bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identification of Ethanol‐intoxicated Patients with Minor Head TVauma Requiring Computed Tomography Scans
Authors: Cook Laura Staffeld , Levitt M. Andrew , Simon Barry , Williams Virgil L. 
Published: August 2010

ABSTRACT Objective:To determine whether clinical parameters and neurologic scores can be used to guide the decision to obtain computed tomography (CT) head scans for ethanol‐intoxicated patients with presumed‐minor head injuries. Methods:In a prospective cohort analysis, 107 consecutive adult patients who presented to a county emergency department (ED) with serum ethanol levels >80 mg/dL and minor head trauma were studied. Commonly used clinical variables were determined for each patient. Each patient also underwent an abbreviated neurologic scoring examination and a Glasgow coma scale (GCS) score evaluation at the time of presentation and one hour later, after which a cranial CT scan was done. For purposes of analysis, patients with and patients without intracerebral injuries visible on CT scans of the head were compared. Results:Nine of 107 patients (8.4%; 95% confidence interval [CI] = 3.9–15.4%) had CT scans that were positive for intracerebral injury. Two patients (1.9%; 95% CI = 0.2–6.6%) needed craniotomy. Five patients had hemotympanum and two patients had bilateral periorbital ecchy‐mosis, but CT scans were negative for intracerebral injury in these patients. There was no statistically significant difference between the patients with and without CT scan abnormalities, based on the clinical variables, the GCS scores, or the abbreviated neurologic scoring examinations at presentation or at one hour. Conclusion:The prevalence of intracerebral injury in CT scans of ethanol‐intoxicated patients with minor head injuries was 8.4%. Commonly used clinical parameters and neurologic scores at presentation and one hour later were unable to predict which patients would have intracerebral injuries as evidenced by CT scans. Our low (1.9%) neurosurgical intervention rate supports the need to develop a selective approach to CT scanning in this population.
Positive‐outcome Bias: Comparison of Emergency Medicine and General Medicine Literatures
Authors: Moscati Ronald , Jehle Dietrich , Ellis David , Fiorello Albert , Landi Michael 
Published: August 2010

ABSTRACT Objective:The existence of positive‐outcome bias in the medical literature is well established. Positive‐outcome bias in two emergency medicine journals was compared with that found in two general medicine journals. Methods:Published original contributions from Annals of Emergency Medicine, American Journal of Emergency Medicine, JAMA, and New England Journal of Medicinewere reviewed. Articles were categorized as demonstrating a positive or negative outcome or showing no difference using new criteria. Descriptive articles were excluded. Results:Of 700 articles reviewed, 177 emergency medicine and 211 general medicine articles met the study criteria. The emergency medicine journals had 142 articles (80%) with positive outcomes, 27 (15%) with negative outcomes, and 8 (5%) with no difference. The general medicine journals had 169 articles (80%) with positive outcomes, 33 (16%) with negative outcomes, and 9 (4%) with no difference. There was no significant difference between journal groups (chi‐square; p = 0.99). The power of the study was 0.80 to detect a difference of 15% between groups with alpha set at 0.05. Conclusions:There was no significant difference in the proportions of positive‐outcome studies published in this sample of the emergency medicine literature compared with the general medicine literature. The potential impact of positive‐outcome bias and methods of dealing with the problem are reviewed.
The Effect of Compression Duration on Hemodynamics during Mechanical High‐impulse CPR
Authors: Swart Gary L. , Mateer James R. , DeBehnke Daniel J. , Jameson Stephen J. , Osborn Jeffrey L. 
Published: August 2010

