bluuebunny/crossref_metadata_2025_split huggingface dataset:
(P2-83) The Use of Focused Assessment with Sonography for Trauma in Patients with Blunt Abdominal Trauma or Pelvic Fracture in the Emergency Departments
Authors: Ufnal B. , Kamiński M. , Szostak M. , Trzos A. , Andres J. 
Published: May 2011

BackgroundThe role of FAST in diagnostic protocols has been adopted in most major trauma centers in well-developed countries. This procedure has become the initial diagnostic way in blunt abdominal trauma patients. However there are researches which show FAST is not reliable triage tool in patients with pelvic fracture.ObjectivesTo evaluate the usefulness of Focused Assessment with Sonography for Trauma in diagnostic of blunt abdominal trauma patients and to bring attention to patients with pelvic fracture who should receive additional tests for the presence of peritoneal fluid.MethodsAn analysis of high-quality evidence resources was performed, limited to the articles published since 2005 year.Results99 articles were found during the search, of which 23 were accurate. 16 articles were based on original research.ConclusionFocused Assessment with Sonography for Trauma plays a key role in the investigation of blunt abdominal trauma and should be used in all emergency departments. FAST-negative patients can remain under observation except major pelvic injury patients. The evaluation of peritoneal fluid in this group has low sensitivity.
(P2-87) Policy Study of the Helmet Legislation in Kerala, India and its Implications
Authors: Vishwanath N.S. 
Published: May 2011

BackgroundWhen implemented properly, universal helmet law increases helmet use substantially, bringing along a reduction in mortality and morbidity due to head injuries. Kerala has seen tremendous success in regards to various indicators for health within India. But when it comes to wearing helmets, the state lags behind others with reported rates as less as 27%.MethodA cross-sectional survey of 300 two-wheel drivers in Thiruvananthapuram City was preformed, which looked into helmet wearing patterns, their determinants, and the risk perception among the respondents. Further, a content analysis of newspaper reports pertaining to helmet legislation from the Thiruvananthapuram edition of two leading newspapers was performed. The reports included were from the periods of July 2003 to June 2005 and July 2008 to June 2010. Lastly, in-depth interviews were conducted with informants from among the key stakeholders in helmet policy of the state.ResultsThe study found 36.8% of the respondents wear a helmet. A scale to measure risk perception was developed for the purpose of this study. The four-item scale has been found to have internal consistency with a Cronbach alpha value of 0.74. The risk perception measured by using this scale has significant relation with helmet-wearing behavior. The content analysis helped in deriving a historical perspective of the policy along with the themes of reporting. The informant interviews provided expert opinions, problem identification, and specific recommendations.DiscussionThe practice of wearing a helmet is low, and people with lower risk perception have greater tendency not to wear helmets. Other findings also show that there are gaps in policy and lack of visionary leadership as far as the policy toward helmet legislation and its implementation.
(P2-88) To Assess the Effect of Camera Surveillance in Improving Compliance with Handwashing Practices in the ICU Setting
Authors: Agarwal D. , Chauhan S. 
Published: May 2011

BackgroundHandwashing has been shown to be the most effective means of reducing cross infection in the healthcare environment. However, staff compliance remains low in the real setting.MethodsA prospective study was carried out over one month period in one cubicle of neurosurgery intensive care unit (ICU). A surveillance camera which was previously installed and functioning was focused on a cubicle of three patients, and recordings of the previous 24 hours were reviewed every day for 15 days. The number of incidents in which handwashing was required but not performed was recorded. An incident was defined as any one of the following: (1) handwashing not performed by healthcare workers; (2) touching different patients without handwashing; (3) using the same gloves for different patients and for different procedures; (4) not performing handwashing after finishing the procedures. Following this 15-day period, all staff were verbally instructed during every shift that they were under surveillance for the next 15 days. Camera recordings of the previous 24 hours were similarly reviewed every day for these 15 days and incidents recorded.ResultsIn the first 15-days period, there was a total of 480 incidents when handwashing was not performed. Of the incidents, 83%(n = 401) occurred during the night shift, especially during the early morning hours. In the subsequent 15 days when the staff were informed that they were under camera surveillance, the total number of events when handwashing was not done was 140. The difference between the two periods was statistically significant(p < 0.01 > .ConclusionHandwashing is practiced poorly in this ICU. As the maximum number of incidents occurred during the night shift, poor motivation may be one of the factors for this behavior. This study shows that camera surveillance plays a major role in changing the staff behavior and may improve compliance for handwashing.
(P2-89) Investigation, the Association of Cardiac Risk Factors and the Risk of Acute Myocardial Infarction, in ED Patients with Non-Diagnostic ECG
Authors: Kashani P. 
Published: May 2011

