bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acceptance of Rapid HIV Screening in a Southeastern Emergency Department
Authors: Freeman Arin E. , Sattin Richard W. , Miller Kelly M. , Dias James K. , Wilde James A. 
Published: November 2009

AbstractObjectives:  The objective was to assess the acceptance of an emergency department (ED) human immunodeficiency virus (HIV) screening program based on the Centers for Disease Control and Prevention (CDC) recommendations for routine HIV screening in health care settings.Methods:  Rapid HIV screening was offered on an opt‐out basis to patients aged 13 to 64 years presenting to the ED by trained HIV counselors. Patients were excluded if they had a history of HIV, were physically or mentally incapacitated, did not understand their right to opt‐out, or did not speak English or Spanish. Statistical analyses, including logistic regression, were performed to assess the associations between the demographics of patients offered testing and their test acceptance or refusal.Results:  From March 2008 to January 2009, a total of 5,080 (91%) of the 5,585 patients offered the HIV test accepted, and 506 (9%) refused. White and married patients were less likely to accept testing than those who were African American and unmarried (p < 0.001). Adult patients were almost twice as likely to accept testing as pediatric patients (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.50 to 2.53). As age increased among pediatric patients, testing refusal decreased (OR = 0.71; 95% CI = 0.59 to 0.85), and as age increased among adult patients, testing refusal increased (OR = 1.17; 95% CI = 1.12 to 1.22). Two percent of persons accepting the test were considered high risk. Males were more likely to report high‐risk behavior than females (OR = 1.83; 95% CI = 1.23 to 2.72).Conclusions:  The opt‐out approach results in high acceptance of routine HIV screening. Widespread adoption of the CDC’s recommendations, although feasible, will require significant increases in resources.
An Interdisciplinary Initiative to Reduce Radiation Exposure: Evaluation of Appendicitis in a Pediatric Emergency Department With Clinical Assessment Supported by a Staged Ultrasound and Computed Tomography Pathway
Authors: Ramarajan Naresh , Krishnamoorthi Rajesh , Barth Richard , Ghanouni Pejman , Mueller Claudia , Dannenburg Bernard , Ewen Wang N. 
Published: November 2009

AbstractObjectives:  In the emergency department (ED), a significant amount of radiation exposure is due to computed tomography (CT) scans performed for the diagnosis of appendicitis. Children are at increased risk of developing cancer from low‐dose radiation and it is therefore desirable to utilize CT only when appropriate. Ultrasonography (US) eliminates radiation but has sensitivity inferior to that of CT. We describe an interdisciplinary initiative to use a staged US and CT pathway to maximize diagnostic accuracy while minimizing radiation exposure.Methods:  This was a retrospective outcomes analysis of patients presenting after hours for suspected appendicitis at an academic children’s hospital ED over a 6‐year period. The pathway established US as the initial imaging modality. CT was recommended only if US was equivocal. Clinical and pathologic outcomes from ED diagnosis and disposition, histopathology and return visits, were correlated with the US and CT. ED diagnosis and disposition, pathology, and return visits were used to determine outcome.Results:  A total of 680 patients met the study criteria. A total of 407 patients (60%) followed the pathway. Two‐hundred of these (49%) were managed definitively without CT. A total of 106 patients (26%) had a positive US for appendicitis; 94 (23%) had a negative US. A total of 207 patients had equivocal US with follow‐up CT. A total of 144 patients went to the operating room (OR); 10 patients (7%) had negative appendectomies. One case of appendicitis was missed (<0.5%). The sensitivity, specificity, negative predictive value, and positive predictive values of our staged US‐CT pathway were 99%, 91%, 99%, and 85%, respectively. A total of 228 of 680 patients (34%) had an equivocal US with no follow‐up CT. Of these patients, 10 (4%) went to the OR with one negative appendectomy. A total of 218 patients (32%) were observed clinically without complications.Conclusions:  Half of the patients who were treated using this pathway were managed with definitive US alone with an acceptable negative appendectomy rate (7%) and a missed appendicitis rate of less than 0.5%. Visualization of a normal appendix (negative US) was sufficient to obviate the need for a CT in the authors’ experience. Emergency physicians (EPs) used an equivocal US in conjunction with clinical assessment to care for one‐third of study patients without a CT and with no known cases of missed appendicitis. These data suggest that by employing US first on all children needing diagnostic imaging for diagnosis of acute appendicitis, radiation exposure may be substantially decreased without a decrease in safety or efficacy.
Violence Prevention in the Emergency Department: Future Research Priorities
Authors: Houry Debra , Cunningham Rebecca M. , Hankin Abigail , James Thea , Bernstein Edward , Hargarten Stephen 
Published: November 2009

