended at this stage.
Urgency, disposition and age groups: a casemix model for emergency medicine
Authors: Bond Malcolm , Erwich‐Nijhout Marianne , Phillips David , Baggoley Christopher 
Published: August 2010

AbstractAimTo evaluate the performance of Urgency and Disposition Groups and Urgency Related Groups, and to develop other casemix systems for use in emergency departments based on easily collected variables.SettingEmergency Department, Flinders Medical Centre, a general metropolitan teaching hospital in Adelaide, South Australia.MethodsCost data from a prospective analysis of 17,819 emergency patient attendances were used to construct casemix systems by evaluating the cost drivers urgency, outcome, age and diagnosis.ResultsUrgency Related Groups were good predictors of costs (55.32% trimmed for outliers), but the least easy system to construct, and not particularly clinically relevant. Urgency and Disposition Groups were useful predictors of costs (43.90% trimmed), with the advantage of being easy to collect and clinically relevant. However, the same advantages are true of the newly developed Urgency, Disposition and Age Groups, which incorporate age as a partitioning variable, and were found to predict 51.23% (trimmed) of total costs.ConclusionUrgency, Disposition and Age Groups can be used as a simple, cost‐efficient method of costing patient attendances to emergency departments. Evaluation of Urgency, Disposition and Age Groups in other emergency departments in Australasia is recommended.
Seeing primary care patients in emergency departments
Authors: Bryant Michael , Tan Gim 
Published: August 2010

AbstractAimsThis study aims to quantify the number of perceived primary care patients attending an emergency department, to determine whether it was safe to send them away and to estimate the costs of treatment.SettingThe Emergency Department, Ballarat Base Hospital, a major provincial hospital.MethodsA prospective analysis of all attendances over a 14 day period, including the costs of managing primary care patients.ResultsOne thousand and forty nine patients attended the emergency department during the study period. Data were complete for 858 patients. There was agreement between medical and triage staff that 263 patients were primary care patients. Triage staff considered 295 patients to be primary care patients. Nine of these patients were subsequently admitted. The average cost for each patient visit to the emergency department was $120.38. The cost of staff contact time for a 15 minute visit was $23.59. If it is assumed that the number of primary care patients attending does not affect staffing levels then the cost is $16.99.ConclusionThere is disagreement between triage and medical staff about who is a primary care patient.Three percent of patients thought to have been able to be managed by a general practitioner needed admission.There are large numbers of patients presenting to the emergency department thought to have been able to be managed by a general practitioner but their numbers are insufficient to support a separate primary care facility within Ballarat Base Hospital.Costs are less to manage primary care patients in the emergency department at Ballarat Base Hospital than in general practice. The cost associated with teaching medical and nursing students, including postgraduate education, in the emergency department has not been quantified.
Emergency department telephone advice: a survey of Australian emergency departments
Authors: Fatovich Daniel , Jacobs Ian 
Published: August 2010

AbstractObjectiveTo ascertain the nature and extent of telephone advice to the public provided from the emergency department.MethodA postal survey of all emergency departments in Australia (n=147).ResultsAn 88% response rate was achieved. Sixty seven percent of emergency departments provide telephone advice. Seventy five percent of Directors of Emergency Medicine consider telephone advice to be worthwhile. The mean number of calls received each month is 627 per emergency department (range 4–12,500). Only 24% of emergency departments provide training on telephone advice. Fifty nine percent of departments do not document the calls.The general impression was that providing telephone advice was time consuming and distracted emergency department staff from direct patient care. Lack of funding to provide a dedicated service was frequently commented upon.The survey data indicated that there are at least 27.6 calls per 100 emergency department attendances; i.e. for every 100 attendances, there are a further 27.6 occasions of service.ConclusionsThe provision of telephone advice from emergency departments is common practice in Australia and appears to be ad hoc. This service has a particular advantage for those who have difficulty accessing medical care. More formalised systems should be established. This would relieve a considerable burden from emergency departments freeing resources for direct patient care.
Prehospital treatment of head injuries ‐ can we do better?
Authors: Havill Jack , Sleigh Jamie , Kersel Denyse , Marsh Nigel 
Published: August 2010