ObjectiveTo investigate the association of cardiac Risk factors and the risk of Acute myocardial infarction, in ED patients with non-diagnostic ECG. Methods:Results474 patients were enrolled,150 had non diagnostic ECG In this study HTN with p-value = 0/012 (> 0/05), HIP with p-value = 0/0001 (> 0/001), FH with p-value = 0/001(> 0/01) was significantly more prevalent in those who ruled in for AMI.ConclusionIn the past studies in patients with non-diagnostic ECG only hypertension Was significantly more prevalent in those who ruled in for AMI and cardiac risk factors have limited clinical value in diagnosing of AMI in ED patients. In this study HLP, HTN, FH was significantly more prevalent in those who ruled in for AMI An observational study is conducted in an educational hospital in Shahid Beheshti university during a period of two years. In this study, patients with symptoms suggestive of AMI including. chest pain, Dyspnea, palpitation, syncope, cerebrovascular accident, nausea, vomiting, vertigo, loss of consciousness were enrolled. Demographic, historical feature and risk factors, such as age, sex, diabetes, hypertension, hyper lipidemia, renal failure, positive family history of CAD, smoking, substance abuse, Alcohol use in the past 24 hours, cocaine use in the past 48 h were recorded. Nondiagnost ECG including these categories: Normal, non specific, early Repolarization, abnormal without signs of ischemia such as old bundle branch block, LVH, … A final diagnosis of Acute myocardial infarction was determined by CK - MB and Troponin - 1.
(P2-90) Modified Delphi Study to Determine Optimal Data Elements for Inclusion in an Emergency Management Database System
Authors: Jabar A. , Rüter A. , Wallis L.A. 
Published: May 2011

TopicInformation and communication technology (ICT).ObjectivesICT are introduced into organizations with the goals of managing resources, increasing efficiency and work productivity and reducing workload. In the context of developing countries, these goals are accentuated given the existing conditions. The aim of this study was to identify hospital institutional capacity indicators to provide recommendations to an emergency management database system operating in the Western Cape province of South Africa as http://hospitalbedbureau.co.za/.MethodologyA two round modified Expert Delphi study was conducted by email. A panel of 16 experts drawn from the fields of emergency medicine, critical care, trauma surgery and disaster medicine were consulted. Participants were initially asked to propose hospital institutional capacity indicators that warranted inclusion in the emergency management database system currently operating in Cape Town, South Africa. In the second round these proposals were collated and scored using a 7 point Likert scale. Areas that did not reach consensus in the Delphi study will be presented as synopsis statements for discussion at the Emergency Medicine Symposium hosted by the department of Accident and Emergency Western Cape.ResultsRound 1 comprised 237 statements. Consensus was defined a priori to be > 80%. A total of 52 of 237 statements had reached consensus upon completion of the Delphi study. This represented 21.9% of the total number of statements. Of these 20 reached consensus at > 90% and 32 reached consensus at > 80%.ConclusionThe use of a Delphi study achieved consensus in aspects of hospital institutional capacity that can be translated into practical recommendations for implementation by the local emergency management database system. Additionally, areas of non-consensus have been identified where further work is required.
(P2-92) Hueh Emergency Medicine Triage: Lessons in Crowd Control
Authors: Kaufmann K.R. , Oh E. , Lin J. 
Published: May 2011

