bluuebunny/crossref_metadata_2025_split huggingface dataset:
Direct Observation Evaluations by Emergency Medicine Faculty Do Not Provide Data That Enhance Resident Assessment When Compared to Summative Quarterly Evaluations
Authors: Ryan James G. , Barlas David , Sharma Manish 
Published: October 2010

AbstractObjectives:  The purpose of this study was to compare quarterly global evaluations with direct observation evaluations to determine if direct observation evaluations provide unique data compared to those obtained from quarterly global evaluations.Methods:  This observational, cohort study was performed at a 3‐year emergency medicine (EM) residency program with 10 residents per year. Faculty used an online Web‐based evaluation system to complete quarterly global evaluations and patient‐specific direct observation evaluations. Two scores were collected for each resident within each quarterly evaluation period: 1) the quarterly evaluation score was the mean score across all faculty who performed a quarterly evaluation and, 2) the direct observation score was the mean score across all faculty who performed a direct observation evaluation. Pearson correlation coefficients were performed across these two groups of evaluations.Results:  Over the 4‐year period of the study 296 complete data sets were available for the analysis. When the quarterly evaluation score was correlated with the direct observation score for each resident at the same evaluation period, we found a very high correlation for each of the eight evaluation questions (r = 0.95–0.96, p < 0.0001). When these evaluations were stratified based on the number of direct observation evaluations that were performed during the evaluation period of interest, the correlation between the quarterly evaluation and the direct observation scores increased as the number of direct observations in the evaluation period increased. The evaluation scores from the faculty who had performed both direct observation and quarterly evaluation methods during the same resident evaluation period were highly correlated even with small numbers of evaluators.Conclusions:  Direct observations are highly correlated with quarterly evaluations when there are greater than three direct observation evaluations completed; however, this correlation drops significantly when the number of direct observations is lower. Direct observation evaluations provide similar data when compared with data obtained from quarterly global evaluations.ACADEMIC EMERGENCY MEDICINE 2010; 17:S72–S77 © 2010 by the Society for Academic Emergency Medicine
Anatomy of a Clerkship Test
Authors: Senecal Emily L. , Askew Kim , Gorney Barbara , Beeson Michael S. , Manthey David E. 
Published: October 2010

AbstractWritten examinations are frequently used to assess medical student performance. Within emergency medicine (EM), a National Board of Medical Examiners (NBME) subject examination for EM clerkships does not exist. As a result, clerkship directors frequently generate examinations within their institution. This article reviews the literature behind the use of standardized examinations in evaluating medical student performance, describes methods for generating well‐written test questions, reviews the statistical concepts of reliability and validity that are necessary to evaluate an examination, and proposes future directions for testing EM students.ACADEMIC EMERGENCY MEDICINE 2010; 17:S31–S37 © 2010 by the Society for Academic Emergency Medicine
Risk Factors for Acute Adverse Events During Ultrasound‐guided Central Venous Cannulation in the Emergency Department
Authors: Theodoro Daniel , Krauss Missy , Kollef Marin , Evanoff Bradley 
Published: October 2010