AbstractThe 2009 Academic Emergency Medicine Consensus Conference working group session participants developed recommendations and research questions for violence prevention in the emergency department (ED). A writing group devised a working draft prior to the meeting and presented this to the breakout session at the consensus conference for input and approval. The recommendations include: 1) promote and facilitate the collection of standardized information related to violence victimization and perpetration in ED settings; 2) develop and validate brief practical screening instruments that can identify those at risk for perpetration of violence toward others or toward self; 3) develop and validate brief practical screening instruments that can identify victims at risk for violent reinjury and mental health sequelae; and 4) conduct efficacy, translational, and dissemination research on interventions for violence prevention. The work group emphasized the critical need and role of ED‐based research to impact surveillance and prevention of future violence‐related injury.
Mental Health and Emergency Medicine: A Research Agenda
Authors: Larkin Gregory Luke , Beautrais Annette L. , Spirito Anthony , Kirrane Barbara M. , Lippmann Melanie J. , Milzman David P. 
Published: November 2009

AbstractThe burden of mental illness is profound and growing. Coupled with large gaps in extant psychiatric services, this mental health burden has often forced emergency departments (EDs) to become the de facto primary and acute care provider of mental health care in the United States. An expanded emergency medical and mental health research agenda is required to meet the need for improved education, screening, surveillance, and ED‐initiated interventions for mental health problems. As an increasing fraction of undiagnosed and untreated psychiatric patients passes through the revolving doors of U.S. EDs, the opportunities for improving the art and science of acute mental health care have never been greater. These opportunities span macroepidemiologic surveillance research to intervention studies with individual patients. Feasible screening, intervention, and referral programs for mental health patients presenting to general EDs are needed. Additional research is needed to improve the quality of care, including the attitudes, abilities, interests, and virtues of ED providers. Research that optimizes provider education and training can help academic settings validate psychosocial issues as core components and responsibilities of emergency medicine. Transdisciplinary research with federal partners and investigators in neuropsychiatry and related fields can improve the mechanistic understanding of acute mental health problems. To have lasting impact, however, advances in ED mental health care must be translated into real‐world policies and sustainable program enhancements to assure the uptake of best practices for ED screening, treatment, and management of mental disorders and psychosocial problems.
Public Health in the Emergency Department: Overcoming Barriers to Implementation and Dissemination
Authors: McKay Mary Pat , Vaca Federico E. , Field Craig , Rhodes Karin 
Published: November 2009

AbstractThis article is the outcome of a consensus building workshop entitled, “Overcoming Barriers to Implementation and Dissemination” convened at the 2009 Academic Emergency Medicine Consensus Conference, ‘‘Public Health in the ED: Surveillance, Screening, and Intervention.” The participants were asked to address potential methods for overcoming barriers to the dissemination and implementation in the emergency department (ED) of evidenced‐based practices to improve public health. The panel discussed three broad areas of interest including methods for disseminating evidence‐based practices, barriers encountered during the process of implementation, and the importance of involvement in activities outside the ED including engagement in policy development and improvement. Four recommendations were discussed in detail and consensus was reached. The recommendations included 1) researchers and advocates should disseminate findings through multiple forums beyond peer‐reviewed publications when an ED‐based public health intervention has enough evidence to support integration into the routine practice of emergency care; 2) local barriers to implementation of public health interventions should be recognized and well understood from multiple perspectives prior to implementation; 3) innovation must be put into place and adapted based on local institutional context and culture as barriers and the best methods for overcoming them will vary across institutions; and 4) use of legislation, regulation, and incentives outside of the ED should support and strengthen ED‐based interventions. For each area of interest, research dimensions to extend the current understanding of methods for effectively and efficiently implementing evidence‐based public health interventions in the ED were discussed and consensus was achieved.
SBIRT in Emergency Care Settings: Are We Ready to Take it to Scale?
Authors: Bernstein Edward , Bernstein Judith A. , Stein Jack B. , Saitz Richard 
Published: November 2009