BackgroundOn 12 January 2010 Port-au-Prince, Haiti was struck by a 7.0 Mw earthquake that devastated the city and destroyed much of the Haiti University and Educational Hospital. In the following weeks, a tent hospital was erected at the site and hundreds of patients were seen daily by expatriate healthcare volunteers. The high volumes of patients, disorganized hospital grounds, and high levels of stress among patients led to issues of crowd control.DiscussionTo improve security a new triage system was designed and implemented based on current emergency medicine models. This design addressed patient flow, triage, environmental conditions, and differentiation of emergency services. The results of this system were a streamlined triage system as well as improved safety.ConclusionsDuring the chaos following the Haiti earthquake, a triage design was implemented at the HUEH that lead to improved Emergency Department patient flow and hospital safety.
(P2-97) The Differences Between Triage and Start that are Applied to Train Derailment
Authors: Hashimoto A. , Ueda T. , Hirata J. , Kuboyama K. , Yamada T. , Kotani J. 
Published: May 2011

The derailment accident occurred on 25 April 2005. 562 passengers were injured and 107 people died. Based on our periodic training in mass disaster triage, we accepted 113 wounded victims regardless of the severity of their condition. Initially, Simple Triage and Rapid Treatment was supposed to be performed by an emergency physician as a triage officer but START is not the most effective method for this case because patients of different severity levels were admitted to our hospital. Therefore, we performed triage by inspection and palpation based on our experience and intuition. Patient's facial color, breathing patterns, and trauma were processed for inspection. Furthermore, palpation was carried on without counting pulse and we diagnosed victims based upon strength of pulse and sensation of cold. From inspirational and sensuous diagnosis, the severity was determined. Comparing START with experiential and intuitive triage, differences between level of consciousness, the severity of trauma, and vital sign were examined. In addition, which components were necessary for primary survey was also reviewed.MethodSevere or moderate, which were evaluated from ISS, vital sign, and Revised Trauma Score: RTS, Probability of survival: PS, were classified and then agreement rate, sensitivity, and specificity between START (S model) and triage (D model) were assessed. For START, data was extracted from clinical records.ResultAgreement rate between the S model and the D model was 76.9%. Moreover, at the percentage of questions answered, the S model showed 84.2% and the D model showed 68.4%. Thus the experiment showed significant difference. 5 over triage cases appeared when the D model was operated. RTS, vital sign, and PS did not show great differences.ConclusionIt could be difficult and insufficient to use START when a mass disaster occurs, however experiential and intuitive triage is also effective as START.
The Plant Cuticle Is Required for Osmotic Stress Regulation of Abscisic Acid Biosynthesis and Osmotic Stress Tolerance inArabidopsis
Authors: Wang Zhen-Yu , Xiong Liming , Li Wenbo , Zhu Jian-Kang , Zhu Jianhua 
Published: May 2011

AbstractOsmotic stress activates the biosynthesis of abscisic acid (ABA). One major step in ABA biosynthesis is the carotenoid cleavage catalyzed by a 9-cis epoxycarotenoid dioxygenase (NCED). To understand the mechanism for osmotic stress activation of ABA biosynthesis, we screened for Arabidopsis thaliana mutants that failed to induce the NCED3 gene expression in response to osmotic stress treatments. The ced1 (for 9-cis epoxycarotenoid dioxygenase defective 1) mutant isolated in this study showed markedly reduced expression of NCED3 in response to osmotic stress (polyethylene glycol) treatments compared with the wild type. Other ABA biosynthesis genes are also greatly reduced in ced1 under osmotic stress. ced1 mutant plants are very sensitive to even mild osmotic stress. Map-based cloning revealed unexpectedly that CED1 encodes a putative α/β hydrolase domain-containing protein and is allelic to the BODYGUARD gene that was recently shown to be essential for cuticle biogenesis. Further studies discovered that other cutin biosynthesis mutants are also impaired in osmotic stress induction of ABA biosynthesis genes and are sensitive to osmotic stress. Our work demonstrates that the cuticle functions not merely as a physical barrier to minimize water loss but also mediates osmotic stress signaling and tolerance by regulating ABA biosynthesis and signaling.
Cocaine‐related attentional bias following trauma cue exposure among cocaine dependent in‐patients with and without post‐traumatic stress disorder
Authors: Tull Matthew T. , McDermott Michael J. , Gratz Kim L. , Coffey Scott F. , Lejuez Carl W. 
Published: May 2011