AbstractBackground:  Ultrasound (US) greatly facilitates cannulation of the internal jugular vein. Despite the ability to visualize the needle and anatomy, adverse events still occur. The authors hypothesized that the technique has limitations among certain patients and clinical scenarios.Objectives:  The purpose of this study was to identify characteristics of adverse events surrounding US‐guided central venous cannulation (CVC).Methods:  The authors assembled a prospective observational cohort of emergency department (ED) patients undergoing consecutive internal jugular CVC with US. The primary outcome of interest was a composite of acute mechanical adverse events including hematoma, arterial cannulation, pneumothorax, and unsuccessful placement. Physicians performing the CVC recorded anatomical site, reason for insertion, and acute complications. The patients with catheters were followed until the catheters were removed based on radiographic evidence or hospital nursing records. ED charts and pharmacy records contributed variables of interest. A self‐reported online survey provided physician experience information. Logistic regression was used to calculate the odds of an adverse outcome.Results:  Physicians attempted 289 CVCs on 282 patients. An adverse outcome occurred in 57 attempts (19.7%, 95% confidence interval [CI] = 15.5 to 24.7), the most common being 31 unsuccessful placements (11%, 95% CI = 7.7 to 14.8). Patients with a history of end‐stage renal disease (odds ratio [OR] = 3.54, 95% CI = 1.59 to 7.89), and central lines placed by operators with intermediate experience (OR = 2.26, 95% CI = 1.19 to 4.32), were most likely to encounter adverse events. Previously cited predictors such as body mass index (BMI), coagulopathy, and pulmonary hyperinflation were not significant in our final model.Conclusions:  Acute adverse events occurred in approximately one‐fifth of US‐guided internal jugular central line attempts. The study identified both patient (history of end‐stage renal disease) and physician (intermediate experience level) factors that are associated with acute adverse events.ACADEMIC EMERGENCY MEDICINE 2010; 17:1055–1061 © 2010 by the Society for Academic Emergency Medicine
Scholarly Tracks in Emergency Medicine
Authors: Regan Linda , Stahmer Sarah , Nyce Andrew , Nelson Bret P. , Moscati Ronald , Gisondi Michael A. , Hopson Laura R. 
Published: October 2010

AbstractOver the past decade, some residency programs in emergency medicine (EM) have implemented scholarly tracks into their curricula. The goal of the scholarly track is to identify a niche in which each trainee focuses his or her scholarly work during residency. The object of this paper is to discuss the current use, structure, and success of resident scholarly tracks. A working group of residency program leaders who had implemented scholarly tracks into their residency programs collated their approaches, implementation, and early outcomes through a survey disseminated through the Council of Emergency Medicine Residency Directors (CORD) list‐serve. At the 2009 CORD Academic Assembly, a session was held and attended by approximately 80 CORD members where the results were disseminated and discussed. The group examined the literature, discussed the successes and challenges faced during implementation and maintenance of the tracks, and developed a list of recommendations for successful incorporation of the scholarly track structure into a residency program. Our information comes from the experience at eight training programs (five 3‐year and three 4‐year programs), ranging from 8 to 14 residents per year. Two programs have been working with academic tracks for 8 years. Recommendations included creating clear goals and objectives for each track, matching track topics with faculty expertise, protecting time for both faculty and residents, and providing adequate mentorship for the residents. In summary, scholarly tracks encourage the trainee to develop an academic or clinical niche within EM during residency training. The benefits include increased overall resident satisfaction, increased success at obtaining faculty and fellowship positions after residency, and increased production of scholarly work. We believe that this model will also encourage increased numbers of trainees to choose careers in academic medicine.ACADEMIC EMERGENCY MEDICINE 2010; 17:S87–S94 © 2010 by the Society for Academic Emergency Medicine
The CORD Academy for Scholarship in Education in Emergency Medicine
Authors: LaMantia Joseph , Kuhn Gloria J. , Searle Nancy S. 
Published: October 2010

AbstractIn 2010 the Council of Emergency Medicine Residency Directors (CORD) established an Academy for Scholarship in Education in Emergency Medicine to define, promote, recognize, and reward excellence in education, education research, and education leadership in emergency medicine. In this article we describe the mission and aims of the Academy.  Academies for medical educators are widespread in medical schools today and have produced many benefits both for faculty and for educational programs. Little effort, however, has been devoted to such a model in graduate medical education specialty societies. While CORD and other emergency medicine organizations have developed numerous initiatives to advance excellence in education, we believe that this effort will be accelerated if housed in the form of an Academy that emphasizes scholarship in teaching and other education activities.  The CORD Academy for Scholarship in Education in Emergency Medicine is a new model for promoting excellence in education in graduate medical education specialty societies.ACADEMIC EMERGENCY MEDICINE 2010; 17:S13–S15 © 2010 by the Society for Academic Emergency Medicine
Emergency Medicine in the Medical School Curriculum
Authors: Wald David A. , Lin Michelle , Manthey David E. , Rogers Rob L. , Zun Leslie S. , Christopher Theodore 
Published: October 2010