AbstractAimsTo examine prehospital factors associated with head injuries.MethodPrehospital and outcome data were collected on a group of 123 patients with head injuries admitted to Waikato Hospital over 41 months.ResultsOver 80% of the head injuries were due to road trauma. Over 60% occurred >30km from the first admission hospital, 35% were >60km away and 43% took more than 90 minutes to arrive in hospital. Helicopter transport was used for 34% of patients. Hypoxia was present in 50% of the patients at the accident scene and 54% of the unintubated patients were breathing poorly on admission to hospital (64% unintubated). The average Glasgow Coma Scale score was 5.4. Glasgow Outcome Scores at six months were: dead (24), vegetative (0), severely disabled (25), moderately disabled (19), normal or mildly disabled (40), and not available (15). The presence of hypoxia and the worst Abbreviated Injury Scale scores occurred more commonly in those who died.ConclusionsMany New Zealanders suffer head injuries a long distance from hospital. The use of helicopter transport shortens admission times. Poor breathing patterns and hypoxia are still major problems. Facilitating early intubation by widening the skills of ambulance officers or utilising doctors in first response teams must be considered.
Multiple bee stings
Authors: Robertson Malcolm L 
Published: August 2010

AbstractMultiple bee stings occur in Australia, but are rarely reported. The importance of this problem in the southern states of North America has recently been well publicised. This review examines the incidence of multiple bee stings, a comparison of European and Africanised honeybees, and the structural function of a bee sting. The toxic effects of bee venom components with reference to both pathophysiology and emergency department presentation and treatment are discussed. Aspects of immunotherapy are covered briefly. Advice for bee sting avoidance and best management of mass attack in the field are also presented.
Colchicine poisoning—overview and new directions
Authors: Harris Roger D , Gillett Mark J 
Published: August 2010

AbstractColchicine overdose is uncommon but frequently fatal. In this article we present two cases which exhibit the wide spectrum of colchicine toxicity and review the drug's pharmacology and organ system effects. Finally we provide a treatment algorithm and propose new directions for management.Colchicine binds to intracellular tubulin and prevents its polymerisation to form microtubules.As microtubules subserve a wide variety of roles in basic cellular function including protein assembly, mitosis, endocytosis, exocytosis, cell shape and motility, colchicine is profoundly toxic to all cell lines of the body.Previous studies have offered little to aid the clinician in the management of such patients. We present a series of treatment guidelines based on the current literature. Specifically, we propose that patients who do not develop gastrointestinal symptoms within eight hours of a small, isolated colchicine ingestion can be medically cleared. Additionally, the onset of gastrointestinal symptoms should be seen as an indicator of possible significant systemic toxicity requiring early resuscitation and intensive monitoring.The newer modalities of treatment including the use of colchicine‐specific Fab fragments and Granulocyte‐Colony Stimulating Factor are also addressed.
Treatment dilemmas in rapid atrial fibrillation
Authors: Richards Karen 
Published: August 2010

AbstractAtrial fibrillation is a common tachyarrhythmia. Cardioversion either electrically or pharmacologically carries the risk of thromboembolism. All patients with resting ventricular rates greater than 140/min require rate control. Many drugs are effective in either slowing and or reverting atrial fibrillation but no one drug appears superior. Atrial fibrillation in the setting of acute myocardial infarction is associated with a high mortality.
Quinine toxicity
Authors: Pearson Scott 
Published: August 2010

AbstractQuinine remains an uncommon but potentially lethal cause of poisoning. It is only available by prescription but is commonly prescribed for the treatment of muscle cramps. Permanent visual disturbance and life threatening cardiac dysrhythmias may occur. A case which illustrates the wide range and severity of symptoms is presented. The management of quinine poisoning includes regular activated charcoal and supportive measures. Parenteral sodium bicarbonate may be useful for cardiac toxicity.
Economic–social interaction in China1
Authors: Lindbeck Assar 
Published: August 2010

AbstractThis paper analyzes economic–social interaction in China in connection with the country's change of economic system. I define an economic system in terms of a multi‐dimensional vector of broad institutional characteristics, and I emphasize that important features of the social development are closely related to specific changes in these various dimensions. I classify China's options for future social improvements into three broad categories: (i) policies that improve the stability and distribution of factor income; (ii) government‐created wedges between factor income and disposable income; and (iii) improvements in the quantity, quality and distribution of human services, such as education and healthcare.
An actualistic perspective into Archean worlds – (cyano‐)bacterially induced sedimentary structures in the siliciclastic Nhlazatse Section, 2.9 Ga Pongola Supergroup, South Africa
Authors: NOFFKE N. , BEUKES N. , BOWER D. , HAZEN R. M. , SWIFT D. J. P. 
Published: August 2010