AbstractThis article summarizes a panel discussion on “SBIRT in the emergency care setting: are we ready to take it to scale?” Dr. Edward Bernstein commented on the historical developments of emergency department (ED) screening, brief intervention (BI), and referral to treatment (SBIRT) research, practice, and knowledge translation. Dr. Jack Stein addressed SBIRT grant program progress to date, the reimbursement stream, SBIRT lessons learned, and unanswered questions. Dr. Richard Saitz reviewed the limitations of the evidence for alcohol and drug ED screening and BI and cautioned on the danger of proceeding to practice and broad dissemination without evidenced based on randomized controlled trials with sufficient sample size and clinically important outcomes.
Tobacco Screening Multicomponent Quality Improvement Network Program: Beyond Education
Authors: Kimmel Sharon , Smith Suzanne L. , Sabino Judith N. , Gertner Eric , Dostal Julie , Greenberg Marna Rayl 
Published: November 2009

AbstractObjectives:  Due to the addictive nature of the disease and interrelated societal influences on the behavior of tobacco use, repeated interventions are often required before people successfully stop using tobacco. Our objective was to implement a multicomponent clinical intervention initiative enabling health care providers to effectively screen for tobacco use. We also sought to describe changes in emergency medicine providers’ documentation of cessation advice to tobacco users.Methods:  The intervention was conducted at three emergency departments (EDs) and four clinics at a community‐based teaching hospital and health network. Health care providers with the opportunity to identify and counsel tobacco‐using patients in ambulatory health care settings were the study population. The authors initiated a quality improvement initiative for tobacco screening that employed a multicomponent strategy to facilitate systemic changes that support 100% tobacco use identification, documentation, and counseling. Baseline, posteducation, and post–wrap‐around documented screening rates were compared within each site across the intervention. Cumulative ED baseline, posteducation, and post–wrap‐around rates of provider advice to tobacco users were compared across the intervention. Percentage of possible available gain was calculated in consideration of a 100% ceiling effect. Statistical analysis was performed using SPSS and MetStat. Descriptive statistics and Pearson’s chi‐square cell frequency were used to analyze and compare sites. Fisher’s exact test was used to compare those tests with a chi‐square cell frequency of five or less. The statistical tests used for pre‐/postintervention percentage comparisons by site had power between 80% and 90%, detecting differences of 10% and 20% or more at a 0.05 level of significance.Results:  Significant increases in posteducation screening rates for all ED sites complemented significant increases in ED post–wrap‐around intervention screening rates. Significant increases in ED provider documented cessation advice were also noted.Conclusions:  This initiative successfully changed tobacco screening behavior of health care providers at all sites. It was particularly successful in the ED, typically an environment less likely to be conducive to preventive health interventions.
Alcohol, Tobacco, and Other Drugs: Future Directions for Screening and Intervention in the Emergency Department
Authors: Cunningham Rebecca M. , Bernstein Steven L. , Walton Maureen , Broderick Kerry , Vaca Federico E. , Woolard Robert , Bernstein Edward , Blow Fred , D’Onofrio Gail 
Published: November 2009