AbstractEmergency medicine (EM) is a dynamic specialty that continues to define itself as a fertile training ground for medical students. Throughout the years, a number of U.S. medical schools have incorporated topics germane to EM training (basic cardiac life support, principles of wound care, splinting, basic procedural skills training, etc.) into the medical school curriculum. By virtue of their broad‐based training and the unique patient care environment that they practice in, EM specialists can serve a multitude of educational roles in the medical school. Whether serving as a problem‐based learning facilitator, collaborating with basic scientists, or teaching medical history‐taking and physical examination skills in the emergency department (ED), EM faculty can effectively teach future physicians in training. Although opportunities for teaching will vary by institution, often all it takes to get involved is asking. Teaching can take place in the ED, classroom, or simulation center, both in the preclinical and in the clinical curriculum. EM faculty may be well suited to help teach procedural skills to students as they enter their clinical clerkships. A formal rotation in EM can also assist the medical school in achieving their institutional objectives or in identifying ways to satisfy the Liaison Committee on Medical Education’s objectives. Patients presenting to the ED span the entire spectrum: young and old, sick and not sick. It is this variety of cases that makes the ED a truly valuable setting for educating students.ACADEMIC EMERGENCY MEDICINE 2010; 17:S26–S30 © 2010 by the Society for Academic Emergency Medicine
Critical Appraisal of Emergency Medicine Educational Research: The Best Publications of 2009
Authors: Kuhn Gloria J. , Shayne Philip , Coates Wendy C. , Fisher Jonathan , Lin Michelle , Maggio Lauren A. , Farrell Susan E. 
Published: October 2010

AbstractObjectives:  The objective was to critically appraise and highlight methodologically superior medical education research specific to emergency medicine (EM) published in 2009.Methods:  A search of the English language literature in 2009 querying Ovid MEDLINE In‐Process & Other Non‐Indexed Citations, Ovid MEDLINE 1950 to Present, Web of Science, Education Resources Information Center (ERIC), and PsychInfo identified 36 EM studies that used hypothesis‐testing or observational investigations of educational interventions. Six reviewers independently ranked all publications based on 10 criteria, including four related to methodology, that were chosen a priori to standardize evaluation by reviewers. This was a refinement of the methods used to appraise medical education published in 2008.Results:  Seven studies met the standards as determined by the averaged rankings and are highlighted and summarized here. This year, 16 of 36 (44%) identified studies had funding, compared to 11 of 30 (36%) identified last year; five of seven (71%) highlighted publications were funded in 2009 compared to three of five (60%) highlighted in 2008. Use of technology in medical education was reported in 14 identified and four highlighted publications, with simulation being the most common technology studied. Five of the seven (71%) featured publications used a quasi‐experimental or experimental design, one was observational, and one was qualitative. Practice management topics, including patient safety, efficiency, and revenue generation, were examined in seven reviewed studies.Conclusions:  Thirty‐six medical education publications published in 2009 focusing on EM were identified. This critical appraisal reviews and highlights seven studies that met a priori quality indicators. Current trends are noted.ACADEMIC EMERGENCY MEDICINE 2010; 17:S16–S25 © 2010 by the Society for Academic Emergency Medicine
Influence of water stress on the glucosinolate profile of Brassica oleracea var. italica and the performance of Brevicoryne brassicae and Myzus persicae
Authors: Khan M.A.M. , Ulrichs Christian , Mewis Inga 
Published: October 2010