ABSTRACTExtensive microbial mats colonize sandy tidal flats that form along the coasts of today's Earth. The microbenthos (mainly cyanobacteria) respond to the prevailing physical sediment dynamics by biostabilization, baffling and trapping, as well as binding. This biotic–physical interaction gives rise to characteristic microbially induced sedimentary structures (MISS) that differ greatly from both purely physical structures and from stromatolites. Actualistic studies of the MISS on modern tidal flats have been shown to be the key for understanding equivalent fossil structures that occur in tidal and shelf sandstones of all Earth ages. However, until now the fossil record of Archean MISS has been poor, and relatively few specimens have been found.This paper describes a study location that displays a unique assemblage with a multitude of exceptionally preserved MISS in the 2.9‐Ga‐old Pongola Supergroup, South Africa. The ‘Nhlazatse Section’ includes structures such as ‘erosional remnants and pockets’, ‘multidirected ripple marks’, ‘polygonal oscillation cracks’, and ‘gas domes’. Optical and geochemical analyses support the biogenicity of microscopic textures such as filamentous laminae or ‘orientated grains’. Textures resembling filaments are lined by iron oxide and hydroxides, as well as clay minerals. They contain organic matter, whose isotope composition is consistent with carbon of biological origin.The ancient tidal flats of the Nhlazatse Section record four microbial mat facies that occur in modern tidal settings as well. We distinguish endobenthic and epibenthic microbial mats, including planar, tufted, and spongy subtypes. Each microbial mat facies is characterized by a distinct set of MISS, and relates to a typical tidal zone. The microbial mat structures are preserved in situ, and are consistent with similar features constructed today by benthic cyanobacteria. However, other mat‐constructing microorganisms also could have formed the structures in the Archean tidal flats.
Narratives of Conquest, Colonialism, and Cutting‐Edge Technology
Authors: RODRÍGUEZ‐ALEGRÍA ENRIQUE 
Published: August 2010

ABSTRACTMany empirical studies have demonstrated that some indigenous technologies in the Americas survived for a long time after European colonization. Still, a narrative of the quick replacement of “Stone Age” indigenous technologies by more efficient European technologies continues to be the main model to explain postcontact technological change. I argue in this article that an important reason for the perseverance of this model is its clear narrative quality. I discuss alternative narrative strategies and examine in detail the case of Xaltocan, Mexico, where indigenous people resumed and intensified chipped‐stone tool production and use after the Spanish conquest, instead of adopting steel knives. I argue that this trend was related to access to the means of production rather than to European notions of “practicality.” This model invites us to rewrite histories of postconquest technological change without assuming a quick replacement of indigenous tools and technologies.
Leaving Few Bones Unturned: Recent Work on Repatriation by Osteologists
Authors: KAKALIOURAS ANN M. 
Published: August 2010

ABSTRACTIn this essay, I consider recent osteological and bioarchaeological contributions to literature on Native American repatriation given the heightened visibility of theoretical and methodological conflicts within physical anthropology over race and race determination. Contestations between researchers, particularly at the osteological nexus with the traditional biological race concept, have intersected with repatriation, both in and out of the anthropological literature, and in federal district court. The publications reviewed here exemplify this emerging multiplicity of practice in osteology and bioarchaeology, and therefore, in toto, incisively portray the complexities that repatriation has brought to skeletal inquiry in the United States.
A Reply to Besteman and Gusterson: Swinging the Pendulum
Authors: BUNZL MATTI 
Published: August 2010

ABSTRACTIn this rejoinder to Catherine Besteman and Hugh Gusterson, I clarify that my essay “The Quest for Anthropological Relevance: Borgesian Maps and Epistemological Pitfalls” is not primarily a critique of their volume Why America's Top Pundits Are Wrong (2005). Instead, I maintain that it takes issue with the current state of sociocultural anthropology and its inability to communicate with a larger public sphere. In conclusion, I reflect on the historical location of my argument, likening my position to advocacy for a swing in the discipline's epistemological pendulum and finding additional cause for such action in the realities of the current political moment.