bluuebunny/crossref_metadata_2025_split huggingface dataset:
Academic Emergency Physicians’ Experiences With Patient Death
Authors: Strote Jared , Schroeder Erika , Lemos John , Paganelli Ryan , Solberg Jonathan , Range Hutson H. 
Published: March 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:255–260 © 2011 by the Society for Academic Emergency MedicineAbstractObjectives:  There is a growing awareness of the effects of patient death on physician well‐being, and the importance of cultural and educational changes to improve coping mechanisms. The objective of this study was to explore both the effects of patient death on academic emergency physicians (EPs) and the coping mechanisms they use to deal with these events.Methods:  Faculty at a convenience sample of four emergency medicine (EM) residency programs were questioned about their responses to patient death in a 15‐question on‐line survey. Descriptive analysis of the data was performed. Independent variables were analyzed for differences in complaints of physical symptoms or consideration of important life changes after patient death.Results:  Of 207 EPs surveyed, 145 (70%) responded. Patient death was experienced frequently, with 95 (66%) witnessing a death at least every month. No training on coping with patient death had occurred for 35 (24%); 93 (64%) had less than 6 hours of training. The most common coping mechanisms included talking with colleagues (113; 78%) or friends and family (100; 69%), as well as simply continuing to work (89; 61%). Postdeath debriefing occurred rarely or never for 93 (64%) of respondents. Most EPs had experienced physical responses to patient death, the most common being insomnia (54; 37%) and fatigue (21; 14%). Common emotional responses included sadness (112; 70%) and disappointment (55; 38%). No significant differences in response rates for physical symptoms or consideration of life changes were found for any of the variables.Conclusions:  Patient death was reported to lead to both physical and emotional symptoms in academic EPs. Postdeath debriefing appears to happen infrequently in teaching settings, and most respondents reported that they themselves received limited training in coping with patient death. Further study is needed to both identify coping mechanisms that are feasible and effective in emergency department settings and develop teaching strategies to incorporate this information into EM residency training.
The Influence of Emergency Medical Services Transport on Emergency Severity Index Triage Level for Patients With Abdominal Pain
Authors: Hiestand Brian , Moseley Mark , MacWilliams Bryan , Southwick Jed 
Published: March 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:261–266 © 2011 by the Society for Academic Emergency MedicineAbstractObjectives:  The Emergency Severity Index (ESI) is a prospectively validated, five‐level emergency department (ED) triage system designed to match triage acuity to both patient acuity and appropriate resource allocation. The study hypothesis was that, in practice, there exists an inappropriate bias toward triaging patients with abdominal pain to a higher ESI level based solely upon their mode of arrival to the ED.Methods:  The authors performed a retrospective case–control study of patients presenting with abdominal pain. Patients were matched on sex, age (±5 years), and date of arrival. Cases were those patients triaged to a Level 2, and controls were those triaged as Level 3. Conditional multiple variable logistic regression was used to evaluate the effect of the following variables on the odds of being triaged as Level 2: mode of arrival, systolic blood pressure (<90 mm Hg; normal, >140 mm Hg), heart rate, severe pain score (≥8 of 10), fever, race, history of cancer, and previous abdominal surgery. Age was also included in the regression modeling to confirm that matching was adequate. One‐hundred cases and 100 controls were necessary to provide adequate sample size. A backward modeling technique was used, requiring a p < 0.05 for retention.Results:  Of the 200 subjects, 52 arrived by emergency medical services (EMS) and 148 walked in. After matching for sex, age, and date of arrival, and after adjusting for heart rate, cancer diagnosis, and severe pain, the odds ratio (OR) for being triaged ESI Level 2 was 7.19 (95% confidence interval [CI] = 2.75 to 18.8, p < 0.0001) for EMS patients compared to walk‐in patients. The admission rate for Level 2 patients was not different from that of Level 3 patients (49% vs. 35% of Level 3 patients, p = 0.06), but EMS patients were more likely to be admitted, regardless of ESI level assignment (65% vs. 34%, p < 0.001).Conclusions:  After adjusting for covariates, EMS patients with abdominal pain were more likely to be triaged to a higher acuity level. Triage level was not associated with admission, but patients arriving by EMS were more likely to be admitted. This may indicate that the effect of EMS arrival on triage level assignment is actually appropriate. Further research is necessary to validate whether mode of arrival should be incorporated in the initial ESI triage acuity assignment.