ABSTRACTAims  Although the co‐occurrence of post‐traumatic stress disorder (PTSD) and cocaine dependence is associated with a wide range of negative clinical outcomes, little is known about the mechanisms that underlie this association. This study investigated one potential mechanism—attentional bias to cocaine imagery following trauma cue exposure.Design  Male and female cocaine‐dependent in‐patients with and without PTSD were exposed to both a neutral and personalized trauma script on separate days, followed by a visual dot‐probe task. A 2 (PTSD versus non‐PTSD) × 2 (neutral versus trauma script) × 2 (male versus female) design was used to examine hypotheses.Setting  Participants were recruited from a residential substance use disorder (SUD) treatment center.Participants  Participants were 60 trauma‐exposed cocaine dependent in‐patients, 30 with current PTSD and 30 without a history of PTSD.Measurements  Attentional bias was assessed using a visual dot‐probe task depicting cocaine‐related imagery following both a neutral script and personalized trauma script.Findings  Following neutral script exposure, PTSD (versus non‐PTSD) participants exhibited an attentional bias away from cocaine imagery. This effect was reversed following trauma script exposure, with PTSD participants exhibiting a greater attentional bias towards the location of cocaine imagery than non‐PTSD participants. Severity of subjective distress following trauma script exposure predicted level of attentional bias among PTSD participants.Conclusions  Cocaine appears to serve an emotion‐regulating function among post‐traumatic stress disorder patients and may be a potential target for brief post‐traumatic stress disorder–substance use disorder interventions that can facilitate residential substance use disorder treatment retention.
Maintenance Rituximab is associated with improved clinical outcome in rituximab naïve patients with Waldenstrom Macroglobulinaemia who respond to a rituximab‐containing regimen
Authors: Treon Steven P. , Hanzis Christina , Manning Robert J. , Ioakimidis Leukothea , Patterson Christopher J. , Hunter Zachary R. , Sheehy Patricia , Turnbull Barry 
Published: May 2011

SummaryThis study examined the outcome of 248 Waldenstrom macroglobulinaemia (WM) rituximab‐naïve patients who responded to a rituximab‐containing regimen. Eighty‐six patients (35%) subsequently received maintenance rituximab (M‐Rituximab). No differences in baseline characteristics, and post‐induction categorical responses between cohorts were observed. The median rituximab infusions during induction was 6 for both cohorts; and 8 over a 2‐year period for patients receiving M‐Rituximab. Categorical responses improved in 16/162 (10%) of observed, and 36/86 (41·8%) of M‐Rituximab patients respectively, following induction therapy (P < 0·0001). Both progression‐free (56·3 vs. 28·6 months; P = 0·0001) and overall survival (Not reached versus 116 months; P = 0·0095) were longer in patients who received M‐Rituximab. Improved progression‐free survival was evident despite previous treatment status, induction with rituximab alone or in combination therapy (P ≤ 0·0001). Best serum IgM response was lower (P < 0·0001), and haematocrit higher (P = 0·001) for patients receiving M‐Rituximab. Among patients receiving M‐Rituximab, an increased number of infectious events were observed, but were mainly ≤grade 2 (P = 0·008). The findings of this observational study suggest improved clinical outcomes following M‐Rituximab in WM patients who respond to induction with a rituximab‐containing regimen. Prospective studies aimed at clarifying the role of M‐Rituximab therapy in WM patients are needed to confirm these findings.
Repeat measurements of glycated haemoglobin A1c and N‐terminal pro‐B‐type natriuretic peptide: divergent behaviour in diabetes mellitus
Authors: Neuhold Stephanie , Resl Michael , Huelsmann Martin , Strunk Guido , Adlbrecht Christopher , Rath Claus , Prager Rudolf , Luger Anton , Clodi Martin , Pacher Richard 
Published: May 2011

