bluuebunny/crossref_metadata_2025_split huggingface dataset:
High Prevalence of Sexually Transmitted Diseases in Women with Urinary Infections
Authors: Berg Elijah , Benson Don M. , Haraszkiewicz Paula , Grieb Jerry , McDonald Jacqueline 
Published: September 2008

ABSTRACTObjective: To determine the prevalence and factors associated with unrecognized sexually transmitted diseases (STDs) in women who had pelvic examinations and were subsequently released from the ED with a sole diagnosis of urinary tract infection (UTI).Methods: A 3‐month retrospective chart review was performed in an urban teaching hospital ED (>70,000 visits/year). Women aged 12–45 years who had pelvic examinations and were released from the ED with a sole diagnosis of UTI were included. Patient complaints, physical findings, and laboratory results were reviewed. Laboratory evaluations included the complete blood count, urinalysis, urine pregnancy test, and cervical cultures for Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas.Results: Of the 94 women who met study criteria, 53% had proven STDs (19% N. gonorrhoeae 22% C. trachornaris 33% Trichomonas). There was no difference between the patients with positive and negative tests for STDs with regard to complaints, physical findings, and laboratory results (all p > 0.05).Conclusions: Women undergoing pelvic examinations who are subsequently released, from this urban ED with the diagnosis of UTI have a high (>50%) prevalence of occult STDs. No complaint, physical finding, or laboratory result reviewed was associated with the risk of an STD. Consideration should be given to empirical antibiotic therapy in similar urban populations.
Shock Index as a Marker for Significant Injury in Trauma Patients
Authors: King Randall W. , Plewa Michael C. , Buderer Nancy M. Fenn , Knotts F. Barry 
Published: September 2008

ABSTRACTObjective: To determine whether the shock index (SI), defined as the ratio of heart rate (HR) to systolic blood pressure (SBP), is a useful marker for significant injury in trauma patients.Methods: A retrospective database analysis was used to relate the SI to the clinical measures: death within 24 hours, injury severity score (ISS) ≥16, intensive care unit (ICU) stay ≥1 day, and amount of blood transfused (BT) ≥2 units. Consecutive trauma patients seen at one level I trauma center over a 24‐month period were reviewed; excluded were patients not requiring trauma team consultation, or those with either incomplete records, severe head injury (Glasgow Coma Scale score ≥8), or age 14 years. The SI was calculated from ED admission vital signs. Receiver operating characteristic (ROC) curves were used to find the value of the SI that maximized the sum of sensitivity and specificity for predicting each measure, separately; a separate analysis was done to determine the optimal SI threshold for predicting any of the severity measures.Results: 1,101 cases met study criteria. The optimal SI values (by ROC analysis) for predicting the severity measures were: 1.10 for death <24 hours, 0.71 for ISS ≥16, 0.77 for ICU ≥1 day, and 0.85 for BT ≥2 units. The optimal SI value (by ROC analysis) for any of the above measures was 0.83; use of this SI cutoff provided a sensitivity of 37% (95% CI 32–42%), a specificity of 83% (95% CI 80–87%). and a negative predictive value of 58% (95% CI 54–61%) for any measure. This SI threshold predicted between 24% fewer cases and 4% more cases of poor outcome than did the optimal thresholds HR and SBP, respectively.Conclusion: The optimal SI threshold performed similarly to the optimal threshold HR or SBP for prediction of injury severity.
A Multisite Survey of Factors Contributing to Medically Unnecessary Ambulance Transports
Authors: IV Anthony J. Billittier , Moscati Ronald , Janicke David , Lerner E. Brooke , Seymour Jeffrey , Olsson Daniel 
Published: September 2008

