bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ranking Hospitals on Surgical Mortality: The Importance of Reliability Adjustment
Authors: Dimick Justin B. , Staiger Douglas O. , Birkmeyer John D. 
Published: August 2010

Objective. We examined the implications of reliability adjustment on hospital mortality with surgery.Data Source. We used national Medicare data (2003–2006) for three surgical procedures: coronary artery bypass grafting (CABG), abdominal aortic aneurysm (AAA) repair, and pancreatic resection.Study Design. We conducted an observational study to evaluate the impact of reliability adjustment on hospital mortality rankings. Using hierarchical modeling, we adjusted hospital mortality for reliability using empirical Bayes techniques. We assessed the implication of this adjustment on the apparent variation across hospitals and the ability of historical hospital mortality rates (2003–2004) to forecast future mortality (2005–2006).Principal Findings. The net effect of reliability adjustment was to greatly diminish apparent variation for all three operations. Reliability adjustment was also particularly important for identifying hospitals with the lowest future mortality. Without reliability adjustment, hospitals in the “best” quintile (2003–2004) with pancreatic resection had a mortality of 7.6 percent in 2005–2006; with reliability adjustment, the “best” hospital quintile had a mortality of 2.7 percent in 2005–2006. For AAA repair, reliability adjustment also improved the ability to identify hospitals with lower future mortality. For CABG, the benefits of reliability adjustment were limited to the lowest volume hospitals.Conclusion. Reliability adjustment results in more stable estimates of mortality that better forecast future performance. This statistical technique is crucial for helping patients select the best hospitals for specific procedures, particularly uncommon ones, and should be used for public reporting of hospital mortality.
Influence of Preliminary Damage on the Load‐Bearing Capacity of Zirconia Fixed Dental Prostheses
Authors: Kohorst Philipp , Butzheinen Lutz Oliver , Dittmer Marc Philipp , Heuer Wieland , Borchers Lothar , Stiesch Meike 
Published: August 2010

AbstractPurpose:The objective of this investigation was to evaluate the influence of differently shaped preliminary cuts in combination with artificial aging on the load‐bearing capacity of four‐unit zirconia fixed dental prostheses (FDPs).Materials and Methods:Forty frameworks were fabricated from white‐stage zirconia blanks (InCeram YZ, Vita) by means of a computer‐aided design/computer‐aided manufacturing system (Cerec inLab, Sirona). Frameworks were divided into four homogeneous groups with ten specimens each. Prior to veneering, frameworks of two groups were “damaged” by defined saw cuts of different dimensions, to simulate accidental flaws generated during shape cutting. After the veneering process, FDPs, with the exception of a control group without preliminary damage, were subjected to thermal and mechanical cycling (TMC) during 200 days storage in distilled water at 36°C. Following the aging procedure, all specimens were loaded until fracture, and forces at fracture were recorded. The statistical analysis of force at fracture data was performed using two‐way ANOVA, with the level of significance chosen at 0.05.Results:Neither type of preliminary mechanical damage significantly affected the load‐bearing capacity of FDPs. In contrast, artificial aging by TMC proved to have a significant influence on the load‐bearing capacity of both the undamaged and the predamaged zirconia restorations (p< 0.001); however, even though load‐bearing capacity decreased by about 20% due to simulated aging, the FDPs still showed mean load‐bearing capacities of about 1600 N.Conclusions:The results of this study reveal that zirconia restorations have a high tolerance regarding mechanical damages. Irrespective of these findings, damage to zirconia ceramics during production or finishing should be avoided, as this may nevertheless lead to subcritical crack growth and, eventually, catastrophic failure. Furthermore, to ensure long‐term clinical success, the design of zirconia restorations has to accommodate the decrease in load‐bearing capacity due to TMC in the oral environment.
Incidence and transfusion risk factors for transfusion‐associated circulatory overload among medical intensive care unit patients
Authors: Li Guangxi , Rachmale Sonal , Kojicic Marija , Shahjehan Khurram , Malinchoc Michael , Kor Daryl J. , Gajic Ognjen 
Published: August 2010