ABSTRACT Objective: To determine whether shorter compression durations combined with fixed increased compression velocity during mechanical high‐impulse CPR (HI‐CPR) improve resuscitation hemodynamics, compared with mechanical standard CPR (SCPR). Methods: A porcine model of ventricular fibrillation was used, with each animal serving as its own control. Twelve anesthetized swine (20–25 kg each) were instrumented for hemodynamic monitoring. Ventricular fibrillation was induced and followed, after 3 minutes, by mechanical SCPR (50% duty cycle) for 10 minutes. Mechanical HI‐CPR was then applied, with compression durations varied randomly at 2‐minute intervals for 20% (COM20), 30% (COM30), and 40% (COM40) of the CPR cycle. A 2‐minute mechanical SCPR control phase completed the experiment. Results: Hemodynamic measurements were significantly better for COM20 and COM30 vs SCPR, including, respectively: mean arterial pressure (MAP), 45 ± 8 and 43 ± 7 vs 36 ± 7 torr; coronary perfusion pressure (CPP), 21± 6 and 21 ± 8 vs 16 ± 6 torr; and end‐tidal CO2 (ETCO2), 7 ± 2 and 6.6± 2 vs 5 ± 1.4 torr. MAP, CPP, and ETCO2 during COM40 were not significantly different from those during SCPR, and there was no difference between COM20 and COM30 for any hemodynamic parameter. Aortic flow velocity was significantly better in COM20, COM30, and COM40 vs SCPR: 2.3± 0.7, 2.1± 0.9, and 1.95 ± 0.9 vs 1.3 ± 0.5 cm/sec, respectively. Conclusion: In a swine model of mechanical HI‐CPR, shorter compression durations combined with fixed increased compression velocity significantly improve resuscitation hemodynamics, compared with those afforded by mechanical SCPR.
Emergency Medicine Career Change: Associations with Performances in Medical School and in the First Postgraduate Year and with Indebtedness
Authors: Xu Gang , Hojat Mohammadreza , Veloski J. Jon 
Published: August 2010

ABSTRACT Objective: Emergency medicine has been identified as the specialty that has gained the most young physicians who have changed their careers. To identify factors that may have contributed to such career changes, the authors compared the characteristics of three groups of physicians trained at their medical school: those who chose and stayed in emergency medicine, those who migrated into emergency medicine from other specialties, and those who moved out of emergency medicine. Methods: A prospective longitudinal study was conducted. The sample consisted of physicians who chose emergency medicine as their careers at graduation and stayed in the specialty (n= 24), those who migrated from other specialties into emergency medicine (n= 51), and those who moved out of emergency medicine (n= 10). This sample was obtained from a total of 2,173 graduates of Jefferson Medical College between 1978 and 1987. The three groups of physicians were compared according to their academic performances both during medical school and after graduation. The dependent variables were freshman and sophomore grade point averages (GPAs), written clinical examination scores, scores on National Board of Medical Examiners examination (Parts I, II, and III), and residency program directors' ratings. Age and indebtedness at medical school graduation and board certification status also were examined.Results: Those physicians who stayed in emergency medicine and those who migrated from other specialties into emergency medicine had similar measures of academic performance, but both of these groups had higher academic performance measures and higher board certification rates than did the physicians who moved out of emergency medicine. Those who stayed in emergency medicine had the highest mean debt in the senior year of medical school. Conclusions: High academic performance and high indebtedness are factors associated with choosing or staying in the specialty of emergency medicine.
An Approach to Emergency Department Photography
Authors: Storrow Alan B. , Stack Lawrence B. , Petersen Phred 
Published: August 2010

ABSTRACTIn the emergency department, photography requires an expedient, portable, adaptable, and relatively simple camera system to take advantage of fleeting opportunities for recording visually educational material. These prerequisites are different from those for traditional medical photography, for which relatively plentiful time and advanced equipment are routinely available. Medical photography departments provide an invaluable service, but are rarely convenient for immediate or spontaneous emergency. department photographs. Although no single system or technique is optimal in all these areas, the authors find certain components and approaches work well. They review photographic equipment, paying attention to speed, ease of use, and quality of output. They also review simple techniques such as film choice, lighting, close‐up photography, standardization, copy work, and radiographs. Attention to these details can help the inexperienced photographer obtain a system and begin to enjoy the rewards of effective photography in the emergency department.
Serum Ethanol Clearance in Intoxicated Children and Adolescents Presenting to the ED
Authors: Simon Harold K. , Cox Jeffrey M. , Sucov Andrew , Linakis James G. 
Published: August 2010