AbstractDrought stress alters the chemical composition of plants, which can influence their tolerance to insect herbivory. To evaluate plant chemical responses to drought stress, broccoli, Brassica oleracea L. var. italica Plenck (Brassicaceae), was grown under well‐watered, drought, and water‐logged conditions. The glucosinolate (GS) levels and the performance of two aphid species, the specialist Brevicoryne brassicae (L.) and the generalist Myzus persicae (Sulzer) (both Hemiptera: Aphididae), in relation to water stress conditions were studied. High Performance Liquid Chromatography analysis showed that water stress changed the levels of GS in broccoli plants. Plants grown for 2 weeks under drought stress were significantly smaller and showed decreased levels of total GS when compared with GS contents of well‐watered plants, whereas water‐logged conditions led to a slight increase in the GS contents. A substantial decrease in indolyl GS was detected in water‐deficient plants, whereas aliphatic GS decreased slightly. Analysis of sugar levels in phloem sap of broccoli plants revealed that plants under water‐logged conditions contained the highest amounts of sugars followed by drought‐stressed and well‐watered plants. The two aphid species responded differently to water stress‐induced changes in their host plants. Significantly larger populations of M. persicae were recorded on plants with a limited water supply than on plants grown under well‐watered or water‐logged conditions. Brevicoryne brassicae was less affected by water stress, and similar population sizes were found on plants that were subject to different treatments. Analysis of covariance showed a significant effect of the plants’ water condition but no significant effect of GS content on the performance of M. persicae. However, the specialist B. brassicae remained unaffected by changes induced under water stress conditions.
Telocytes in human isolated atrial amyloidosis: ultrastructural remodelling
Authors: Mandache E. , Gherghiceanu M. , Macarie C. , Kostin S. , Popescu L. M. 
Published: October 2010

AbstractThe human heart can be frequently affected by an organ‐limited amyloidosis called isolated atrial amyloidosis (IAA). IAA is a frequent histopathological finding in patients with long‐standing atrial fibrillation (AF). The aim of this paper was to investigate the ultrastructure of cardiomyocytes and telocytes in patients with AF and IAA. Human atrial biopsies were obtained from 37 patients undergoing cardiac surgery, 23 having AF (62%). Small fragments were harvested from the left and right atrial appendages and from the atrial sleeves of pulmonary veins and processed for electron microscopy (EM). Additional fragments were paraffin embedded for Congo‐red staining. The EM examination certified that 17 patients had IAA and 82% of them had AF. EM showed that amyloid deposits, composed of characteristic 10‐nm‐thick filaments were strictly extra‐cellular. Although, under light microscope some amyloid deposits seemed to be located within the cardiomyocyte cytoplasm, EM showed that these deposits are actually located in interstitial recesses. Moreover, EM revealed that telopodes, the long and slender processes of telocytes, usually surround the amyloid deposits limiting their spreading into the interstitium. Our results come to endorse the presumptive association of AF and IAA, and show the exclusive, extracellular localization of amyloid fibrils. The particular connection of telopodes with amyloid deposits suggests their involvement in isolated atrial amyloidosis and AF pathogenesis.
Characterisation of zuclopenthixol metabolism by in vitro and therapeutic drug monitoring studies
Authors: Davies S. J. C. , Westin A. A. , Castberg I. , Lewis G. , Lennard M. S. , Taylor S. , Spigset O. 
Published: October 2010

Davies SJC, Westin AA, Castberg I, Lewis G, Lennard MS, Taylor S, Spigset O. Characterisation of zuclopenthixol metabolism by in vitro and therapeutic drug monitoring studies.Objective:  Zuclopenthixol pharmacokinetics is incompletely characterised. We investigated potential interactions mediated through cytochrome P450 enzymes.Method:  In vitro, we examined the impact of CYP2D6 and CYP3A4 inhibitors on zuclopenthixol metabolism in microsomes from six human livers. Subsequently, we compared dose‐corrected serum zuclopenthixol concentrations in 923 samples from a therapeutic drug monitoring database from patients prescribed oral (n = 490) or injected (n = 423) zuclopenthixol alone or with fluoxetine, paroxetine, levomepromazine or carbamazepine.Results:  In vitro fluoxetine, paroxetine, ketoconazole and quinidine all significantly inhibited zuclopenthixol metabolism. Ketoconazole and quinidine together abolished zuclopenthixol disappearance. Clinically, dose‐corrected oral zuclopenthixol serum concentrations increased significantly, after adjustment, by 93%, 78% and 46% during co‐treatment with fluoxetine, paroxetine and levomepromazine and decreased 67% with carbamazepine. Carbamazepine caused dose‐dependent reductions in the oral zuclopenthixol concentration–dose ratio (P < 0.001), fluoxetine (P < 0.001) and paroxetine (P = 0.011) dose‐dependent increases and levomepromazine an increase related to its serum concentration (P < 0.001). Results for injected zuclopenthixol were similar but not all reached statistical significance.Conclusion:  The In vitro study suggests zuclopenthixol is metabolised primarily by CYP2D6 and CYP3A4. The clinical study supports this, demonstrating the impact of co‐prescribed inhibitors or inducers. Guidelines should incorporate these interactions noting the potential for zuclopenthixol‐related toxicity or treatment failure.
Dalteparin, a low‐molecular‐weight heparin, promotes angiogenesis mediated by heparin‐binding VEGF‐A in vivo
Authors: NORRBY KLAS , NORDENHEM ARVID 
Published: October 2010