BACKGROUND: Transfusion‐associated circulatory overload (TACO) is a frequent complication of blood transfusion. Investigations identifying risk factors for TACO in critically ill patients are lacking.STUDY DESIGN AND METHODS: We performed a 2‐year prospective cohort study of consecutive patients receiving blood product transfusion in the medical intensive care unit (ICU) of the tertiary care institution. Patients were followed for development of transfusion‐related complications. TACO was defined as acute hydrostatic pulmonary edema occurring within 6 hours of transfusion. In a nested case‐control design, transfusion characteristics were compared between cases (TACO) and controls after matching by age, sex, and ICU admission diagnostic category. In a secondary analysis, patient characteristics before transfusion were compared between cases (TACO) and randomly selected controls.RESULTS: Fifty‐one of 901 (6%) transfused patients developed TACO. Compared with matched controls, TACO cases had a more positive fluid balance (1.4 L vs. 0.8 L, p = 0.003), larger amount of plasma transfused (0.4 L vs. 0.07 L, p = 0.007), and faster rate of blood component transfusion (225 mL/hr vs. 168 mL/hr, p = 0.031). In a secondary analysis comparing TACO cases and random controls, left ventricular dysfunction before transfusion (odds ratio [OR], 8.23; 95% confidence interval [CI], 3.36‐21.97) and plasma ordered for the reversal of anticoagulant (OR, 4.31; 95% CI, 1.45‐14.30) were significantly related to the development of TACO.CONCLUSION: Volume of transfused plasma and the rate of transfusion were identified as transfusion‐specific risk factors for TACO. Left ventricular dysfunction and fresh‐frozen plasma ordered for the reversal of anticoagulant were strong predictors of TACO before the onset of transfusion.
Loss Reduction Through Worker Satisfaction: The Case of Workers’ Compensation
Authors: Butler Richard J. , Johnson William G. 
Published: August 2010

AbstractA prospective study of occupational low back pain (LBP) indicates loss reduction efforts in workers’ compensation that improve workers satisfaction with the treatment of their claim significantly improves levels of recovery (reduces losses) and lowers workers’ compensation insurance costs. The improved outcomes associated with greater worker satisfaction with the firm's treatment of their injury claim, as well as with the treatment from their health care provider, are robust to five alternative measures of back problems, including leg pain and back pain scales, measures of functional limitation, and quality of life scales. Satisfaction with effectiveness of the health care is more important in recovery than satisfaction with the provider's bedside manner. While satisfaction with health care provider significantly improves back pain and functionality at 6 months, satisfaction with the employer's treatment of the claim is equally important at 6 months and grows in quantitative importance at 1 year. Overall, higher satisfaction with claim treatment reduces the likelihood that an injury becomes an indemnity claim and results in almost a 30 percent reduction in claim costs.
Oregon Trauma System: Change in Initial Admission Site and Post‐admission Transfer of Injured Patients
Authors: Hedges Jerris R. , Mullins Richard J. , Zimmer‐Gembeck Melanie , Helfand Mark , Southard Patricia 
Published: August 2010

ABSTRACT Objective:Associate statewide trauma system development with a change in the percentage of injured patients initially hospitalized at Levels I and II categorized trauma hospitals and a change in the length of stay (LOS) prior to arrival at a Level I or II hospital (PRE‐LOS) and total LOS (T‐LOS) for post‐admission transfer patients. Methods:A retrospective analysis was performed using a hospital discharge database of 235,395 discharges with codes for acute injury managed at 74 acute care hospitals in Oregon State from 1983 to 1991. Primary outcome measures were admission site and transfer patient PRE‐LOS and T‐LOS. Predictor variables included category of initial hospital admission site, injury severity scale (ISS) score, head injury, age, and status of trauma system (pre‐system, 1983 to 1987; transitional, 1988 to 1989; and post‐system, 1991 to 1992). Results:There was a significant increase in the percentage of initial admissions to hospitals with Level I or II categorization (17.6%, 26.2%, and 27.6% for the three periods of development, respectively; p < 0.00001). The percentage of patients with ISS scores greater than 15 admitted initially to Level I or II hospitals increased from 33.4% to 52.6% and 57.3%; p < 0.00001). Only 1,059 (0.57%) of 185,321 patients initially admitted to Level III, Level IV, or noncategorized hospitals were transferred to a Level I or II hospital. Mean PRE‐LOS for the 1,059 transferred patients showed a significant decrease with system development (2.3, 1.9, and 1.8 days, respectively; p < 0.02). When adjusted for age, ISS score, and head injury effects, mean T‐LOS was significantly reduced for the transitional and post‐system periods (p < 0.05). Conclusions:In Oregon, development of a statewide trauma system was associated with increased initial admissions to Level I and II trauma hospitals. For those patients transferred to higher levels of care post‐admission, hospital LOSs were decreased with trauma system development.
Stress Levels in EMS Personnel: A Longitudinal Study with Work‐schedule Modification
Authors: Cydulka Rita K. , Emerman Charles L. , Shade Bruce , Kubincanek John 
Published: August 2010

