bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predicting Regional Variations in Mortality from Motor Vehicle Crashes
Authors: Clark David E. , Cushing Brad M. 
Published: January 2008

AbstractObjective: To show that the previously‐observed inverse relationship between population density and per‐capita mortality from motor vehicle crashes can be derived from a simple mathematical model that can be used for prediction. Methods: The authors proposed models in which the number of fatal crashes in an area was directly proportional to the population and also to some power of the mean distance between hospitals. Alternatively, these can be parameterized as Weibull survival models. Using county and state data from the U.S. Census, the authors fitted linear regression equations on a logarithmic scale to test the validity of these models. Results: The southern states conformed to a different model from the other states. If an indicator variable was used to distinguish these groups, the resulting model accounted for 74% of the variation from state to state (Alaska excepted). After controlling for mean inter‐hospital distance, the southern states had a per‐capita mortality 1.37 times that of the other states. Conclusions: Simply knowing the mean distance between hospitals in a region allows a fairly accurate estimate of its per‐capita mortality from vehicle crashes. After controlling for this factor, vehicle crash mortality per capita is higher in the southern states, for reasons yet to be explained.
Emergency Medical Services in China
Authors: Thomas Tamara L. , Clem Kathleen J. 
Published: January 2008

AbstractThe objective of this article is to identify and describe Chinese emergency medical services (EMS) components. Chinese EMS system development began in the 1980s with “importing” of EMS principles from other systems. China is now attempting to unify these principles. Chinese EMS systems are absent in most rural areas. Urban ambulance dispatch or “rescue” centers provide both transport and inpatient care. Ambulances are staffed with either a physician or a driver. There is not extensive overlap between hospital emergency physicians and ambulance physicians and no out‐of‐hospital providers at the paramedic or emergency medical technician level exist. Access to EMS is accomplished by dialing 1‐2‐0. Emergency calls go directly to the rescue center and a physician is dispatched. No on‐line radio communication between hospitals and ambulances typically takes place. China has assimilated both traditional and unique EMS components and is undergoing development. It remains unclear whether a systematized EMS structure will emerge.
Domestic Violence and Out‐of‐hospital ProvidersA Potential Resource to Protect Battered Women
Authors: Husni M. Elaine , Linden Judith A. , Tibbles Carrie 
Published: January 2008

AbstractObjective: The primary objective was to determine the prevalence of domestic violence (DV) in a subset of women presenting to the Boston emergency medical services (EMS) system and to evaluate documentation. A secondary objective was to determine the rate of refusal of transport to the hospital for DV‐positive patients, compared with the general population. Methods: A retrospective chart review of ambulance run sheets from a nonconsecutive, convenience sample between July and December 1995 was performed. Women presenting with injury, obstetric/gynecologic complaints, or psychiatric complaints were included. Records were reviewed, and labeled as positive, probable, suggestive, or negative for DV, based on a previously used classification system. A weighted kappa test was performed, and data were analyzed using chi‐square and t‐test. Results: Among 1,251 charts reviewed, 876 met criteria for inclusion. The percentage of positive cases was 5.4% (95% CI = 3.9% to 6.9%), probable 10.8% (8.8% to 12.9%), suggestive 2.6% (1.6% to 3.7%), and negative 81.2% (78.6% to 83.6%). Among DV‐positive patients, the refusal to transport rate was 23.4% (11.3% to 35.5%), compared with a 7.1% (5.8% to 9.3%) rate for the entire study population (n= 876), and 4.7% for the general Boston EMS population during the same year. More DV patients presented during the night shift compared with other shifts. Conclusions: Domestic violence is common in this high‐risk population. A substantial proportion of women in this population refuse transport to the hospital. Out‐of‐hospital personnel should be trained with the tools to identify and document DV, assess patient safety, offer timely resources, and empower victims to make choices.
Return to the Emergency Department among Elders: Patterns And Predictors
Authors: McCusker Jane , Cardin Sylvie , Bellavance Franc¸ois , Belzile Éric 
Published: January 2008