Norrby K, Nordenhem A. Dalteparin, a low‐molecular‐weight heparin, promotes angiogenesis mediated by heparin‐binding VEGF‐A in vivo. APMIS 2010; 118: 949–57.Tumors are angiogenesis dependent and vascular endothelial growth factor‐A (VEGF‐A), a heparin‐binding protein, is a key angiogenic factor. As chemotherapy and co‐treatment with anticoagulant low‐molecular‐weight heparin (LMWH) are common in cancer patients, we investigated whether angiogenesis in vivo mediated by VEGF‐A is modulated by metronomic‐type treatment with: (i) the LMWH dalteparin; (ii) low‐dosage cytostatic epirubicin; or (iii) a combination of these two drugs. Using the quantitative rat mesentery angiogenesis assay, in which angiogenesis was induced by intraperitoneal injection of very low doses of VEGF, dalteparin sodium (Fragmin®) and epirubicin (Farmorubicin®) were administered separately or in combination by continuous subcutaneous infusion at a constant rate for 14 consecutive days. Dalteparin was administered at 27, 80, or 240 IU/kg/day, i.e., doses that reflect the clinical usage of this drug, while epirubicin was given at the well‐tolerated dosage of 0.4 mg/kg/day. While dalteparin significantly stimulated angiogenesis in an inversely dose‐dependent manner, epirubicin did not significantly affect angiogenesis. However, concurrent treatment with dalteparin and epirubicin significantly inhibited angiogenesis. The effect of dalteparin is the first demonstration of a proangiogenic effect of any LMWH in vivo. The fact that co‐treatment with dalteparin and epirubicin significantly inhibited angiogenesis suggests a complex drug effect.
Fusobacterium necrophorum– detection and identification on a selective agar
Authors: BANK STEFFEN , NIELSEN HANNE MERETE , HOYER MATHIASEN BORIS , CHRISTIANSEN LETH DORTE , HAGELSKJÆR KRISTENSEN LENA , PRAG JØRGEN 
Published: October 2010

Bank S, Nielsen HM, Hoyer Mathiasen B, Christiansen Leth D, Hagelskjær Kristensen L, Prag J. Fusobacterium necrophorum– detection and identification on a selective agar. APMIS 2010; 118: 994–9.Within the last decade, Fusobacterium necrophorum subsp. funduliforme has been considered a clinically important pathogen causing pharyngitis especially in adolescents and young adults. F. necrophorum pharyngitis can progress into Lemierre’s syndrome, which is a severe and life‐threatening infection. However, throat swabs are not cultured anaerobically in the routine and even if cultured anaerobically, it can be difficult to identify F. necrophorum from the normal flora of the throat. F. necrophorum is therefore often overlooked as the cause of pharyngitis. In our laboratory, a F. necrophorum selective agar has been developed containing vancomycin and nalidixin, which inhibit the growth of most Gram‐positive and many Gram‐negative bacteria, respectively. β‐haemolysis of horse blood can be detected, which further facilitates the detection and identification of F. necrophorum. The F. necrophorum selective agar was evaluated against a quantitative real‐time polymerase chain reaction assay and shown to have a significantly higher sensitivity for detecting F. necrophorum than the anaerobic agar commonly used in Denmark. Furthermore, the F. necrophorum selective agar does not require experienced laboratory technicians, require fewer subcultures, is probably less expensive and is faster to perform than other culture methods.