ABSTRACT Objective:To determine if stress levels of emergency medical services (EMS) personnel can be reduced by adjusting work schedules to personnel preferences. Methods:A prospective, longitudinal, cohort study with a work‐schedule modification intervention was performed. All EMS personnel employed by the City of Cleveland EMS were eligible for participation. EMS employees voluntarily completed an abbreviated medical personnel stress survey (MPSS‐R), a 20‐question validated stress‐assessment tool, in September 1989, February 1991, and September 1991. A new scheduling pattern was introduced March 1991. At that time, 27 EMS employees volunteered to work the new schedule (12 hours/shift: 3 days on/2 days off/2 days on/3 days off). The remaining 109 EMS employees remained on the old schedule (8 hours/shift: 6 days on/2 days off). Results:Mean MPSS‐R stress scores increased significantly from September 1990 (61.9 ± 7.87) to September 1991 (65.08± 7.23) (p < 0.05). In September 1991, mean stress scores of EMS personnel working the new schedule (64.39± 7.82) were not significantly lower than stress scores of EMS personnel working the old schedule (65.25 ± 7.10). Conclusion:Stress in EMS personnel increased despite a new schedule pattern designed to accommodate the preferences of EMS personnel.
Social‐work Services in an Emergency Department: An Integral Part of the Health Care Safety Net
Authors: Wrenn Keith , Rice Nancy 
Published: August 2010

ABSTRACT Objective:To quantify and describe the activities of social workers dedicated to a large urban emergency department (ED). Methods:A retrospective case series of all patients seen by social workers in an urban university hospital ED over a period of six weeks. Results:Social‐work service was provided to 5% of ED patients. Three distinct groups of patients were usually seen by social workers: the elderly, young adults, and children less than 5 years of age. The median age of the group referred for social work services was greater than that of the ED population as a whole; triage acuity also was greater in the referred group. The types of services provided varied with age. Among those patients with social‐work consultations, the average time spent with each patient was over one hour and did not vary according to the age, sex, race, or insurance status of the patient. More than 60% of the social worker's time was spent with patients or their significant others. Conclusion:Social workers provide valuable services to ED patients. The availability of social workers in the ED reduces the demands for emergency physicians and nurses to arrange home health care, nursing home placement, and other social‐service functions. Cost savings through diversion of nonacute social admissions are possible. The types of services provided vary and depend to a large extent on patient age. The availability of dedicated social‐work personnel in the ED and the education of emergency personnel regarding the services that they can provide should be beneficial for patients, staff, and the hospital served.
A Prospective Evaluation of Risk Factors for Infections from Dog‐bite Wounds
Authors: Dire Daniel J. , Hogan David E. , Riggs Mark W. 
Published: August 2010