ABSTRACTObjectives: To determine the social and demographic factors associated with medically unnecessary ambulance utilization, and to determine the willingness of patients to use alternate modes of transportation to the ED.Methods: A multisite prospective survey was conducted of all patients arriving by ambulance to 1 suburban and 4 urban EDs in New York State during a l‐week period.Results: For 626 patients surveyed, 71 (11.3%) transports were judged medically unnecessary by the receiving emergency physicians using preestablished guidelines. The patient's type of medical insurance and age were significant predictors of unnecessary ambulance transport (stepwise forward logistic regression analysis). Of the 71 patients whose ambulance transports were deemed medically unnecessary, 42 (59%) were Medicaid recipients and 53 (74%) were <40 years of age. The most common reason for using ambulance transport was lack of an alternate mode of transportation (38.5%), although 82% would have been willing to use an alternate mode of transportation if it had been available. Of those who had medically unnecessary ambulance use, 30% indicated that they would not pay for the ambulance service if billed and 50% believed the cost of their ambulance transports was <$100. More than 85% of the patients whose ambulance transports were deemed medically unnecessary were unemployed; and nearly 85% reported a net annual income of <$20,000. While 33% had a primary care provider, only 22% had attempted to contact their doctors before requesting an ambulance.Conclusions: Patient age 40 years and Medicaid coverage were associated with medically unnecessary ambulance use. Those patients for whom ambulance use was considered medically unnecessary commonly had no alternate means of transportation. Providing alternate means of unscheduled transportation may reduce the incidence of unnecessary ambulance use.
Magnesium Attenuates the Neutrophil Respiratory Burst in Adult Asthmatic Patients
Authors: Cairns Charles B. , Krafi Monica 
Published: September 2008

ABSTRACTIntroduction: IV magnesium (Mg2+) has been proposed as an emergent treatment for acute asthma exacerbations. Recent studies have focused on the effects of Mg2+ on bronchial smooth muscle, yet asthma is primarily an inflammatory disease.Objective: To assess the effects of Mg2+ on the neutrophil respiratory burst of adult patients with asthma. Methods: A prospective, blind study of volunteer adult asthmatic patients was performed. The patients' polymorphonuclear neutrophils (PMNs) were isolated, purified, and placed into phosphate‐buffered saline with the following test conditions: concentrations of magnesium chloride (MgCl2) added: 0 mmol MgCl2, 1 mmol MgCl2 (low), and 10 mmol MgCl2 (high) both with and without the calcium (Ca) ionophore A23187 (0.1 mmol). PMNs were activated using N‐formyl‐methionyl‐leucyl‐phenylalanine (fMLP) (10 pmol), and the production of superoxide (O‐2) was measured by the spectrophotometric reduction of cytochrome c.Results: Mg2+ reduced activated PMN O‐2 production compared with that for no Mg2+ (1.0 ± 0.1 nmol O‐2/5 ± 105 PMN/min) in both low (‐0.52* ± 0.3 nmol O‐2/5 ± 105 PMN/min) and high (‐0.76* ± 0.3 nmol O‐2/5 ± 105 PMN/min; *p < 0.05) concentrations. The addition of A23187 increased O‐2 production in both the high (0.53* ± 0.02 nmol O‐2/5 ± 105 PMN/min) and the low (1.5* ± 0.6 nmol O‐2/5 ± 105 PMN/ min) Mg2+ groups, with no change in the control group (1.2 ± 0.2 nmol O‐2/105 PMN/min).Conclusions: In clinically relevant concentrations, Mg2+ attenuates the neutrophil respiratory burst in adult asthmatic patients. Mg2+ appears to affect PMNs by interfering with extracellular Ca2+ influx. Mg2+ may have a beneficial anti‐inflammatory effect in asthmatic individuals.
Reliability of Faculty Clinical Evaluations of Non‐Emergency Medicine Residents during Emergency Department Rotations
Authors: Ryan James G. , Mandel Francine S. , Sama Andrew , Ward Mary E. 
Published: September 2008

ABSTRACTObjectives: To assess the reliability of faculty evaluations of non‐emergency medicine (non‐EM) residents during clinical ED rotations and to determine the effect that the “leniency” of grading by these evaluators had on the residents' final evaluations.Methods: A prospective, observational study of the evaluation patterns of EM faculty was performed in an academic ED (50, 000 visits yearly census). Each resident was evaluated on a daily basis by a board‐certified or board‐prepared emergency physician. The evaluation form rated 7 characteristics, but only the rating for overall clinical competence was used for data analysis. If an attending evaluated the same resident more than once, only the first evaluation was used to avoid bias from prior exposure. The scoring patterns of the evaluators, both individually and in groups, were analyzed using 1‐way analysis of variance. Evaluator leniency was estimated using the mean evaluator score across all residents. Since each resident was evaluated by a different combination of evaluators, evaluator leniency for each resident was estimated from the mean leniency of the evaluators who specifically assessed that resident.Results: During the period of the study, 66 residents rotated through the ED, yielding a total of 401 evaluations. When the scoring patterns of individual evaluators were analyzed, a high degree of variability was found in the mean scores (range 5.23–8.09) and SDs (range 0.45–1.55) across evaluators; p = 0.0001. There was a moderate correlation between the mean overall competence score received by each resident and that resident's evaluators' leniency, r = 0.52; p = 0.0001.Conclusions: There is significant variability in the scoring patterns of individual evaluators. The evaluators in this study showed large variations in both leniency (as measured by their mean score) and range restriction (as measured by their SD). The differences in evaluator scoring leniency have a moderate correlation with the overall score received by the resident.
A Model for an Integrated Emergency Medicine/Trauma Service
Authors: Hartmann John , Gabram Sheryl , Jacobs Lenworth , Libby Mark 
Published: September 2008

