bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Bedside Ultrasound to Assess Degree of Dehydration in Children With Gastroenteritis
Authors: Chen Lei , Hsiao Allen , Langhan Melissa , Riera Antonio , Santucci Karen A. 
Published: October 2010

AbstractObjectives:  Prospectively identifying children with significant dehydration from gastroenteritis is difficult in acute care settings. Previous work by our group has shown that bedside ultrasound (US) measurement of the inferior vena cava (IVC) and the aorta (Ao) diameter ratio is correlated with intravascular volume. This study was designed to validate the use of this method in the prospective identification of children with dehydration by investigating whether the IVC/Ao ratio correlated with dehydration in children with acute gastroenteritis. Another objective was to investigate the interrater reliability of the IVC/Ao measurements.Methods:  A prospective observational study was carried out in a pediatric emergency department (PED) between November 2007 and June 2009. Children with acute gastroenteritis were enrolled as subjects. A pair of investigators obtained transverse images of the IVC and Ao using bedside US. The ratio of IVC and Ao diameters (IVC/Ao) was calculated. Subjects were asked to return after resolution of symptoms. The difference between the convalescent weight and ill weight was used to calculate the degree of dehydration. Greater than or equal to 5% difference was judged to be significant. Linear regression was performed with dehydration as the dependent variable and the IVC/Ao as the independent variable. Pearson’s correlation coefficient was calculated to assess the degree of agreement between observers.Results:  A total of 112 subjects were enrolled. Seventy‐one subjects (63%) completed follow‐up. Twenty‐eight subjects (39%) had significant dehydration. The linear regression model resulted in an R2 value of 0.21 (p < 0.001) and a slope (B) of 0.11 (95% confidence interval [CI] = 0.08 to 0.14). An IVC/Ao cutoff of 0.8 produced a sensitivity of 86% and a specificity of 56% for the diagnosis of significant dehydration. Forty‐eight paired measurements of IVC/Ao ratios were made. The Pearson correlation coefficient was 0.76.Conclusions:  In this pilot study the ratio of IVC to Ao diameters, as measured by bedside US, was a marginally accurate measurement of acute weight loss in children with dehydration from gastroenteritis. The technique demonstrated good interrater reliability.ACADEMIC EMERGENCY MEDICINE 2010; 17:1042–1047 © 2010 by the Society for Academic Emergency Medicine
Inaccuracy of the Global Assessment Score in the Emergency Medicine Standard Letter of Recommendation
Authors: Oyama Leslie C. , Kwon Manon , Fernandez Jorge A. , Fernández‐Frackelton Madonna , Campagne Danielle D. , Castillo Edward M. , Lin Michelle 
Published: October 2010

AbstractObjectives:  The standard letter of recommendation (SLOR) is used by most emergency medicine (EM) faculty to submit evaluations for medical students applying for EM residency programs. In the global assessment score (GAS) section, there is a crucial summative question that asks letter writers to estimate the applicant’s rank order list (ROL) position in their own program. The primary aim of the study was to determine if these estimated global assessment tiers agreed with the actual ROL, using the criteria recommended by the Council of Emergency Medicine Residency Directors (CORD).Methods:  Data from SLORs written by EM faculty from five California institutions were retrospectively collected from the 2008–2009 residency application year. Descriptive and comparative statistical analyses were performed using the documented GAS tiers and actual ROL positions.Results:  A total of 105 SLORs were reviewed from the five participating institutions. Three SLORs were excluded and 102 were analyzed. Only 27 (26%) SLORs documented a GAS tier that accurately predicted the applicant’s actual ROL position. The GAS tier overestimated the applicant’s position on the ROL in 67 (66%) SLORs, whereas it underestimated the position in eight (8%) SLORs. Accuracy was poor regardless of the number of letter writers on the SLOR (p = 0.890), the writer’s administrative title (p = 0.326), whether the student was a home or visiting student (p = 0.801), or if the student had prior EM rotation experience (p = 0.793).Conclusions:  Standard letter of recommendation writers are inaccurate in estimating the ROL position of the applicant using the GAS tier criteria. The GAS tiers were accurate only 26% of the time. Because of the valuable role that the SLOR plays in determining an applicant’s competitiveness in the National Resident Matching Program (NRMP) in EM, future discussion should focus on improving the consistency and accuracy of the GAS section. Furthermore, there needs to be a national dialogue to reassess the utility of the criterion‐based GAS within the SLOR.ACADEMIC EMERGENCY MEDICINE 2010; 17:S38–S41 © 2010 by the Society for Academic Emergency Medicine
Feasibility and Reliability of the SHOT: A Short Scale for Measuring Pretreatment Severity of Alcohol Withdrawal in the Emergency Department
Authors: Gray Sara , Borgundvaag Bjug , Sirvastava Anita , Randall Ian , Kahan Meldon 
Published: October 2010