ABSTRACT Objective:To define risk factors for infections from dog‐bite wounds and to model the probability of wound infection in patients presenting without infection who are treated as outpatients. Methods:A prospective survey of 769 consecutive dog‐bite victims presenting over a two‐year period to a community hospital emergency department (ED) with an emergency medicine residency program. A standardized wound‐cleaning protocol was used, which included debride‐ment and wound closure when indicated. Wounds were examined for infection at follow‐up. Variables analyzed included demographic data (patient age, gender, race); wound information (wound age, type, number, location, depth); and treatment (prior to hospital, ED debridement, suturing, tetanus or rabies shots, antibiotics). Results:There were 734 patients with complete records. These patients had a mean age of 13.4 ± 13.2 years (range, 4 months to 71 years). Infection was evident in 2.5% of the wounds upon presentation. There were 704 patients (765 wounds) managed as outpatients and without wound infection at initial presentation. Wounds were distributed as follows: 26.7% head/neck, 20.4% hand, 15.7% arm, 10.1% trunk, 9.5% thigh, 15.9% leg, and 1.7% foot. There were 32.9% puncture, 39.9% full‐thickness, and 60.1% partial‐thickness wounds. Wound infections were diagnosed in 2.1% of these wounds at follow‐up. Wounds requiring surgical debridement had a sevenfold higher infection rate (p = 0.01). Patients more than 50 years of age had a sixfold higher infection rate than younger patients (p = 0.05). Stepwise logistic regression found the following variables to be the best predictors for wound infection: full‐thickness [p = 0.006, odds ratio (OR) = 6.23], female gender (p = 0.048, OR = 2.88), and wound debridement (p = 0.024, OR = 5.01). Combinations of these three variables predict infection rates from 0.35% to 23.9%. Conclusion:A low wound infection rate was seen in this cohort of dog‐bite victims who were treated on an outpatient basts. Wound depth, patient gender, and wound debridement were the clinical variables that best predicted the likelihood of developing infection. Future intervention‐al studies should concentrate on wounds with high probabilities of infection.
Closed Reduction of a Traumatically Dislocated Testicle
Authors: Madden John F. 
Published: August 2010

ABSTRACTTraumatic testicular dislocation is an uncommon event, with fewer than 60 cases having been reported in the literature. It is imperative that the emergency physician be aware of the possibility of testicular dislocation following perineal trauma and either seek emergent urologic consultation or attempt relocation of the testicle immediately. Testicular dislocation (following a motorcycle crash) that was successfully managed by closed reduction in the emergency department (ED) is presented. Following a benign course during subsequent observation, the patient was released with close urologic follow‐up.
A Public Health Approach to Emergency Medicine: Preparing for the Twenty‐first Century
Authors: Bernstein Edward , Goldrank Lewis R. , Kellerman Arthur L. , Hargarten Stephen W. , Jui Jonathon , Fish Susan S. , Herbert Barbara H. , Flores Carlos , Caravati Martin E. , Krishel Scott , Stevens Carl D. , Kirsch Thomas D. , Lowe Robert A. , Lowenstein S. R. , Baraff Larry J. , Mueller‐Orsay Elizabeth J. , Ling Louis J. , Sklar David P. 
Published: August 2010

ABSTRACTThis paper focuses on the implications of an inadequate public health/ preventive health care system for emergency medicine (EM), the role that EM providers can play in remedying critical health problems, and the benefits gained from a public health approach to EM. A broad definition of public health is adopted, suggesting shared goals of public health and EM. Critical problems posed for EM include alcohol, tobacco, and other drug abuse; injury; violence; sexually transmitted diseases and human immunodeficiency virus (HIV) infection; occupational and environmental exposures; and the unmet health needs of minorities and women. A blueprint for future merging of public health issues with EM is presented that includes the application of public health principles to 1) clinical practice; 2) public education, community involvement, and public policy advocacy; 3) development of medical school and residency public health/ prevention curricula and teaching methods; and 4) research opportunities and surveillance. Finally, recommendations are proposed that require restructuring the present health care system to provide resources, incentives, and organizational changes that promote an integration of public health and preventive services in the practice of EM.
Methodology‐dependent Variation in Documentation of Outcome Predictors in Out‐of‐hospital Cardiac Arrest
Authors: Gallagher E. John , Lombardi Gary , Gennis Paul , Treiber Marsha 
Published: August 2010

ABSTRACT Objective: To identify variation in outcome predictor documentation in out‐of‐hospital cardiac arrest associated with two different methods of data collection: concurrent questioning of personnel following a resuscitation attempt and archival report review. Methods: All patients ≤ 18 years old who had had out‐of‐hospital cardiac arrests, verified using the New York City 911 telephone system, between October 1, 1990, and April 1, 1991, were eligible for inclusion. The authors reviewed the first 200 cases of presumed primary cardiac arrest involving a resuscitation attempt from among 3,243 consecutive ambulance call reports for cardiac arrest occurring during the study period. This archival data set was compared with data for the same 200 cases gathered through direct interview of field personnel by trained paramedics. The two data sets had been compiled independently by different individuals, using the same data collection instrument, which conformed to the Utstein template. Results: Comparison of the data obtained from ambulance records with the data obtained from interviews of prehospital personnel revealed several areas of variance. Of note was a significantly lower proportion of bystander‐witnessed ventricular fibrillation (VF) in the data set gathered from written reports (7% vs 18%; 95% CI for the difference 4–18%; p = 0.001). Conclusion: Differences in methods of collection of out‐of‐hospital cardiac arrest data are associated with a more than twofold variation in the reported incidences of witnessed cardiac arrests manifesting as VF. Methodology‐dependent variation in this important “denominator” may produce substantially different estimates of survival within the same cohort of patients.
Abdominal Pumping
Authors: Hillman Harold 
Published: August 2010