AbstractObjectives: 1) To describe the pattern of return visits to the emergency department (ED) among elders over the six months following an index visit; 2) to identify the predictors of early return (within 30 days) and frequent return (three or more return visits in six months); and 3) to evaluate a newly developed screening tool for functional decline, Identification of Seniors At Risk (ISAR), with regard to its ability to predict return visits. Methods: Subjects were patients aged 65 years or more who visited the EDs of four Canadian hospitals during the weekday shift over a three‐month recruitment period. Excluded were patients who: could not be interviewed, due either to their medical conditions or to cognitive impairment, and no other informant was available; refused linkage of study data; or were admitted to hospital at the initial (index) visit. Measures made at the index ED visit included: 27 self‐report screening questions on social, physical, and mental risk factors, medical history, use of hospital services, medications, and alcohol. Six of these questions comprised the ISAR scale. Return visits and diagnoses during the six months after the index visit were abstracted from the utilization database. Results: Among 1,122 patients released from the ED, 492 (43.9%) made one or more return visits; 216 (19.3%) returned early and 84 (7.5%) returned frequently. Earlier returns were more likely than later returns to be for the same diagnosis (p = 0.003). Using logistic regression, hospitalization during the previous six months, feeling depressed, and certain diagnoses predicted both early and frequent returns. Also, a history of heart disease, having ever been married, and not drinking alcohol daily predicted early return; a history of diabetes, a recent ED visit, and lack of support predicted frequent use. Conclusions: In the first month after an ED visit, return rates are highest and are more likely to be for the same diagnosis. Both medical and social factors predict early and frequent returns to the ED; patients at increased risk of return can be quickly identified with a short, self‐report questionnaire. The ISAR screening tool, developed to identify patients at increased risk of functional decline, can also identify patients who are more likely to return to the ED.
Attenuation of Verapamil‐induced Myocardial Toxicity in an Ex‐vivo Rat Model Using a Verapamil‐specific Ovine Immunoglobin
Authors: Hill Robert E. , Heard Kennon , Bogdan Gregory M. , Cairns Charles B. , Dart Richard C. 
Published: January 2008

Abstract Objective: To determine whether an ovine verapamil‐specific immunoglobin G (V‐IgG) attenuates verapamil toxicity in an ex‐vivo rat left ventricular papillary muscle model. Methods: The authors dissected left ventricular papillary muscle strips from male Sprague‐Dawley rats (350‐410 g) and suspended them in an oxygen‐perfused Tyrode buffer bath at 37.5°C. Muscle strips equilibrated for 90 minutes under electrical stimulation of 1 Hz. Resting and developed tension (mg) were monitored continuously. A concentration—response trial was performed with verapamil concentrations ranging from 31 to 1,020 nM; 510 nM produced consistent reduction in developed tension. A trial of V‐IgG was then conducted by administering the following treatments to papillary muscle strips in a randomized manner: V‐IgG + 510 nM verapamil, nonspecific ovine IgG (N‐IgG) + 510 nM verapamil (protein control), and 510 nM verapamil alone. Immunoglobin G was administered in equimolar concentrations to verapamil. Attenuation was expressed as inhibition of the verapamil‐induced reduction of developed tension. Results: The V‐IgG comparative trial indicated the V‐IgG + verapamil treatment had a mean reduction in developed tension of 14.1% (SD ± 12.2) compared with 36.2% (SD ± 14.9) for N‐IgG + verapamil and 34.9% (SD ± 8.1) for verapamil alone (p < 0.05). There was no difference between the two control groups. Conclusion: Verapamil‐specific IgG attenuated verapamil‐induced reduction of developed tension in an ex‐vivo rat model.
The Effect of Written Informed Consent on Detection of Violence in the Home
Authors: Hollander Judd E. , Schears Raquel M. , Shofer Frances S. , Baren Jill M. , Moretti Lisa M. , Datner Elizabeth M. 
Published: January 2008

