bluuebunny/crossref_metadata_2025_split huggingface dataset:
Olanzapine versus Droperidol for the Treatment of Primary Headache in the Emergency Department
Authors: Hill Chandler H. , Miner James R. , Martel Marc L. 
Published: August 2008

AbstractObjectives:  The objective was to determine if there is a difference in pain relief or frequency and severity of side effects in emergency department (ED) patients with primary headache treated with either intramuscular (IM) olanzapine or IM droperidol.Methods:  This was a prospective, randomized nonblinded clinical trial of adult ED patients undergoing treatment for suspected primary headache. Consenting patients were randomized to receive either droperidol 5 mg IM or olanzapine 10 mg IM. Prior to receiving treatment, patients were asked to complete a 100‐mm visual analog scale (VAS) describing their pain and a 4‐point verbal rating scale (VRS) describing their pain as none, mild, moderate, or severe. Patients also completed a 100‐mm VAS describing their level of nausea. Pain and nausea measurements were repeated 30 and 60 minutes after medication administration. Patients also completed the Barnes Akathisia Scale (BAS) 30 and 60 minutes after medication administration. Descriptive statistics were used as appropriate. Pain relief was compared both in terms of the decrease in VAS scores and in the proportion of patients who reported moderate or severe pain whose report later changed to mild or no pain.Results:  One‐hundred patients were enrolled; 13 were withdrawn before administration of the study medication, 8 in the droperidol group and 5 in the olanzapine group, leaving 87 patients for analysis. Forty‐two patients received droperidol and 45 received olanzapine. In the droperidol group, 35/40 (87.5%) patients who had reported moderate or severe pain at baseline reported mild or no pain at 60 minutes. In the olanzapine group, 38/44 (86.4%) reported this change (p = 0.89). The mean percent change from baseline VAS pain score at 60 minutes was −37% (95% CI = −84% to 11%) for droperidol and −37% (95% CI = −64% to 10%) for olanzapine (p = 0.30). The mean percent change from baseline for the VAS nausea score was −59% (95% CI = −70% to −47%) for droperidol and −64% (95% CI = −77% to −51%) for olanzapine (p = 0.83). There was no difference in any report of akathisia by the BAS between the groups (p = 0.63).Conclusions:  Both olanzapine and droperidol are effective treatments for primary headaches in the ED. No significant differences were found between the medications in terms of pain relief, antiemetic effect, or akathisia. Olanzapine may be used to treat primary headache and it is an effective alternative to droperidol.
Simulator Training Improves Fiber‐optic Intubation Proficiency among Emergency Medicine Residents
Authors: Binstadt Emily , Donner Scott , Nelson Jessie , Flottemesch Thomas , Hegarty Cullen 
Published: August 2008

AbstractObjectives:  The objective was to observe how a workshop using a virtual reality bronchoscopy simulator and computer‐based tutorial affects emergency medicine (EM) resident skill in fiber‐optic intubation.Methods:  In this observational before‐and‐after study, EM resident performance on three simulated pediatric difficult airway cases was observed before and after a short computer‐based tutorial and 10 minutes of self‐directed practice. The primary outcome was the total time required to place the endotracheal tube (ETT), secondary outcomes included the number of endoscope collisions with mucosa, and a calculated efficiency score measuring the proportion of time participants spent looking at correct central airway structures. Nonparametric Wilcoxon signed rank tests compared performance on the first versus the repeat attempt for each of the three simulated cases. Participants were surveyed regarding their assessments of the experience.Results:  Significant decreases in median procedure times and number of scope collisions and increases in median efficiency scores were seen for Cases 1 and 2. Case 3 showed no significant changes in outcomes between first and repeat attempts. Participants positively assessed the training and felt that its use would improve clinical practice.Conclusions:  Participation in a simulation‐based fiber‐optic intubation skill workshop can improve fiber‐optic intubation performance rapidly among EM residents. Future research should evaluate if this enhanced performance translates to improved clinical performance in the emergency department (ED).
The Effect of Emergency Department Crowding on Patient Satisfaction for Admitted Patients
Authors: Pines Jesse M. , Iyer Sanjay , Disbot Maureen , Hollander Judd E. , Shofer Frances S. , Datner Elizabeth M. 
Published: August 2008