ABSTRACT Objective: To determine the rate of serum ethanol clearance in 39 children and adolescents who presented intoxicated to one ED. Methods: All pediatric patients presenting to a university hospital ED, for whom serial ethanol levels had been determined between January 1989 and May 1993, were evaluated. Age, gender, presenting complaint, initial serum glucose concentration, timed serum ethanol concentrations, and rate of serum ethanol clearance were determined retrospectively for all the patients. Results:39 pediatric patients had had serial serum ethanol concentrations determined. The patients ranged in age from 6 weeks to 17 years (mean 14.6 years). Initial serum ethanol levels ranged from 13.7 to 84.2 mmol/L (63–388 mg/dL) and the mean serum ethanol clearance rate was 4.0 mmol/L/hr (18.6 mg/dL/hr), consistent with clearance rates previously reported for adults. Conclusion: These data suggest that the rate of serum ethanol clearance in children and adolescents presenting to the ED approaches that previously reported for adults. Clinical diminution of intoxication should not be more rapid for children and adolescents than it is for adults.
Family Abuse and Neglect: A Case‐based Ethics Model
Authors: Tilden Virginia P. , Schmidt Terri A. 
Published: August 2010

ABSTRACTThe ethical dilemma of caring for the patient from a multiproblem family with suspected domestic violence is discussed. An ethical decision making model that organizes patient data and encourages systematic analysis of the case is reviewed to address the responsibility of the emergency physician to intervene and the options available. The analysis explores specific issues related to mandatory reporting laws, discretionary reporting, and factors to be weighed in deciding the best action for protecting various members within a family when abuse is known or suspected.
Infrared Tympanic Thermometry in the Evaluation of Pediatric Acute Otitis Media
Authors: Brennan Daniel F. , Falk Jay L. , Rothrock Steven G. , Kerr Robert B. 
Published: August 2010

ABSTRACT Objective: The reliability of infrared tympanic thermometry (ITT) in children and the effect of acute otitis media (AOM) on ITT are unsettled. This study assessed the effect of AOM on ITT and the utility of ITT in the diagnosis of AOM. Methods: 520 consecutive children, aged 6 months to 6 years, presenting to the ED of an urban teaching hospital were eligible for this prospective observational study. Nurses recorded oral or rectal reference temperatures (RefTs) and bilateral ITT temperatures upon presentation. Emergency physicians were blinded to the ITT temperatures. AOM was diagnosed according to published clinical criteria. Results: Among 520 patients, 108 had unilateral AOM and 78 had bilateral AOM. In patients with unilateral AOM, the infected ears were warmer (I = 100.4 ± 1.8°F) than the uninfected ears (U = 100.3 ± 1.8°F, p = 0.035). However, the disparity in TM temperatures in infected and uninfected ears with unilateral AOM (I ‐ U = 0.2 ± 0.9°F) was similar to the difference between right and left ears in those without AOM (R ‐ L = 0.1 ± 0.8°F, p = 0.60). Compared with patients without AOM, patients with AOM demonstrated no significant elevation of ITT temperatures over RefTs (I ‐ RefT = ‐0.8 ± 1.2°F in AOM; ITT ‐RefT = ‐0.8 ± 1.2°F in non‐AOM; p = 0.94). This study had >99% power to detect a 1.0°F difference for all groups compared. Conclusions: Infrared tympanic temperatures are not helpful in diagnosing AOM in children. AOM has little direct effect on ITT temperatures.
Do schizophrenics well adapted in the community need neuroleptics?: A DEPOT NEUROLEPTIC WITHDRAWAL STUDY
Authors: Dencker S. J. , Lepp M. , Malm U. 
Published: August 2010

Two depot neuroleptics (flupenthixol palmitate and clopemthixol de canoate) used for at least 15 months were withdrawn in 32 schizephrenic outpatients belonging to the most symptom‐free and social cohort of a total patient population. They all had only slight schizophrenic symptoms, were well adapted in the community, and had been free from relapse for at least 2 years before the study. They were assessed by means of rating scales every month during the first six months and then after 9 and 12 months.After the one‐year trial 26 patients had relapsed. Moreover, after the control period further 4 out of 6 patients relapsed during the following drug‐free year. These results indicate the necessity of a long follow‐up period after withdrawal of depot neuroleptics. Moreover, the results suggest that periodical drug‐free periods of about 3 months are appropriate in symptom‐poor patients during long‐term treatment with long‐acting antipsychotic drugs.
A specific fluorimetric method for assay of drug levels in serum of patients treated with clopenthixol decanoate injections
Authors: Overø K. Fredricson 
Published: August 2010