AbstractStudies of programmatic interventions for victims of violence in the home may require the use of informed consent. The use of informed consent may result in ascertainment bias, with victims of violence being less likely to participate. Objective: To investigate the effect of written informed consent on the detection of violence in the home during emergency department (ED) screening. Methods: The authors performed a nonrandomized, controlled trial of 3,466 patients at an urban university ED. On odd days, patients (n? 1,857) were read a brief scripted statement and screened using standardized questions. On even days, patients (n? 1,609) received standard written informed consent prior to the same screening questions (writ‐IC). The main outcome was the number of cases of violence in the home detected using each screening protocol. Results: Fewer writ‐IC patients participated in screening (82% vs 92%; p < 0.001). Despite a higher refusal rate in the writ‐IC group, there was no difference in the number of victims detected by each screening method: choked/kicked/bit/punched? (writ‐IC, 7.3 vs routine screen, 6.5%; p ? 0.3); slapped/grabbed/shoved? (7.3 vs 6.7%; p ? 0.4); threatened/actually used knife/gun to scare/hurt you? (8.3 vs 9.4%; p ? 0.3); thrown object to harmyou? (5.2 vs 4.6%; p ? 0.4); forced sex? (5.8 vs 4.7%; p ? 0.15); or afraid current/former intimate partner would hurt you physically? (13.9 vs 11.9%; p ? 0.9). Conclusions: A written informed consent process in screening for violence in the home is associated with a higher refusal rate than routine screening, but use of written informed consent does not result in a lower rate of detection for multiple forms of violence. The authors did not find any support for the hypothesis that the use of written informed consent would decrease detection of violence in the home.
A Comprehensive Set of Coded Chief Complaints for the Emergency Department
Authors: Aronsky Dominik , Kendall Diane , Merkley Kathleen , James Brent C. , Haug Peter J. 
Published: January 2008

Abstract Objective: To develop a generally applicable set of coded chief complaints for the computerized patient records of emergency departments (EDs). Methods: At an urban teaching ED the chief complaints of more than 50,000 patients were analyzed retrospectively during a 29‐month period (June 1995—October 1997). Applying continuous quality improvement methods, a multidisciplinary team examined the current process documenting the patient's chief complaint. During two prospective periods (November 1997—December 1998; January 1999—June 1999), more than 34,000 chief complaints were analyzed. To reduce free‐text charting practices, a variety of interventions on individual and team level were applied. Quantitative analysis was performed with statistical process control charts, and a qualitative evaluation was performed with a questionnaire. Results: The charting of chief complaint in free‐text format decreased from 23% to 1%. The range among individual ED staff members narrowed from 45% to 9%. During the refinement of the set of coded chief complaints, six infrequently charted items were removed. Five new chief complaints identified by analysis of free‐text entries during the second study period were added. The current set of chief complaints consists of 54 codable and the three original free‐text items. The ED staff members perceived all the interventions beneficial. A poster displaying all available terms as a visual aid, however, had the largest impact on charting the patient's chief complaint in coded format. Conclusions: Applying continuous quality improvement methods, the authors created a clinically developed and applicable set of codable chief complaints that can be easily integrated into a computerized patient record of an ED.
Safety Net Research in Emergency Medicine Proceedings of the Academic Emergency Medicine Consensus Conference on “The Unraveling Safety Net”
Authors: Gordon James A. , Billings John , Asplin Brent R. , Rhodes Karin V. 
Published: January 2008

AbstractA primary goal of the Academic Emergency Medicine Consensus Conference, “The Unraveling Safety Net: Research Opportunities and Priorities,” was to explore a formal research agenda for safety net research in emergency medicine. This paper represents the thoughts of active health services researchers regarding the structure and direction of such work, including some examples from their own research. The current system for safety net care is described, and the emergency department is conceptualized as a window on safety net patients and systems, uniquely positioned to help study and coordinate integrated processes of care.
The Epidemiology of the Homeless Population and Its Impact on an Urban Emergency Department
Authors: D'Amore Jason , Hung Oliver , Chiang William , Goldfrank Lewis 
Published: January 2008