ABSTRACTThis article reviews the author's experience with a form of interposed abdominal compression cardiopulmonary resuscitation (IAC‐CPR) in the United Kingdom. The development of the technique based upon animal resuscitation, including the use of phasic compression (abdominal pumping) for the resuscitation of rats from 30 minutes of cardiac arrest due to hypothermia, is reviewed. A simple technique for clinical use is described. The technique uses a hard‐covered book or bean‐shaped board applied to the abdomen below the umbilicus and compressed alternately with cardiac massage while respiration is assisted. Anecdotal clinical results suggest that further controlled clinical investigation is warranted.
Hemodynamics, Survival Benefits, and Complications of Interposed Abdominal Compression during Cardiopulmonary Resuscitation
Authors: Sack Jeffrey B. , Kesselbrenner Michael B. 
Published: August 2010

ABSTRACT Objective: To review and describe the hemodynamics and mechanism of benefit of interposed abdominal compression cardiopulmonary resuscitation (IAC‐CPR) as well as the current complications and survival data withtheuseoflAC‐CPR. Methods: Critical review of selected, published English‐language studies analyzing IAC‐CPR. Overview of hemodynamic effects, complications, and survival data of IAC‐CPR vs standard CPR. Results: Several investigators have demonstrated improvements in coronary perfusion pressure, carotid and cerebral blood flows, and augmented venous return using IAC‐CPR compared with standard CPR. Recently, IAC‐CPR has been shown to improve survival from in‐hospital cardiac arrest. To date, there has been no increase in complications seen with the use of abdominal compression during CPR. Recommendations: IAC‐CPR should be considered an adjunct to standard CPR for adult patients experiencing in‐hospital cardiac arrest, after an adequate airway has been secured. More research is needed before IAC‐CPR can be recommended for out‐of‐hospital cardiac arrest, for patients who have not been intubated, or for children.
Comparison of Hydromorphone and Meperidine for Ureteral Colic
Authors: Jasani Neil B. , O'Connor Robert E. , Bouzoukis James K. 
Published: August 2010

ABSTRACTObjective:To compare the efficacies of meperidine and hydromorphone in the treatment for ureteral colic in the emergency department (ED).Methods:A prospective, double‐blind, randomized clinical trial was conducted over six months at a tertiary referral center with 93,000 annual ED visits. Seventy‐three patients completed the study. The patients received either 1 mg of hydromorphone or 50 mg of meperidine IV at t = 0. Pain intensity was determined using a 10‐cm visual analog scale at t = 0, 15, 30, 60, and 120 minutes. A second dose of the study drug could be given between t = 15 and t = 120 minutes when the clinician believed the initial dose was ineffective. Patients requiring more than one additional dose of analgesia were treated as nonresponders and were removed from the study.Results:Thirty‐six patients received hydromorphone and 37 received meperidine. The initial pain intensities (hydromorphone group = 8.4 ± 1.5; meperidine group = 8.5 ± 2.1), age distributions, sex distributions, and side effects of the two groups were comparable. Pain relief was better (p < 0.05) with hydromorphone at t = 15, 30, 60, and 120 minutes. The hydromorphone group required rescue analgesia less often (31% vs 68%, p < 0.01), had fewer IV pyelographies (IVPs) (28% vs 54%, p < 0.05), and had a lower proportion of hospital admissions (25% vs 49%, p = 0.08).Conclusions:For the fixed doses used in this study, the adult ureteral colic patients receiving hydromorphone achieved more pain relief, required less rescue medication, underwent fewer IVPs, and avoided hospital admission more frequently than did those receiving meperidine.