A fluorimetric method is presented for the simultaneous and specific assay in serum of clopenthixol decanoate, clopenthixol and a clopenthixol metabolite, deprived of the ethanol group in the side chain. The sepration is achieved by extractions and thin layer chromatography and fluorescence brought about by treatment with sulphuric acid. The limit of detection in 3 ml serum samples is about 2 ng/ml for clopenthixol and metabolite, and somewhat higher for the ester.In addition serum data are presented for patients treated with intramuscular injections of 100‐600 mg clopenthixol decanoate in Viscoleor̀ every second week. Relatively stable (maan max./min. ratio about 2; maximum after 3‐7 days) clopenthixol levels were recorded through‐out the dosage interval. Somewhat lower meabolite levels were found. There was no evidence for the presence of clopenthixol decanoate.
Cannabis ‐ 1988
Authors: Hollister Leo E. 
Published: August 2010

ABSTRACTIn this updating review of research on cannabis particular attention has been paid to the increasing number of studies of the disposition of the components of cannabis in man, as well as possible effects on health. Specific binding sites for cannaboids have not been demostrated. Approximately 80 metabolites of tetradrocannabiol (THC) have been discovered, of which 11‐OH‐THC is the main metabolite, but it contributes little to the overall effect when the drug is smoked or given intravenously. The minimu plasma level of THC associted with the psychotropic effect is 25 ng/ml.Cannabis may produce directly an acute panic reaction, a toxic delirium, and acute paranoid state, or acute mania. Cannabis use may aggrevate schizophrenia, but it is much less certain whether it can lead to sociopathy or even to “amotivational syndrome”. Despite widespred use of cannabis in virtually all parts of the world, no catastrophic effects on health have been noted. Cannabis appears to be relatively safe as compared with current social drugs. It is, however, still too early in the history of the present episode of cannabis use to be sanguine about possible bad effects.
Anorexia Nervosa. Treatment and triggering factors
Authors: Nygaard JofrM Alice 
Published: August 2010

Nygaard JA. Anorexia Nervosa. Treatment and triggering factors. Acta Psychiatr Scand Suppl. 361, Vol. 82. 1990: 44–49.In the period from 1976 to 1983, 84 anorexia nervosa (AN) patients were treated in the Medical and Child Psychiatry Units of the University Hospital of Bergen. Five were men, 79 women. The criteria used for diagnosis are DSM‐III (1) A, B, D and E, but not C. All the patients in this study were treated according to the methods of Bassøe & Eskeland (2) and Bassøe (3) in order to give the patients the necessary insight into the pathophysiology of hunger and to inform them about the symptoms. Those of the patients with personal problems connected with their family or social milieu were given help through therapeutic discussions. However, we stressed that very sick patients should not be put under any pressure to undergo this treatment. I will describe the treatment we employed and the results obtained. It was found to be of great importance that the patients received treatment in the early stages of the condition. Also that the patient, as a part of the prophylaxis of the condition, was informed about the dangers of slimming. A short survey of other methods of treatment found in the literature is given.My conclusion is hat AN is triggercd by a combination of genetic disposition plus some kind of stress followed by a primary weightloss.
Anorexia Nervosa and Bulimia Nervosa
Authors: Støylen Inge Jarl , Laberg Jon Chr. 
Published: August 2010

Støylen IJ, Laberg JC. Anorexia Nervosa and Bulimia Nervosa. Perspectives on etiology and cognitive behavior therapy. Acta Psychiatr Scand Suppl. 361, Vol. 82. 1990: 52–58.This article gives a brief historical introduction to the field of eating disorders. Anorexia Nervosa (AN) and Bulimia Nervosa (BN) are seen from a sociocultural point of view, and the current emphasis on slimness is regarded as an important factor in the etiology of eating disorders. A short description of the central features of BN is given, and some important explanatory psychological models are described with the emphasis on the cognitive‐behavioral model. Recent controlled treatment studies are cited.
Attention training in the cognitive rehabilitation of schizophrenic patients:a review of efficacy studies
Authors: Suslow T , Schonauer K , Arolt V 
Published: August 2010