AbstractThis article is a product of a breakout session on injury prevention from the 2009 Academic Emergency Medicine consensus conference on “Public Health in the ED: Screening, Surveillance, and Intervention.” The emergency department (ED) is an important entry portal into the medical care system. Given the epidemiology of substance use among ED patients, the delivery of effective brief interventions (BIs) for alcohol, drug, and tobacco use in the ED has the potential to have a large public health impact. To date, the results of randomized controlled trials of interventional studies in the ED setting for substance use have been mixed in regard to alcohol and understudied in the area of tobacco and other drugs. As a result, there are more questions remaining than answered. The work group developed the following research recommendations that are essential for the field of screening and BI for alcohol, tobacco, and other drugs in the ED. 1) Screening—develop and validate brief and practical screening instruments for ED patients and determine the optimal method for the administration of screening instruments. 2) Key components and delivery methods for intervention—conduct research on the effectiveness of screening, brief intervention, and referral to treatment (SBIRT) in the ED on outcomes (e.g., consumption, associated risk behaviors, and medical psychosocial consequences) including minimum dose needed, key components, optimal delivery method, interventions focused on multiple risk behaviors and tailored based on assessment, and strategies for addressing polysubstance use. 3) Effectiveness among patient subgroups—conduct research to determine which patients are most likely to benefit from a BI for substance use, including research on moderators and mediators of intervention effectiveness, and examine special populations using culturally and developmentally appropriate interventions. 4) Referral strategies—a) promote prospective effectiveness trials to test best strategies to facilitate referrals and access from the ED to preventive services, community resources, and substance abuse and mental health treatment; b) examine impact of available community services; c) examine the role of stigma of referral and follow‐up; and d) examine alternatives to specialized treatment referral. 5) Translation—conduct translational and cost‐effectiveness research of proven efficacious interventions, with attention to fidelity, to move ED SBIRT from research to practice.
Research Using Emergency Department–related Data Sets: Current Status and Future Directions
Authors: Hirshon Jon Mark , Warner Margaret , Irvin Charlene B. , Niska Richard W. , Andersen Daniel A. , Smith Gordon S. , McCaig Linda F. 
Published: November 2009

AbstractThe 2009 Academic Emergency Medicine consensus conference focused on “Public Health in the ED: Surveillance, Screening and Intervention.” One conference breakout session discussed the significant research value of health‐related data sets. This article represents the proceedings from that session, primarily focusing on emergency department (ED)‐related data sets and includes examples of the use of a data set based on ED visits for research purposes. It discusses types of ED‐related data sets available, highlights barriers to research use of ED‐related data sets, and notes limitations of these data sets. The paper highlights future directions and challenges to using these important sources of data for research, including identification of five main needs related to enhancing the use of ED‐related data sets. These are 1) electronic linkage of initial and follow‐up ED visits and linkage of information about ED visits to other outcomes, including costs of care, while maintaining deidentification of the data; 2) timely data access with minimal barriers; 3) complete data collection for clinically relevant and/or historical data elements, such as the external cause‐of‐injury code; 4) easy access to data that can be parsed into smaller jurisdictions (such as states) for policy and/or research purposes, while maintaining confidentiality; and 5) linkages between health survey data and health claims data. ED‐related data sets contain much data collected directly from health care facilities, individual patient records, and multiple other sources that have significant potential impact for studying and improving the health of individuals and the population.
The Clinical Impact of Health Behaviors on Emergency Department Visits
Authors: Bernstein Steven L. 
Published: November 2009

AbstractModifiable health behaviors are an important cause of visits to emergency departments (EDs). Substance use, unsafe sexual behavior, interpersonal violence, unintentional injury, and other risky behaviors account for a large proportion of ED volume, as well as up to 40% of all deaths in the United States. While emergency physicians commonly treat the illnesses and injuries caused by these behaviors, additional opportunities exist to screen, intervene, refer, and initiate treatment for patients with these health risks. This article reviews the epidemiology and clinical impact of risky health behaviors on ED visits and suggests strategies for creating a research agenda in these areas.
IGHV3‐21 gene usage is associated with high TCL1 expression in chronic lymphocytic leukemia
Authors: Mansouri Mahmoud R. , Sevov Marie , Åleskog Anna , Jondal Mikael , Merup Mats , Sundström Christer , Osorio Lyda , Rosenquist Richard 
Published: November 2009