Eur J Clin Invest 2011; 41 (12): 1292–1298AbstractBackground  Patients with diabetes mellitus have a substantially increased risk of developing cardiovascular disease. However, the absolute risk greatly varies not only among patients, but the risk profile for an individual patient may also change over time. We investigated the prognostic role of repetitive measurements of Glycated haemoglobin A1c (HbA1c) and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) in patients with longstanding diabetes.Materials and methods  For this prospective, observational study data from 544 consecutive patients were collected between 2005 and 2008. HbA1c and NT‐proBNP were measured at baseline and after 1 year. The median observation period was 40 months. Endpoints were all‐cause mortality, cardiac, cardiovascular and all‐cause hospitalizations.Results  N‐terminal pro‐B‐type natriuretic peptide concentrations significantly increased from 230 ± 385 to 280 ± 449 pg mL−1 (P < 0·001); during the same time, HbA1c significantly decreased from 7·6 ± 1·5 to 7·3 ± 1·2 (P < 0·001). NT‐proBNP was the best baseline predictor in a Cox regression model consisting of NT‐proBNP, HbA1c, age, gender and duration of diabetes for all endpoints (P < 0·001). NT‐proBNP at follow‐up was the best predictor for the remaining period (P < 0·001, all endpoints). HbA1c at baseline and follow‐up was predictive for all‐cause hospitalizations (P = 0·005 both). In a third model that investigated the plasticity of both markers, changes in HbA1c concentration had no predictive value, but a change of NT‐proBNP concentration was highly predictive (P = 0·025 all‐cause mortality, P < 0·001 all other endpoints).Conclusions  N‐terminal pro‐B‐type natriuretic peptide and HbA1c concentrations significantly diverged over a 1‐year period. NT‐proBNP was the most potent predictor of outcome at baseline and follow‐up, and changes in NT‐proBNP concentrations were linked to an altered risk profile, unlike changes in HbA1c levels.
Oesophageal sensation in response to high PCO2 and acidic solutions in nonerosive reflux disease
Authors: Hershcovici Tiberiu , Poh Choo H. , Fass Ofer Z. , Ashpole Nicole , Akiba Yasutada , Guillén‐Rodríguez Jose M. , Kaunitz Jonathan D. , Fass Ronnie 
Published: May 2011

Eur J Clin Invest 2011AbstractBackground  Heartburn is commonly associated with the presence of acid in the oesophageal lumen. However, in patients with nonerosive reflux disease (NERD), the mechanism by which acid traverses the mucosa is not clear. We hypothesized that the luminal acid signal traverses the oesophageal epithelium in the form of the highly permeant gas CO2, which then is reconverted to H+ in the submucosa.Materials and methods  Ten patients with heartburn, normal upper endoscopy and increased oesophageal acid exposure (NERD patients) and 10 healthy subjects were enrolled. Perceptual responses to intraoesophageal acid (0·1 N HCl solution) and a high PCO2 solution were determined using a randomized cross over design. Stimulus–response functions to perfusions were quantified by three parameters: lag time to symptom perception, intensity rating and perfusion sensitivity score.Results  In NERD patients, the difference in lag time to typical symptom perception, intensity rating and perfusion sensitivity score between high PCO2 and acid perfusions was statistically significant (P = 0·02, 0·01 and 0·02, respectively). However, the difference in the same perfusion parameters between acid and high PCO2 perfusions was nonsignificant in healthy controls. When NERD and controls were compared, the difference between the different perfusion variables was nonsignificant (adjusted to age).Conclusions  In NERD subjects, acid perfusion reliably evoked heartburn symptoms of greater intensity than in healthy controls. Nevertheless, a high PCO2 perfusion failed to produce symptoms in either group.