Eligibility and Rate of Treatment for Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke Using Different Criteria
Authors: Huang Poyin , Khor Gim‐Thean , Chen Chun‐Hung , Lin Ruey‐Tay , Liu Ching‐Kuan 
Published: March 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:273–278 © 2011 by the Society for Academic Emergency MedicineAbstractObjectives:  The rate of recombinant tissue plasminogen activator (rtPA) use for stroke is low among the Chinese‐Taiwanese. The study objective was to determine if less restrictive exclusion criteria for rtPA would increase eligibility and the rate of treatment.Methods:  This retrospective before‐and‐after study was conducted from 2006 to 2009. The authors compared stroke patients treated under the old rtPA exclusion criteria (January 2006 to December 2008) with those treated with less restrictive rtPA exclusion criteria (January to December 2009). Rates of eligibility and treatment and reasons for exclusion from rtPA between the two phases were assessed.Results:  Of 461 eligible patients during the study period, 333 were evaluated by the old criteria and 128 were evaluated by the less restrictive criteria. Minor or improving stroke was the primary exclusion reason in both groups (194/333, 58% vs. 70/128, 55%). Eligibility for rtPA was increased in the less restrictive criteria (35/127, 27%, 95% confidence interval [CI] = 20% to 36%) compared to the old criteria (40/333, 12%, 95% CI = 8.7% to 16%; p = 0.0001). Fewer patients were excluded due to old age in the less restrictive criteria (0/128, 0%) compared to the old criteria (37/333, 11%; p = 0.0001). The rate of consent refusal increased in the less restrictive criteria (27/128, 21%, 95% CI = 14% to 29%) compared to the old criteria (23/333, 6.9%, 95% CI = 4.4% to 10%; p < 0.0001). Rate of rtPA treatment was unchanged between the less restrictive criteria (8/128, 6.3%, 95% CI = 2.7% to 12%) and the old criteria (17/333, 5.1%, 95% CI = 3% to 8%; p = 0.63).Conclusions:  Increasing eligibility for rtPA does not increase the rate of treatment, possibly due to the high symptomatic intracerebral hemorrhage rate among Chinese‐Taiwanese, which is a major concern among emergency physicians (EPs), neurologists, and patients. Dealing with perceived safety issues of rtPA is crucial before the rate of treatment can be increased.
Risk for Cost‐related Medication Nonadherence Among Emergency Department Patients
Authors: Mazer Maryann , Bisgaier Joanna , Dailey Elizabeth , Srivastava Kavita , McDermoth Monique , Datner Elizabeth , Rhodes Karin V. 
Published: March 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:267–272 © 2011 by the Society for Academic Emergency MedicineAbstractObjectives:  There has been a rapid rise in prescription drug costs over the past decade. As a result, many Americans are unable to afford their medications, especially in the current economic recession. Medication nonadherence is known to have adverse effects on health outcomes. The purpose of this study was to gain a preliminary understanding of cost‐related medication nonadherence (CRMN) disclosure among screened emergency department (ED) patients and to describe the extent to which CRMN is associated with other economic and psychosocial risk factors.Methods:  This was a prospective, cross‐sectional study of a convenience sample of adult patients presenting to an urban academic ED with 61,962 annual visits in 2009. Nonemergent patients received an optional self‐administered Social Health Survey between May and October 2009. Results were assessed from the sample of anonymous surveys that were completed and collected. Standard statistical methods were used to determine the frequencies and relative risks (RRs) for CRMN with 95% confidence intervals (CIs).Results:  A total of 384 (25.5%) of the 1,506 adult patients who completed the survey either screened positive for any prior CRMN (20.7%) or disclosed concerns about affording medication (4.8%). Patients were significantly more likely to report risk for CRMN if they used tobacco (RR = 1.8, 95% CI = 1.5 to 2.2) or illicit drugs (RR = 2.0, 95% CI = 1.6 to 2.4), experienced intimate partner violence (IPV; RR = 1.8, 95% CI = 1.5 to 2.2), or reported concerns about overall financial instability (RR = 3.9, 95% CI = 3.2 to 4.7), food insufficiency (RR = 3.7, 95% CI = 3.1 to 4.3), housing problems (RR = 2.5, 95% CI = 2.1 to 2.9), and inadequate health insurance coverage (RR = 7.7, 95% CI = 6.2 to 9.5).Conclusions:  Risk for medication nonadherence due to cost concerns was identified in a quarter of nonemergent urban ED patients in our sample and was more likely to be reported by patients experiencing other economic and psychosocial risks. These findings indicate a need to include discussions about medication affordability and referrals to social services as part of ED discharge planning.