Abstract Objectives: To characterize the homeless adult population of an urban emergency department (ED) and study the medical, psychiatric, and social factors that contribute to homelessness. Methods: A prospective, case—control survey of all homeless adult patients presenting to an urban, tertiary care ED and a random set of non‐homeless controls over an eight‐week period during summer 1999. Research assistants administered a 50‐item questionnaire and were trained in assessing dentition and triceps skin‐fold thickness. Inclusion criteria: all homeless adults who consented to participate. Homelessness was defined as being present for any person not residing at a private address, group home, or drug treatment program. Randomly selected controls were concurrently enrolled with a 3:1 homeless:control rate. Exclusion criteria: critically ill, injured, or incapacitated patients, or patients <21 years of age. Univariate analysis with appropriate statistical tests was used. The Mantel‐Haenszel test was used to adjust for population differences. Results: Two hundred fifty‐two homeless subjects and 88 controls were enrolled. Data are presented for homeless vs control patients, and all p‐values were <0.01. Odds ratios (ORs) with 95% confidence intervals (95% CIs) are given where appropriate: mean age (±SD) ? 42 ± 10 vs 48 ± 13; male gender 95% vs 54% (OR ? 17; 95% CI ? 8 to 37); history of (hx) tuberculosis 49% vs 15% (OR ? 2.5; 95% CI ? 1.2 to 3); hx HIV infection 35% vs 13% (OR ? 3.8; 95% CI ? 1.8 to 8); hx penetrating trauma 62% vs 16% (OR ? 8.62; 95% CI ? 4.4 to 17.1); hx depression 70% vs 15% (OR ? 13.4; 95% CI ? 6.7 to 27); hx schizophrenia 27% vs 7% (OR ? 5.1; 95% CI ? 2.0 to 14); hx alcoholism 81% vs 15% (OR ? 24; 95% CI ? 12 to 49); significant tooth loss (>3) 43% vs 18% (OR ? 3.3; 95% CI ? 1.8 to 6.4); percentage of body fat 16.5% vs 19.7%; hx social isolation (no weekly social contacts) 81% vs 11% (OR ? 33.3; 95% CI ? 14 to 100); mean number of ED visits/year 6.0 vs 1.6. Conclusions: In the study population homelessness was associated with a history of significantly higher rates of infectious disease, ethanol and substance use, psychiatric illness, social isolation, and rates of ED utilization.
America's Health Care Safety Net Intact or Unraveling?
Authors: Richardson Lynne D. , Hwang Ula 
Published: January 2008

AbstractIn virtually every community in this nation, the emergency department (ED) is an integral part of the health care safety net, often serving as the only available point of access to the health care system for many vulnerable and disenfranchised individuals. The authors present a brief overview of the March 2000 report released by the Institute of Medicine that described and assessed the current status of the nation's health care safety net. The authors discuss the role of the ED as a safety net provider and as a window onto the status of the rest of the health care system. The authors describe the Andersen behavioral model of health services use and suggest it as a useful theoretical framework for emergency medicine researchers who are interested in studying these issues.
The Emergency Medical Treatment and Labor Act as a Federal Health Care Safety Net Program
Authors: Fields W. Wesley , Asplin Brent R. , Larkin Gregory L. , Marco Catherine A. , Johnson Loren A. , Yeh Charlotte , Ghezzi Keith T. , Rapp Michael 
Published: January 2008

AbstractDespite the greatest economic expansion in history during the 1990s, the number of uninsured U.S. residents surpassed 44 million in 1998. Although this number declined for the first time in recent years in 1999, to 42.6 million, the current economic slow‐down threatens once again to increase the ranks of the uninsured. Many uninsured patients use hospital emergency departments as a vital portal of entry into an access‐improverished health care system. In 1986, Congress mandated access to emergency care when it passed the Emergency Medical Treatment and Labor Act (EMTALA). The EMTALA statute has prevented the unethical denial of emergency care based on inability to pay; however, the financial implications of EMTALA have not yet been adequately appreciated or addressed by Congress or the American public. Cuts in payments from public and private payers, as well as increasing demands from a larger uninsured population, have placed unprecedented financial strains on safety net providers. This paper reviews the financial implications of EMTALA, illustrating how the statute has evolved into a federal health care safety net program. Future actions are proposed, including the pressing need for greater public safety net funding and additional actions to preserve health care access for vulnerable populations.
Tying a Knot in the Unraveling Health Care Safety Net
Authors: Asplin Brent R. 
Published: January 2008