AbstractObjectives:  The objective was to study the association between factors related to emergency department (ED) crowding and patient satisfaction.Methods:  The authors performed a retrospective cohort study of all patients admitted through the ED who completed Press‐Ganey patient satisfaction surveys over a 2‐year period at a single academic center. Ordinal and binary logistic regression was used to study the association between validated ED crowding factors (such as hallway placement, waiting times, and boarding times) and patient satisfaction with both ED care and assessment of satisfaction with the overall hospitalization.Results:  A total of 1,501 hospitalizations for 1,469 patients were studied. ED hallway use was broadly predictive of a lower likelihood of recommending the ED to others, lower overall ED satisfaction, and lower overall satisfaction with the hospitalization (p < 0.05). Prolonged ED boarding times and prolonged treatment times were also predictive of lower ED satisfaction and lower satisfaction with the overall hospitalization (p < 0.05). Measures of ED crowding and ED waiting times predicted ED satisfaction (p < 0.05), but were not predictive of satisfaction with the overall hospitalization.Conclusions:  A poor ED service experience as measured by ED hallway use and prolonged boarding time after admission are adversely associated with ED satisfaction and predict lower satisfaction with the entire hospitalization. Efforts to decrease ED boarding and crowding might improve patient satisfaction.
Echocardiographic Evaluation of a TASER‐X26 Application in the Ideal Human Cardiac Axis
Authors: Ho Jeffrey D. , Dawes Donald M. , Reardon Robert F. , Lapine Anne L. , Dolan Benjamin J. , Lundin Erik J. , Miner James R. 
Published: August 2008

AbstractObjectives:  TASER electronic control devices (ECDs) are used by law enforcement to subdue aggressive persons. Some deaths temporally proximate to their use have occurred. There is speculation that these devices can cause dangerous cardiac rhythms. Swine research supports this hypothesis and has reported significant tachyarrhythmias. It is not known if this occurs in humans. The objective of this study was to determine the occurrence of tachyarrhythmias in human subjects subjected to an ECD application.Methods:  This was a prospective, nonblinded study. Human volunteers underwent limited echocardiography before, during, and after a 10‐second TASER X26 ECD application with preplaced thoracic electrodes positioned in the upper right sternal border and the cardiac apex. Images were analyzed using M‐mode through the anterior leaflet of the mitral valve for evidence of arrhythmia. Heart rate (HR) and the presence of sinus rhythm were determined. Data were analyzed using descriptive statistics.Results:  A total of 34 subjects were enrolled. There were no adverse events reported. The mean HR prior to starting the event was 108.7 beats/min (range 65 to 146 beats/min, 95% CI = 101.0 to 116.4 beats/min). During the ECD exposure, the mean HR was 120.1 beats/min (range 70 to 158 beats/min, 95% CI = 112.2 to 128.0 beats/min) and a mean of 94.1 beats/min (range 55 to 121 beats/min, 95% CI = 88.4 to 99.7 beats/min) at 1 minute after ECD exposure. Sinus rhythm was clearly demonstrated in 21 (61.7%) subjects during ECD exposure (mean HR 121.4 beats/min; range 75 to 158 beats/min, 95% CI = 111.5 to 131.4). Sinus rhythm was not clearly demonstrated in 12 subjects due to movement artifact (mean HR 117.8 beats/min, range 70 to 152 beats/min, 95% CI = 102.8 to 132.8 beats/min).Conclusions:  A 10‐second ECD exposure in an ideal cardiac axis application did not demonstrate concerning tachyarrhythmias using human models. The swine model may have limitations when evaluating ECD technology.
Direct Comparison of the Diagnostic Accuracy of Fifty Protein Biological Markers of Pulmonary Embolism for Use in the Emergency Department
Authors: Nordenholz Kristen E. , Mitchell Alice M. , Kline Jeffrey A. 
Published: August 2008