AbstractBackground:  Use of a symptom‐triggered scale to measure the severity of alcohol withdrawal could reduce the rate of seizures and other complications. The current standard scale, the Clinical Institute of Withdrawal Assessment (CIWA), takes a mean (±SD) of 5 minutes to complete, requiring 30 minutes of nursing time per patient when multiple measures are required.Objectives:  The objective was to assess the feasibility and reliability of a brief scale of alcohol withdrawal severity.Methods:  The SHOT is a brief scale designed to assess alcohol withdrawal in the emergency department (ED). It includes four items: sweating, hallucinations, orientation, and tremor (SHOT). It was developed based on a literature review and a consensus process by emergency and addiction physicians. The SHOT was first piloted in one ED, and then a prospective observational study was conducted at a different ED to measure its feasibility and reliability. Subjects included patients who were in alcohol withdrawal. One nurse administered the SHOT and CIWA, and the physician repeated the SHOT independently. The SHOT was done only at baseline, before treatment was administered.Results:  In the pilot study (12 patients), the SHOT took 1 minute to complete on average, and the CIWA took 5 minutes. Sixty‐one patients participated in the prospective study. For the SHOT and the CIWA done by the same nurse, the kappa was 0.88 (95% confidence interval [CI] = 0.52 to 1.0; p < 0.0001), and the Pearson’s r was 0.71 (p < 0.001). The kappa for the nurse’s CIWA score and the physician’s SHOT score was 0.61 (95% CI = 0.25 to 0.97; p < 0.0006), and the Pearson’s r was 0.48 (p = 0.002). The SHOTs performed by the nurse and physician agreed on the need for benzodiazepine treatment in 30 of 37 cases (82% agreement, kappa = 0.35, 95% CI = 0.03 to 0.67; p < 0.02). The mean (±SD) time taken by nurses and physicians to complete the SHOT was 1 (± 0.52) minute (median = 0.6 minutes). Seventeen percent of patients scored positive on the SHOT for hallucinations or disorientation.Conclusions:  The SHOT has potential as a feasible and acceptable tool for measuring pretreatment alcohol withdrawal severity in the ED. Further research is needed to validate the SHOT, to assess the utility of serial measurements of the SHOT, and to demonstrate that its use reduces length of stay and improves clinical outcomes.ACADEMIC EMERGENCY MEDICINE 2010; 17:1048–1054 © 2010 by the Society for Academic Emergency Medicine
An Evaluation of Resident Work Profiles, Attending–Resident Teaching Interactions, and the Effect of Variations in Emergency Department Volume on Each
Authors: Thibodeau Lorraine G. , Geary Sean P. , Werter Christopher 
Published: October 2010