Cost‐effectiveness of Telemetry for Hospitalized Patients With Low‐risk Chest Pain
Authors: Ward Michael J. , Eckman Mark H. , Schauer Daniel P. , Raja Ali S. , Collins Sean 
Published: March 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:279–286 © 2011 by the Society for Academic Emergency MedicineAbstractBackground:  The majority of chest pain admissions originate in the emergency department (ED). Despite a low incidence of cardiac events, limited telemetry availability, and its questionable benefit, these patients are routinely admitted to a monitored setting.Objectives:  The objectives were to analyze the cost‐effectiveness of admission to telemetry versus admission to an unmonitored hospital bed in low‐risk chest pain patients and explore when the use of telemetry may be cost‐effective.Methods:  The authors constructed a decision analytic model to evaluate the scenario of an ED admission of an otherwise healthy 55‐year‐old patient with low‐risk chest pain defined as an acute coronary syndrome (ACS) probability of 2%. Costs were estimated from 2009 Medicare data for hospital reimbursement and physician services, as well as published data on disability costs. Published studies were used to estimate the risk of ACS, cardiac arrest, time to defibrillation, survival, long‐term disability, and quality of life.Results:  In the base case, telemetry was more effective (0.0044 quality‐adjusted life‐years [QALYs]) but more costly ($299.67) than a floor bed, resulting in a high marginal cost‐effectiveness ratio (mCER) of $67,484.55 per QALY. In comprehensive sensitivity analyses, the mCER crossed below the willingness‐to‐pay (WTP) threshold of $50,000 per QALY when the following scenarios were met: the probability of ACS exceeds 3%, the probability of cardiac arrest is greater than 0.4%, the probability of shockable dysrhythmia is above 83%, the probability of delay in telemetry bed availability is below 52%, and the opportunity cost of delay to telemetry bed placement is below $119.Conclusions:  Telemetry may be a “cost‐effective” use of health care resources for chest pain patients when patients have a probability of ACS above 3% or for patients with a minimal delay and cost associated with obtaining a monitored bed. Further research is needed to better stratify low‐risk chest pain patients to the appropriate inpatient setting and to understand the frequency and costs associated with delays in obtaining monitored beds.
A Prospective Case Series of Single‐syringe Ketamine–Propofol (Ketofol) for Emergency Department Procedural Sedation and Analgesia in Adults
Authors: Andolfatto Gary , Willman Elaine 
Published: March 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:237–245 © 2011 by the Society for Academic Emergency MedicineAbstractObjectives: The objective was to evaluate the effectiveness, recovery time, and adverse event profile of intravenous (IV) mixed 1:1 ketamine–propofol (ketofol) for adult procedural sedation and analgesia (PSA) in the emergency department (ED).Methods: Prospective data were collected on all PSA events over a 4.5‐year period in a trauma‐receiving suburban teaching hospital. PSAs using a 1:1 single‐syringe mixture of 10 mg/mL ketamine and 10 mg/mL propofol in patients over 21 years of age were analyzed. Physiologic data, drug doses, adverse events, recovery time, patient satisfaction, and staff satisfaction were recorded.Results: Ketofol PSA was used in 728 patients for primarily orthopedic procedures. Median patient age was 53 years (range = 21 to 99 years, interquartile range [IQR] = 36–70 years). The median dose of ketamine and propofol was 0.7 mg/kg each (range = 0.2 to 2.7 mg/kg, IQR = 0.5–0.9 mg/kg), and median recovery time was 14 minutes (range = 3 to 50 minutes, IQR = 10–17 minutes). PSA was effective in 717 cases (98%). Bag–mask ventilation occurred in 15 patients (2.1%; 95% confidence interval [CI] = 1.0% to 3.1%). Recovery agitation occurred in 26 patients (3.6%; 95% CI = 2.2% to 4.9%), of whom 13 (1.8%; 95% CI = 0.8% to 2.7%) required treatment. One patient experienced vomiting and one patient was admitted to the hospital for monitoring of transient dysrhythmia and hypotension. No sequelae were identified. The median staff satisfaction scores were 10 (IQR = 9–10) on a scale of 1 to 10, and 97% of patients would have chosen the same method of PSA in the future.Conclusions: Ketofol is an effective PSA agent in adult ED patients. Recovery times are short and adverse events are few. Patients and ED staff were highly satisfied.