AbstractThe U.S. health care system continues to rely on a diverse and poorly organized health care safety net to provide care for its uninsured and underinsured residents. Last year, the Institute of Medicine (IOM) published a report entitled America's Health Care Safety Net: Intact but Endangered. The IOM cited several threats to the safety net, including inadequate monitoring of safety net function, poor integration of services, financial threats for core safety net providers, and the destabilizing effects of a rapid shift from traditional Medicaid to Medicaid managed care products. This paper reviews the findings of the IOM report, highlighting the key issues for emergency medicine. In response to the IOM's challenges, emergency departments should be used more effectively to monitor local safety net viability and to enhance the integration of community health care safety net delivery systems.
Child Health Insurance Outreach through the Emergency Department A Pilot Study
Authors: Gordon James A. , Dupuie Terry A. 
Published: January 2008

AbstractIn 1997 the U.S. government funded the Children's Health Insurance Program (CHIP), but the $48 billion initiative has had limited success in finding and enrolling uninsured children. While such children are more likely to receive care in emergency departments (EDs), no national initiative has targeted EDs for child health insurance outreach. Objective: As a pilot study for a national multicenter study, this study evaluated the effectiveness of child health insurance outreach in an ED setting. Methods: This was a prospective observational study of the outreach efforts of a single case manager from August 1998 to July 1999, performed at Foote Hospital ED in Jackson, Michigan (45,000 visits/year). All patients ≤18 years old presenting during the duty‐hours of the intervention worker were eligible. The case manager approached the parent of all uninsured children and provided information and an application for government‐sponsored health insurance. She followed up with a brief phone interview of each parent to determine whether the targeted child had received the insurance, and whether the new coverage was due to the ED referral. Missing information was confirmed from state insurance records. Data were analyzed with frequency tabulations and 95% confidence intervals. Results: Seventy‐eight children participated (median age 7 years; 55% male; 87% white). Forty‐four percent (95% CI ? 32% to 55%) of families referred for government‐sponsored child health insurance successfully obtained it; 31% (95% CI ? 21% to 42%) could be traced directly to intervention efforts by interview (n ? 17) or by state records (n ? 7). Nineteen percent (95% CI ? 11% to 30%) got other private insurance. Of those who got government‐sponsored insurance due to the intervention, all but one were covered by Medicaid. Conclusions: The ED may be an important outreach site for child health insurance programs. National efforts to address the lack of insurance among children should include partnerships with the ED.
Recently Discharged Inpatients as a Source of Emergency Department Overcrowding
Authors: Baer Ryan B. , Pasternack Joel S. , Zwemer Frank L. 
Published: January 2008

Abstract Objective: To assess the impact on the emergency department (ED) of recently discharged inpatients and how they contribute to and worsen the current situation of ED overcrowding. Methods: Retrospective, observational study of medical records and billing data of all patients presenting to the ED within seven days of inpatient discharge from the hospital (“returns”) in September 2000. The data were collected from electronic logs. Billing charges were used to estimate ED resources. Medical records were reviewed to classify visits: 1) new problem, 2) related problem, likely preventable, 3) related problem, not likely preventable, 4) unable to classify, or 5) incomplete chart. Results: One‐hundred seventy‐four returns occurred among 6,290 total ED visits (3%). Significant differences between returns and total ED patients were noted for length of stay (LOS) (6.58 vs 5.22 hours, p ? 0.000), percent admitted (47% vs 19%, p ? 0.000), and ED billing ($1,415.67 vs $391.00, p ? 0.000). The highest rate of admission was for patients presenting 48‐72 hours after inpatient discharge (65.4%). Admission rate was higher for patients presenting >48 hours than <48 hours (54% vs 33%, p ? 0.01). A review of the medical records (117/174) revealed: 15 new problems (13%); 16 related, likely preventable (14%); 72 related, not likely preventable (62%); 4 unable to assess (2%); and 10 incomplete charts (9%). Conclusions: The ED is appropriately utilized as a safety net for discharged inpatients. Though “returns” are a small percentage of ED patients, they have longer LOSs, have higher ED charges, and are more frequently admitted. Returns increase the strain on an already overcrowded ED.