AbstractObjectives:  This study examines the effect of variations in emergency department (ED) volume on physician work efficiency (new patients per hour) and work profile (patient‐related activities, including both direct and indirect patient care) and whether these differ between first‐ (Postgraduate Year [PGY]1) and third‐ (PGY3) year residents. The authors also determine if changes in volume are associated with changes in teaching interactions between attending and resident physicians.Methods:  This was a prospective observational study of resident and attending physicians in the ED. Research assistants (RAs) followed ED residents during clinical shifts and recorded a multitude of data including the amount of time spent in specific activities, the number of new patients seen, and the frequency of attending physician teaching interactions.Results:  Third‐year residents see more new patients per hour (1.79 vs. 1.16, p < 0.001) than do their first‐year counterparts. In addition, third‐year residents spend almost 50% less time with each patient (10.7 minutes vs. 19.4 minutes, p < 0.001), and first‐year residents spend three times as much time per shift discussing patients with attending physicians (59.4 minutes vs. 27.3 minutes, p = 0.002). More of the PGY1/attending interactions resulted in educational exchanges (54.9% vs. 34.6%, p = 0.003). PGY1 residents also spend more time on dictations per patient (9.6 minutes vs. 5.4 minutes, p = 0.01) and more time on paperwork per patient (18.5 minutes vs. 6.5 minutes, p = 0.007). As ED volume tripled, PGY1 residents were able to increase their patient load to a greater extent than were PGY3 residents by decreasing the length of each patient encounter as volume increased. Overall, ED volume had no effect on the number of teaching interactions, although the length of exchange decreased as volume increased.Conclusions:  Third‐year residents see and carry more patients than do their first‐year counterparts. They do so primarily by decreasing the amount of time spent with patients and attendings and working more efficiently overall. However, they are not as capable of altering their work profiles in the face of increased volume as their first‐year counterparts. While the length of teaching interactions is decreased as volume increases, the number of those interactions resulting in teaching remains constant regardless of volume.Academic Emergency Medicine 2010; 17:S62–S66 © 2010 by the Society for Academic Emergency Medicine
Best Educational Practices in Pediatric Emergency Medicine During Emergency Medicine Residency Training: Guiding Principles and Expert Recommendations
Authors: Cloutier Robert L. , Walthall Jennifer D. H. , Mull Colette C. , Nypaver Michele M. , Baren Jill M. 
Published: October 2010

AbstractThe state of pediatric emergency medicine (PEM) education within emergency medicine (EM) residency programs is reviewed and discussed in the context of shifting practice environments and new demands for a greater focus on the availability and quality of PEM services. The rapid growth of PEM within pediatrics has altered the EM practice landscape with regard to PEM. The authors evaluate the composition, quantity, and quality of PEM training in EM residency programs, with close attention paid to the challenges facing programs. A set of best practices is presented as a framework for discussion of future PEM training that would increase the yield and relevance of knowledge and experiences within the constraints of 3‐ and 4‐year residencies. Innovative educational modalities are discussed, as well as the role of simulation and pediatric‐specific patient safety education. Finally, barriers to PEM fellowship training among EM residency graduates are discussed in light of the shortage of practitioners from this training pathway and in recognition of the ongoing importance of the EM voice in PEM.ACADEMIC EMERGENCY MEDICINE 2010; 17:S104–S113 © 2010 by the Society for Academic Emergency Medicine
Emergency Medicine Quality Improvement and Patient Safety Curriculum
Authors: Kelly John J. , Thallner Elaine , Broida Robert I. , Cheung Dickson , Meisl Helmut , Hamedani Azita G. , Klauer Kevin , Welch Shari J. , Beach Christopher 
Published: October 2010

ACADEMIC EMERGENCY MEDICINE 2010; 17:e110–e129 © 2010 by the Society for Academic Emergency MedicinePrefaceAll of us who have worked on this curriculum are career emergency physicians (EPs) who have become leaders with a focus on emergency medicine (EM) quality and safety.About 2 years ago, I approached my colleagues of the American College of Emergency Physicians Quality Improvement and Patient Safety (ACEP QIPS) Section and dreamed an idea of creating an EM quality and safety curriculum: an outline that would explain a topic few EPs understand. That outline would be used as a curriculum to teach our EM residents (and even our attendings, physician’s assistants, and nurse leaders) about EM quality and safety.My goal is for this curriculum to become an integral part of every EM residency program and department. We know that quality and safety in patient care does not happen by accident. We must teach these concepts to everyone on our emergency department (ED) team. The safety of our patients depends on this.I would like to thank each of the authors who spent many months on this project, along with the ACEP QIPS Section and ACEP Quality and Performance Committee.Also, I would like to thank ACEP staff Angela Franklin and Idania Lorenti for their help in getting this project to completion. I must also sincerely acknowledge the early work and ideas generated by Drs. Shari Welch and David John: their contributions clearly helped shape this article.—John J. Kelly, DO
Within‐field distribution of Aphis gossypii and aphidophagous lady beetles in chili, Capsicum annuum
Authors: Rahman Touhidur , Roff Mohammad Nor Mohd , Ghani Idris Bin Abd 
Published: October 2010