ABSTRACTObjective: To describe a model for an integrated multidisciplinary trauma service and to compare survival outcomes for patients resuscitated by either emergency medicine (EM) or surgical housestaff assigned to the trauma service.Methods: A prospective observational study was performed using injured patients evaluated in the trauma room at Hartford Hospital from July 1 through December 31, 1995. Inclusion criteria included an ICD‐9‐CM code of 800 through 959.9 and any of the following: transfer from another hospital, admission to the intensive care unit, hospitalization for ±23 hours, survival probability of ±90%, or Abbreviated Injury Score of ±3. Patients were excluded for burns necessitating transfer to a burn unit for definitive care, and for missing data elements that prevented a patient from being analyzed by the TRISS method. Data elements included mechanism of injury, Injury Severity Score, Revised Trauma Score, probability of survival, age, gender, and whether an EM resident was team leader. Patients in the EM cohort (group 1) were compared with patients for whom a surgical resident was team leader (group 2) for all data elements and for hospital survival. TRISS analysis was performed to evaluate outcomes in comparison with national norms.Results: After exclusions, 609 patients were left for analysis. There were 141 (30%) resuscitated with an EM resident as team leader. No significant difference was found for matched variables between the groups. Both groups had good comparability with the Major Trauma Outcome Study (MTOS) database baseline, with M scores of 0.949 and 0.942, respectively. Outcomes for both groups also compared favorably with the MTOS norm for survival, with Z scores of 2.38 and 2.35 for groups 1 and 2.Conclusions: These results suggest that in this model of integrated EW trauma service, equivalent survival outcomes occur whether EM or surgery housestaff act as team leaders.
Burnout and Its Correlates in Emergency Physicians: Four Years' Experience with a Wellness Booth
Authors: Goldberg Richard , Boss R. Wayne , Chan Linda , Goldberg Janet , Mallon William K. , Moradzadeh Doris , Goodman Eric A. , McConkie Mark L. 
Published: September 2008

ABSTRACTObjective: To measure the degree of burnout among emergency physicians (EPs) and to identify and rank predictive factors.Methods: Using the Maslach Burnout Inventory as well as a 79‐item questionnaire, a cross‐sectional survey was conducted for physician registrants at the Annual Scientific Assemblies of the American College of Emergency Physicians from 1992 to 1995. Degrees of burnout were stratified into low, moderate, and high ranges. University and stepwise multiple regression analyses were conducted to identify and rank correlates to burnout scores.Results: Of 1, 272 registrants taking the inventory, 60% registered in the moderate to high burnout ranges. Twenty‐one correlates were identified. These were classified broadly in terms of negative perceptions of self, negative practice habits and attitudes, and unhealthy lifestyles. The most highly ranked correlates were: self recognition of burnout, lack of job involvement, negative self‐assessment of productivity, dissatisfaction with career, sleep disturbances, increased number of shifts per month, dissatisfaction with specialty services, intent to leave the practice within 10 years, higher levels of alcohol consumption, and lower levels of exercise. Age and years of practice were not significant predictors of burnout. Projected attrition rates were 7.5% over 5 years and 25% over 10 years.Conclusions: Elevated levels of burnout exist among a substantial percentage of surveyed EPs. However, there is evidence for a “survivor” category of practitioners for whom burnout either does not develop or is a reversible process. The projected attrition rate over 5 and 10 years appears to be no greater than that of the average medical specialty.
New–onset Atrial Fibrillation: When Is Admission Medically Justified?
Authors: Mulcahy Beth , Coates Wendy C. , Henneman Philip L. , Lewis Roger J. 
Published: September 2008