AbstractT‐cell leukemia/lymphoma protein 1 (TCL1) was recently shown to display an expression pattern in chronic lymphocytic leukemia (CLL) corresponding to molecular subtypes, where poor‐risk patients demonstrated higher expression levels. Here, we examined the mRNA expression pattern of TCL1 in 144 patients with CLL, including 67 immunoglobulin heavy‐chain variable (IGHV) mutated, 58 IGHV unmutated and 19 patients with IGHV3‐21 usage. A higher TCL1 expression level was detected in patients with CLL with unmutated vs. mutated IGHV genes (P < 0.001), whereas no difference was demonstrated within the IGHV3‐21 cohort (i.e., mutated vs. unmutated and stereotyped vs. non‐stereotyped complementarity determining region 3). The IGHV3‐21 subgroup displayed high TCL1 mRNA expression, differing significantly from other IGHV mutated cases (P < 0.001), although 11/19 had mutated IGHV genes. Furthermore, high TCL1 expression levels were associated with significantly shorter overall survival (P < 0.001). Altogether, we show that TCL1 mRNA expression may predict clinical outcome in CLL and that the IGHV3‐21 subset, regardless of mutational status, displays high TCL1 expression.
Kasabach–Merritt phenomenon: a single centre experience
Authors: Ryan Clodagh , Price Vicotria , John Philip , Mahant Sanjay , Baruchel Sylvain , Brandão Leonardo , Blanchette Victor , Pope Elena , Weinstein Miriam 
Published: November 2009

AbstractObjective:  Kasabach–Merritt phenomenon (KMP) can lead to life‐threatening bleeding, and its optimum treatment has not been established. We review the experience of managing KMP in a single institution.Methods:  A retrospective chart review on all children with KMP treated at the Hospital for Sick Children, Toronto, over an 18 yr period was carried out.Results:  All 15 patients had profound thrombocytopenia and hypofibrinogenemia at presentation, half had bleeding symptoms, and three had cardiac failure. All patients received corticosteroids. Five responded to steroids alone, given for an average of 13 wk, increasing platelets to >20 × 109/L at a mean of 6.2 d and fibrinogen >1 g/dL at 25.6 d. Ten patients received at least one other therapeutic modality in addition to steroids, including vincristine, interferon, anti‐platelet agents and pentoxifylline. Five patients received vincristine, for a mean of 6 wk, with two patients responding. Eight patients received interferon, for a mean of 4 months, with two patients responding. Overall, the mean time to increasing platelets >20 × 109/L was 56 d, to >150 × 109/L was 88 d and fibrinogen >1 g/dL 49 d. Ten patients showed a partial response to embolisation, with a mean of 2.8 procedures performed. Thrombotic complications occurred in 7%. Twelve patients remain alive, with relapse in six patients, all treated successfully. One patient died, and two patients have been lost to follow‐up.Conclusion:  KMP is a rare condition, with significant morbidity and mortality. The therapeutic approach should include a multidisciplinary team and consensus on guidelines.
Effects of forest management on epiphytic lichen diversity in Mediterranean forests
Authors: Aragón Gregorio , Martínez I. , Izquierdo P. , Belinchón R. , Escudero A. 
Published: November 2009

AbstractQuestion: What are the responses of epiphytic lichens to the intensity of management along a large environmental gradient in Mediterranean Quercus forests?Location: Central Spain.Methods: This study was carried out on 4590 trees located in 306 forest stands dominated by Quercus faginea or Quercus ilex ssp. ballota. The effect of forest management and other predictor variables on several species diversity indicators were studied. Variables modelled were total species richness, cyanolichen richness and community composition. A large number of predictor variables were included: forest fragmentation (patch size, stand variability), climate and topographic (altitude, slope, sun radiation, annual rainfall and mean annual temperature) and intensity of management. General linear models and constrained ordination techniques were used to model community traits and species composition, respectively.Results: Total richness and especially cyanolichens richness were significantly and negatively affected by the intensity of management. Lichen composition was influenced by management intensity, climatic and topographic variables and stand variability.Conclusions: In Mediterranean forests, human activities related to forestry, agricultural and livestock use cause impoverishment of lichen communities, including the local disappearance of the most demanding species. The conservation of unmanaged forests with a dense canopy is crucial for lichen diversity.