AbstractUnderstanding the spatial distribution of insect pests and their natural enemies can be very important for a successful integrated pest management approach. In Malaysia, Aphis gossypii Glover (Hemiptera: Aphididae) is the only aphid species colonizing and responsible for significant crop losses in chili, Capsicum annuum L. (Solanaceae). Several species of aphidophagous lady beetles (Coleoptera: Coccinellidae) occur naturally, of which three species [Menochilus sexmaculatus (Fabricius), Coelophora inaequalis (Fabricius), and Coccinella transversalis (Fabricius)] predominate in chili ecosystems. In this study, we investigated the spatial distribution of A. gossypii and associated lady beetle predators during two growing seasons of C. annuum, using Spatial Analysis by Distance Indices (SADIE). Both aphid and lady beetle populations were spatially aggregated, the strength of aggregation being strongest mid‐way through the cropping cycle. We concluded that the aggregated distribution of adult lady beetles is driven by the spatial distribution of A. gossypii.
Obstruction of the lung capillaries by blood platelet aggregates and leucocytes in sudden infant death syndrome
Authors: HANSSEN TOR‐ARNE , JØRGENSEN LEIF 
Published: October 2010

Hanssen T‐A, Jørgensen L. Obstruction of the lung capillaries by blood platelet aggregates and leucocytes in sudden infant death syndrome. APMIS 2010; 118: 958–67.Altogether 34 cases of sudden infant death were studied postmortem with particular emphasis on the pathological changes in the lungs. Light microscopy, including application of immunohistochemical methods, and transmission electron microscopy were used for the identification of blood platelets and white blood cell types in alveolar capillaries. The main findings were platelet aggregates and a varying number of neutrophil polymorphonuclear granulocytes in the lung capillaries, mixed with a smaller number of lymphocytes. The findings may be interpreted as an early sign of inflammation with capillary thrombosis, resulting in ischaemia, i.e. arrest of flow. In 21% of the cases, inflammatory cells had also expanded focally into alveolar spaces, creating the picture of localized areas of bronchopneumonia. An infant dying suddenly of a traumatic head injury served as a control. Neither platelets nor leucocytes were observed in the alveolar capillaries of this infant. In conclusion, in lungs from cases of sudden infant death syndrome, the alveolar capillaries are obstructed by platelet aggregates and leucocytes, interpreted as signs of an initial stage of lung inflammation with ischaemia.
Infection Rates of Rifampin/Gentamicin-Coated Titan Coloplast Penile Implants. Comparison with Inhibizone-Impregnated AMS Penile Implants
Authors: Dhabuwala Chirpriya , Sheth Sheila , Zamzow Brent 
Published: October 2010

ABSTRACT

Introduction
It is a common practice to soak Titan® Coloplast penile implants in antibiotic solution prior to implantation. Experience with Inhibizone impregnation suggests that rifampin coating significantly reduces infection rates of penile implant surgery. In this article we describe the results of coating Titan Coloplast penile implants with rifampin/gentamicin solution.

Aim
To compare infection rates of Titan® Coloplast penile implants coated with vancomycin/gentamycin, rifampin/gentamicin, and Inhibizone-impregnated American Medical Systems (AMS) penile implants.

Methods
Chart review was done for all Mentor/Coloplast and AMS implant surgeries performed at our center between the dates January 1, 2002 and February 8, 2010. Infection rates for Titan® Coloplast penile implants coated with vancomycin/gentamycin, rifampin/gentamicin, and Inhibizone-impregnated (AMS) penile implants were compared.

Main Outcome Measures
Infection rates for penile implants coated with different antibiotics.