Emergency Physician–performed Ultrasound to Diagnose Cholelithiasis: A Systematic Review
Authors: Ross Marshall , Brown Michael , McLaughlin Kyle , Atkinson Paul , Thompson Jenny , Powelson Susan , Clark Steve , Lang Eddy 
Published: March 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:227–235 © 2011 by the Society for Academic Emergency MedicineAbstractObjectives:  The authors sought to determine the diagnostic test characteristics of bedside emergency physician (EP)‐performed ultrasound (US) for cholelithiasis in symptomatic emergency department (ED) patients.Methods:  A search was conducted of MEDLINE, EMBASE, the Cochrane Library, bibliographies of previous systematic reviews, and abstracts from major emergency medicine conference proceedings. We included studies that prospectively assessed the diagnostic accuracy of emergency US (EUS) for cholelithiasis, compared to a criterion reference standard of radiology‐performed ultrasound (RADUS), computed tomography (CT), magnetic resonance imaging (MRI), or surgical findings. Two authors independently performed relevance screening of titles and abstracts, extracted data, and performed the quality analysis. Disagreements were resolved by conference between the two reviewers. EUS performance was assessed with summary receiver operator characteristics curve (SROC) analysis, with independently pooled sensitivity and specificity values across included studies.Results:  The electronic search yielded 917 titles; eight studies met the inclusion criteria, yielding a sample of 710 subjects. All included studies used appropriate selection criteria and reference standards, but only one study reported uninterpretable or indeterminate results. The pooled estimates for sensitivity and specificity were 89.8% (95% confidence interval [CI] = 86.4% to 92.5%) and 88.0% (95% CI = 83.7% to 91.4%), respectively.Conclusions:  This study suggests that in patients presenting to the ED with pain consistent with biliary colic, a positive EUS scan may be used to arrange for appropriate outpatient follow‐up if symptoms have resolved. In patients with a low pretest probability, a negative EUS scan should prompt the clinician to consider an alternative diagnosis.
Identifying Neurocognitive Deficits in Adolescents Following Concussion
Authors: Thomas Danny G. , Collins Michael W. , Saladino Richard A. , Frank Virginia , Raab Jenny , Zuckerbraun Noel S. 
Published: March 2011

ACADEMIC EMERGENCY MEDICINE 2011; 18:246–254 © 2011 by the Society for Academic Emergency MedicineAbstractObjectives:  This study of concussed adolescents sought to determine if a computer‐based neurocognitive assessment (Immediate Postconcussion Assessment and Cognitive Test [ImPACT]) performed on patients who present to the emergency department (ED) immediately following head injury would correlate with assessments performed 3 to 10 days postinjury and if ED neurocognitive testing would detect differences in concussion severity that clinical grading scales could not.Methods:  A prospective cohort sample of patients 11 to 17 years of age presenting to the ED within 12 hours of a head injury were evaluated using two traditional concussion grading scales and neurocognitive testing. ED neurocognitive scores were compared to follow‐up scores obtained at least 3 days postinjury. Postconcussive symptoms, outcomes, and complications were assessed via telephone follow‐up for all subjects.Results:  Sixty patients completed phone follow‐up. Thirty‐six patients (60%) completed follow‐up testing a median of 6 days postinjury. Traditional concussion grading did not correlate with neurocognitive deficits detected in the ED or at follow‐up. For the neurocognitive domains of verbal memory, processing speed, and reaction time, there was a significant correlation between ED and follow‐up scores trending toward clinical improvement. By 2 weeks postinjury, 23 patients (41%) had not returned to normal activity. At 6 weeks, six patients (10%) still had not returned to normal activity.Conclusions:  Immediate assessment in the ED can predict neurocognitive deficits seen in follow‐up and may be potentially useful to individualize management or test therapeutic interventions. Neurocognitive assessment in the ED detected deficits that clinical grading could not and correlated with deficits at follow‐up.
Marathon of eponyms: 17 Quincke oedema (Angioedema)
Authors: Scully C , Langdon J , Evans J 
Published: March 2011

Oral Diseases (2011) 17, 342–344The use of eponyms has long been contentious, but many remain in common use, as discussed elsewhere (Editorial: Oral Diseases. 2009: 15; 185). The use of eponyms in diseases of the head and neck is found mainly in specialties dealing with medically compromised individuals (paediatric dentistry, special care dentistry, oral and maxillofacial medicine, oral and maxillofacial pathology, oral and maxillofacial radiology and oral and maxillofacial surgery) and particularly by hospital‐centred practitioners. This series has selected some of the more recognized relevant eponymous conditions and presents them alphabetically. The information is based largely on data available from MEDLINE and a number of internet websites as noted below: the authors would welcome any corrections. This document summarizes data about Quincke’s oedema.