Objective: To review the literature on effects of attention and cognitive training on attentional functioning in schizophrenic patients. Method: Relevant efficacy studies were identified by literature searches (in Medline, Current Contents, Psyclit, and Psyndex databases) and through the reference lists of key papers. Results: Re‐examination of findings from nine methodologically adequate studies using computer‐based or non‐computer‐based training procedures provided inconsistent results. On 16 of 35 outcome measures significant performance improvements were observed from pre‐treatment to post‐treatment but on the majority of the applied measures no performance improvement could be determined. In general, treatment effect sizes but also power of tests were low. For nearly all the outcome measures for which differential training effects were reported there also exist contradictory outcome results. Conclusion: There is inconclusive evidence that attention training is effective in schizophrenia. Longitudinal efficacy studies are needed in which different aspects of attention are systematically exercised and assessed.
Cognitive‐behavioural intervention in deliberate self‐harm
Authors: Raj. M. Antony Joseph , Kumaraiah V. , Bhide Ajit V. 
Published: August 2010

Objective: The objective of the study was to find the efficacy of cognitive behaviour therapy (CBT) in the management of deliberate self‐harm (DSH) patients. Method: The experimental group (n=20) was given 10 sessions of CBT. CBT included cognitive methods, behavioural methods, problem‐solving skills training and behavioural counselling to significant others. The control group (n=20) was given routine medical treatment. Post‐assessment was done for both groups at the end of 3 months. Results: The analysis of pre–post‐assessment revealed that only the experimental group showed significant improvement on all the variables, except on impulsivity. Conclusion: CBT was effective in the management of DSH patients.
Thrombosis associated with physical restraints
Authors: Hem E. , Steen O. , Opjordsmoen S. 
Published: August 2010

Objective: Physical restraint is controversial, but still frequently used in psychiatric units. We describe two cases of thromboembolic phenomena, one with a fatal outcome, in association with physical restraint. Method: The world literature on physical restraint and thrombosis was reviewed by undertaking a search of electronic databases. Results: To our knowledge, we are the first to report thrombosis associated with physical restraint. Conclusion: Immobilization and trauma to the legs while restraining a patient are adequate explanations for the occurrence of thrombosis. Special attention should be paid to thrombosis when employing restraints in psychiatric wards. Further systematic research into physical restraints in psychiatry is clearly needed.
Putative clinical subtypes of social phobia:a factor‐analytical study
Authors: Perugi G. , Nassini S. , Maremmani I. , Madaro D. , Toni C. , Simonini E. , Akiskal H. S. 
Published: August 2010

Objective: To examine symptomatological subtypes of social phobia (SP) and their relationships with a number of feared situations and avoidant personality disorder (APD). Method: In 153 out‐patients with SP according to DSM‐III‐R criteria, clinical subtypes were investigated by means of principal component factor analysis of the Liebowitz Social Anxiety Scale (LSAS). We compared the various SP subtypes on the basis of the highest Z‐scores obtained on each LSAS factor. Results: Five factors (interpersonal anxiety, formal speaking anxiety, stranger‐authority anxiety, eating and drinking while being observed, anxiety of doing something while being observed) emerged, accounting for 64.7% of the total variance. When the dominant LSAS factor groups were compared, the highest values in the numbers of feared situations and the presence of APD were observed in the ‘interpersonal anxiety’ dominant group and the lowest in the ‘anxiety of doing something while being observed’. The ‘interpersonal anxiety’ dominant group was the most likely to present a positive family history for SP and a lifetime comorbidity with mood disorders. Conclusion: The emerging multidimensional structure of phobia is congruent with, and further enriches, the existing literature.
Validation of psychiatric patients' statements on coercive measures
Authors: Poulsen Henrik Day , Engberg Md Marianne 
Published: August 2010

Objective: To investigate the accuracy of psychiatric patients' statements on coercive measures compared with medical file information using empirical methodology, and relating the statements to patients' psychopathology. Method: One hundred and forty‐three in‐patients were identified consecutively, and interviewed using a structured questionnaire. Psychopathology was measured using BPRS, and social functioning using GAF. Patients' statements about coercion were compared with information in the medical files. Results: In general, patients stated to have been subjected to more coercion than was evident from the files. In particular, statements about forced medication, earlier involuntary commitments and present legal status showed low accordance with information in the files. Low accordance was related to the severity of psychopathology and being schizophrenic. Conclusion: The existence of a ‘grey zone’ between patients' and doctors' perception of coercion was confirmed. Knowledge of patients' psychopathology seems essential when considering medical, legal and ethical aspects of the use of coercion.