Results
Infection rates for Titan® Coloplast penile implants coated with vancomycin/gentamycin and Inhibizone-impregnated (AMS) penile implants was 4.4% and 1.3%, respectively (P = 0.05). None of the rifampin/gentamicin-coated Titan® Coloplast penile implants have developed infection. Rifampin is the common antibiotic both in rifampin/gentamicin-coated Coloplast implants and Inhibizone®. The infection rate in this combined rifampin/gentamicin-coated Titan Coloplast implants and Inhibizone-coated AMS implants group was 0.63% (P = 0.03).

Conclusion
Both rifampin/gentamicin-coated Titan® Coloplast penile implants and Inhibizone-impregnated (AMS) penile implants appear to have lower infection rates compared with vancomycin/gentamycin-coated Titan® Coloplast penile implants The present study does not suggest superiority of rifampin/gentamicin-coated Titan® Coloplast penile implants or Inhibizone-impregnated (AMS) penile implants but we strongly suggest that all Titan® Coloplast penile implants should be coated with rifampin/gentamicin solution.
Annual influenza vaccination: coverage and attitudes of primary care staff in Australia
Authors: Ward Kirsten , Seale Holly , Zwar Nicholas , Leask Julie , MacIntyre C. Raina 
Published: October 2010

Please cite this paper as:Wardet al.(2011) Annual influenza vaccination: coverage and attitudes of primary care staff in Australia. Influenza and Other Respiratory Viruses 5(2), 135–141.Background Annual influenza vaccination is recommended for all Australian health care workers (HCWs) including those working in primary health care. There is limited published data on coverage, workplace provision, attitudes and personal barriers to influenza vaccination amongst primary health care staff. The aim of this study was to contribute to the limited literature base in this important area by investigating these issues in the primary health care setting in New South Wales (NSW), Australia.Methods A postal survey was sent to general practitioners (GPs) and practice nurses (PNs) from inner city, semi‐urban and rural areas of NSW, Australia. There were 139 responses in total (response rate 36%) from 79 GPs (response rate 30%) and 60 PNs (response rate 46%).Results Reported influenza vaccination coverage in both 2007 and 2008 was greater than 70%, with GPs reporting higher coverage than PNs in both years. The main barriers identified were lack of awareness of vaccination recommendations for general practice staff and concern about adverse effects from the vaccine.Conclusions Rates of influenza vaccination coverage reported in this study were higher than in previous studies of hospital and institutional HCWs, though it is possible that the study design may have contributed to these higher results. Nevertheless, these findings highlight that more needs to be done to understand barriers to vaccination in this group, to inform the development of appropriate strategies to increase vaccination coverage in primary health care staff, with a special focus on PNs.
The influence of the assessment method on the incidence of visual field progression in glaucoma: a network meta‐analysis
Authors: Ernest Paul J. G. , Viechtbauer Wolfgang , Schouten Jan S. A. G. , Beckers Henny J. M. , Hendrikse Fred , Prins Martin H. , Webers Carroll A. B. 
Published: October 2010

Abstract.Purpose:  To study and quantify the difference in incidence of progression between methods for the assessment of glaucomatous visual field progression.Methods:  We identified 2450 articles published up to April 2009 in the following data sources: PubMed, EMBASE, and Cochrane. Ten studies covering 30 methods were included. All studies aimed to compare different methods for the assessment of glaucomatous visual field progression in the same study population. A network meta‐analysis using a mixed‐effects model was performed to combine within‐study between‐method comparisons with indirect comparisons from other studies. The summarized incidence of progression was calculated for every method, and methods were ranked according to this incidence.Results:  In total, methods were compared in 1040 eyes of 948 patients with glaucoma. On average, 21% of the eyes progressed. When all 30 methods were ranked, the incidence ranged from 2% to 62%. These incidences are corrected for a baseline mean deviation (MD) value of −7 decibels and a mean follow‐up time of 6 years. Besides the assessment method, the incidence was only determined by the follow‐up period and baseline MD value, leaving no unexplained variance in the incidence of progression.Conclusion:  The incidence of progression varies considerably between different studies. This is mainly caused by the variety of methods used to assess progression but also by differences in follow‐up time and baseline visual field loss.