Association of serum‐soluble CD26 and CD30 levels with asthma, lung function and bronchial hyper‐responsiveness at school age
Authors: Remes Sami T , Delezuch Weronika , Pulkki Kari , Pekkanen Juha , Korppi Matti , Matinlauri Irma H 
Published: March 2011

AbstractAim:  There is a need for markers of Th1 and Th2 imbalance in diseases such as asthma. CD30 is an activation marker of Th2 cells, and importance of Th1 marker CD26 was recently found in adult asthma. We studied whether serum‐soluble CD30 (sCD30) or serum‐soluble CD26 (sCD26) could support early diagnosis of asthma in children at school age.Methods:  sCD26 and sCD30 were measured in 34 children with clinically confirmed asthma, 31 with possible asthma and in 147 controls. In addition, the associations of flow volume spirometry, methacholine inhalation challenge and free running test results with serum sCD26 or sCD30 were analysed.Results:  Serum sCD30 was significantly higher in children with confirmed asthma (mean 91.5 IU/mL, SD 23.0) than in the controls (78.8 IU/mL, 25.9; p = 0.042). No significant differences were found in serum sCD26 levels between the groups. There was a negative correlation of mean mid expiratory flow values with serum sCD26 (r = −0.22, p = 0.0018). Neither methacholine inhalation challenge nor free running test results were associated with serum sCD26 or sCD30.Conclusion:  Serum sCD30 was higher in children with asthma. However, marked overlap in serum sCD30 between asthmatic and healthy children limits the usefulness of sCD30 as a diagnostic marker of asthma.
Kinin system activation in vasculitis*
Authors: Kahn Robin , Karpman Diana 
Published: March 2011

AbstractVasculitis is a systemic autoimmune inflammatory disease, characterized by inflammation in and around vessel walls leading to perturbed vessel patency and tissue damage. Many different organs may be involved. In this review, pathogenetic mechanisms of vasculitis are discussed, with special reference to activation of the kinin system. Mechanisms of kinin system activation are described, ultimately leading to release of kinins from high molecular weight kininogen. These vasoactive peptides promote inflammation.Conclusion:  Kinin system activation during vasculitis promotes inflammation.
Emergency treatment of obstructive bronchitis: change from nebulizers to metered dose inhalers with spacers
Authors: Mecklin Minna , Paassilta Marita , Kainulainen Heidi , Korppi Matti 
Published: March 2011

AbstractAim:  To evaluate how the change from drug nebulizers to metered dose inhalers (MDI) with spacers succeeded and influenced the hospitalization rate and the length of the emergency room (ER) and hospital stay in wheezing preschool‐aged children.Methods:  After educating and training the nurses and physicians, the use of MDIs with spacers was started on 1 November 2006 in the ER and acute wards of our hospital. All of the 1‐to‐5‐year‐old patients admitted for bronchial obstruction from 1 November 2004 to 28 February 2005 and from 1 November 2006 to 28 February 2007 were included in this retrospective hospital chart review.Results:  In 2004–2005, 78% of the children were treated with salbutamol administered by nebulizers, and in 2006–2007, 84% with salbutamol administered by MDIs with spacers. The hospitalization rate was about 50% in both groups, and no difference was seen in the length of the hospital stay. The children treated with the MDIs with spacers stayed in the ER for a longer time.Conclusion:  The change from drug nebulizers to MDIs with spacers in the treatment of acute bronchial obstruction in 1‐to‐5‐year‐old children was successful after the staff was educated and trained.
Beyond Reasonable Doubt: Catching The Drug Cheats at The London Olympic
Authors: Erotokritou-Mulligan Ioulietta , Sönksen Peter , Holt Richard 
Published: March 2011

Abstract
A drugs-free London Olympic Games in 2012? Statisticians can help make it happen. Ioulietta Erotokritou-Mulligan, Peter Sönksen and Richard Holt explain how statisticians have been working with medics, scientists and lawyers to catch the athletes who abuse growth hormone.
Dare You Buy a Henry Moore on ebay?
Authors: Gastwirth Joseph , Johnson Wesley 
Published: March 2011

Abstract
When the rarefied world of modern art sales meets the digital age, almost anything is possible. You, too, can buy a Henry Moore on eBay. But it is risky. The old, high-commission auction-houses have rivals, but you will need statistics to guide you. Joseph Gastwirth and Wesley Johnson tell you where the fakes may be lurking.