ABSTRACTObjective: To determine 1) the percentage of patients with new–onset atrial fibrillation for whom admission is medically justified and 2) whether those patients for whom hospitalization is medically justified can be reliably identified in the ED.Methods: A retrospective, descriptive cohort analysis was performed using consecutive adult patients with new–onset atrial fibrillation seen in an urban, county hospital ED from 1987 through 1992. Admissions were categorized as medically justified if patients were hypotensive (systolic blood pressure <90 mm Hg), had a diagnosis other than new–onset atrial fibrillation that warranted admission, or had a significant complication during the ED stay or during the subsequent hospitalization. The need for admission was considered to have been apparent during the ED evaluation if the patient fulfilled the above criteria for a medically justified admission while in the ED.Results: Admission was medically justified for 143 of the 216 patients (66%; 95% CI 60–71%) admitted to our institution. For those patients whose admissions were medically justified, the most common concurrent conditions were congestive heart failure and chest pain suggestive of myocardial ischemia. The need for admission was apparent during the ED evaluation for 140 of the 143 patients (98%; 95% CI 94–100%) whose admissions were categorized as medically justified.Conclusion: Approximately one third of patients with new–onset atrial fibrillation may not require admission to the hospital. Most patients (98%) for whom admission is medically justified can be reliably identified during the ED evaluation.
Sertraline Overdose
Authors: Lau G. T. , Horowitz B. Zane 
Published: September 2008

ABSTRACTObjective: To determine the clinical presenting signs and symptoms in presumed overdoses of sertraline, a recently approved antidepressant.Methods: A prospective study involving five western regional poison control centers was performed to evaluate the clinical manifestations of presumed sertraline ingestions (overdoses). Information about calls pertaining to sertraline ingestions was recorded on a standard data collection form. Data including subject age, sex, amount ingested, coingestants, time interval to evaluation, vital signs, presenting signs and symptoms, ECG abnormalities, treatment given, disposition, and length of stay in the ED were collected over a nine–month period.Results: Of 42 ingestions reported, two were adverse reactions to normal doses and 40 were overdoses. Stated amounts of sertraline ingested ranged from 50 to 8, 000 mg (mean 1, 579 mg). Mean patient age was 35. 3 years (range 1 to 69 years). Mean interval to presentation was 3. 0 hours. Seventeen of the 40 patients ingested sertraline alone. Of this subgroup, ten had no sign or symptom. The most common abnormalties reported in isolated sertraline overdose were tremor, lethargy, and nausea. Less common findings included agitation, confusion, and vomiting. There was no significant morbidity in this subgroup of presumed isolated sertraline ingestion. Of the 23 patients who ingested other medications along with sertraline, four were asymptomatic. Benzodiazepines and alcohol were the most frequently coingested substances. Lethargy, nausea, dry mouth, and mydriasis were the most common features reported in this group. Treatment included lavage, activated charcoal, and observation. Twelve patients were admitted for 24–hour observation, none had an adverse outcome. Of the patients released from the ED, the mean length of stay was 3. 9 hours.Conclusion: Sertraline is commonly taken in overdose with other medications or alcohol. The signs and symptoms that develop in association with an overdose of sertraline appear to be minor and of short duration.
The Minimum Clinically Important Difference in Physician–assigned Visual Analog Pain Scores
Authors: Todd Knox H. , Funk Joseph P. 
Published: September 2008

ABSTRACTObjective: To determine the minimum clinically important difference in physician–assigned visual analog scale (VAS) pain scores.Methods: Physicians attending emergency medicine didactic conferences were enrolled in this descriptive study. The subjects sequentially reviewed 11 written scenarios describing patients in moderate to severe pain. The subjects rated their perceptions of each patient's pain on a 100–mm VAS, then contrasted this pain with that of the previous patient scenario. For these contrasts, the subjects chose one of five responses: “much less,” “a little less,” “about the same,” “a little more,” or “much more” pain. The minimum clinically important difference was defined as the difference between scores for scenario pairs in which one patient's pain was rated “a little less” or “a little more” severe.Results: There were 230 comparisons by 23 health professionals. Of these, 64 were judged “a little less,” and 56 “a little more,” painful. These 120 comparisons, with their pain score differences, were used to determine the minimum clinically important difference. Pain judged to be “a little less” or “a little more” severe was associated with a mean difference in VAS scores of 18 mm (95% CI 16–20 mm), corresponding to a decrement of 23% (95% CI 20–26%) from the more painful scenario.Conclusions: Pain research outcomes involving a <18–mm difference, or a 23% decrement in physician–assigned VAS pain scores, although statistically significant, may have little clinical importance.
Serial Electrocardiograms for Chest Pain Patients with Initial Nondiagnostic Electrocardiograms: Implications for Thrombolytic Therapy
Authors: Silber Steven H. , Leo Paul J. , Katapadi Manmohan 
Published: September 2008

ABSTRACTObjectives: To determine the proportion of acute myocardial infarction (AMI) patients without ST–segment elevation who subsequently develop ST–segment elevation during their hospital courses; and to compare demographics and presenting features of AMI patient subgroups: those with initial ST–segment elevation, those with in–hospital ST–segment elevation, and those with no ST–segment elevation.Methods: A retrospective cohort analysis of admitted chest pain patients who had a hospital discharge diagnosis of AM1 was performed. Each chart was examined for initial ECG interpretation, serial ECG analysis, patient age, gender, cardiac risk factors, in‐hospital survival, time between sequential ECGs, and number of ECGs performed within the first 48 hours of hospital admission.Results: Of the 114 charts reviewed, 20 patients had ECGs meeting thrombolytic criteria on arrival. Of the 94 AM1 patients who had nondiagnostic ECGs on arrival, 19 (20%) subsequently developed ECG changes meeting thrombolytic criteria. Seven patients developed these changes within eight hours of the initial ECG, four from eight to 12 hours after, two from 12 to 24 hours after, and six more than 24 hours after. Most patients who had documented AMIs did not develop ECG criteria for thrombolytic therapy during their hospitalizations. Male gender and smoking history were more commonly associated with late ST‐segment elevation for those presenting with nondiagnostic ECGs. All the patients who had late diagnostic ECG changes survived to hospital discharge. Serial ECGs were performed more frequently in the group who had initially diagnostic ECGs and least frequently in the group who did not develop ST‐segment elevation during their hospitalizations.Conclusions: Most patients with AM1 do not meet ECG criteria for the administration of thrombolytic therapy. A significant minority (20%) of the admitted chest pain patients with subsequently confirmed AMIs developed ECG criteria for thrombolytics during their hospitalizations. Further attention to such patients who have delayed ST‐segment elevation is warranted. A standardized in‐hospital serial ECG protocol should be considered to identify admitted patients who develop criteria for thrombolytic or other coronary revascularization therapy.
Mycobacterial Sepsis Following Intravesical Instillation of Bacillus Calmette–Guérin
Authors: Garyfallou Garyfallos T. 
Published: September 2008

ABSTRACTIntravesical bacillus Calmette–Guerin (BCG) administration for bladder cancer may lead to BCG dissemination in the compromised host. A case of a 63–year–old man with shock secondary to BCG sepsis is reported. The recognition and treatment of disseminated BCG infection are discussed. In addition to standard therapy for urosepsis, early therapy with steroids and coverage with antitubercular medications should be initiated for patients with this condition. In general, the author recommends that all febrile patients who have received BCG immunotherapy within three years, and who have no obvious source for their fever, have acid–fast bacilli blood cultures done for Mycobacterium bovis, and that these patients be admitted to the hospital for further evaluation.
Emergency Physician Terminations: Doing It Right
Authors: Zun Leslie S. 
Published: September 2008

ABSTRACTEmergency physicians (EPs), like other specialists in medicine, can be terminated from their positions. Little has been written about the process of physician termination. It is important that this process be well thought–out and performed in a professional manner to ensure that there is no undue damage to the physician or to the institution. The institution must be aware of the effects of terminations on its ability to recruit and retain EPs. To properly terminate a physician employee, the physician manager must use the appropriate termination rationale, ensure appropriate performance evaluations, provide for remediation, understand the psychology of termination, and address the alternatives to termination prior to the termination. Indeed, the hiring process itself must address the grounds on which termination may occur. Successful terminations are performed by planning the process, reviewing the file and the contract, arranging the meeting, examining the termination process, and considering the legal implications and due process issues.