AbstractObjectives:  Pulmonary embolism (PE) is associated with abnormal concentrations of many proteins involved in inflammation, hemostasis, and vascular injury. The authors quantified the diagnostic accuracy of a battery of protein biological markers for the detection of PE in emergency department (ED) patients.Methods:  A random and a consecutive sample of ED patients evaluated for PE were prospectively enrolled at two academic EDs between August 2005 and April 2006. A plasma sample was obtained at enrollment, and all patients were followed by telephone and medical record review at 90 days for the development of venous thromboembolism (VTE) defined as PE or deep venous thrombosis (DVT), requiring the consensus of two of three blinded physician reviewers. Measurements of potential biological markers were performed by technicians blinded to the study objectives. The diagnostic accuracy of each biological marker was determined by the area under the receiver operating characteristic (ROC) curve.Results:  Fifty potential biological markers were measured in 304 ED patients, including 22 patients (7%, 95% confidence interval [CI] = 4% to 10%) with VTE. Fourteen biological markers demonstrated an area under the curve (AUC) with the lower limit of the 95% CI ≥ 0.5. Of these, three demonstrated an AUC ≥ 0.7: D‐dimer (0.90), C‐reactive protein (CRP; 0.78), and myeloperoxidase (MPO; 0.78).Conclusions:  From 50 candidate biological markers, only D‐dimer, CRP, and MPO demonstrated sufficient diagnostic accuracy to suggest potential utility as biological marker of PE.
Interobserver Agreement in Assessment of Clinical Variables in Children with Blunt Head Trauma
Authors: Gorelick Marc H. , Atabaki Shireen M. , Hoyle John , Dayan Peter S. , Holmes James F. , Holubkov Richard , Monroe David , Callahan James M. , Kuppermann Nathan ,   for the Pediatric Emergency Care Applied Research Network (PECARN)
Published: August 2008

AbstractObjectives:  To be useful in development of clinical decision rules, clinical variables must demonstrate acceptable agreement when assessed by different observers. The objective was to determine the interobserver agreement in the assessment of historical and physical examination findings of children undergoing emergency department (ED) evaluation for blunt head trauma.Methods:  This was a prospective cohort study of children younger than 18 years evaluated for blunt head trauma at one of 25 EDs in the Pediatric Emergency Care Applied Research Network (PECARN). Patients were excluded if injury occurred more than 24 hours prior to evaluation, if neuroimaging was obtained at another hospital prior to evaluation, or if the patient had a clinically trivial mechanism of injury. Two clinicians independently completed a standardized clinical assessment on a templated data form. Assessments were performed within 60 minutes of each other and prior to clinician review of any neuroimaging (if obtained). Agreement between the two observers beyond that expected by chance was calculated for each clinical variable, using the kappa (κ) statistic for categorical variables and weighted kappa for ordinal variables. Variables with a lower 95% confidence limit (LCL) of κ > 0.4 were considered to have acceptable agreement.Results:  Fifteen‐hundred pairs of observations were obtained. Acceptable agreement was achieved in 27 of the 32 variables studied (84%). Mechanism of injury (low, medium, or high risk) had κ = 0.83. For subjective symptoms, kappa ranged from 0.47 (dizziness) to 0.93 (frequency of vomiting); all had 95% LCL > 0.4. Of the physical examination findings, kappa ranged from 0.22 (agitated) to 0.89 (Glasgow Coma Scale [GCS] score). The 95% LCL for kappa was <0.4 for four individual signs of altered mental status and for quality (i.e., boggy or firm) of scalp hematoma if present.Conclusions:  Both subjective and objective clinical variables in children with blunt head trauma can be assessed by different observers with acceptable agreement, making these variables suitable candidates for clinical decision rules.
Clerkship Directors in Emergency Medicine: Statement of Purpose
Authors: Wald David A. , Manthey David E. , Lin Michelle , Ander Douglas S. , Fisher Jonathan 
Published: August 2008

AbstractThe Academy of Clerkship Directors in Emergency Medicine (CDEM) provides a forum for the collaborative exchange of ideas among emergency medicine (EM) medical student educators, a platform for the advancement of education, research, and faculty development, and establishes for the first time a national voice for undergraduate medical education within our specialty. CDEM plans to take a leading role in providing medical student educators with additional educational resources and opportunities for faculty development and networking. CDEM will work to foster the professional growth and development of undergraduate medical educators within our specialty. The advancement of undergraduate education within our specialty and beyond will come primarily from the support, hard work, and dedication of the educators. To accomplish our goals, at the departmental, medical school, and national level, we must come together to further promote our specialty across the spectrum of undergraduate medical education. The first step has already been taken with the formation of the Academy of CDEM.
Resident Response to Integration of Simulation‐based Education into Emergency Medicine Conference
Authors: Wang Ernest E. , Beaumont Jennifer , Kharasch Morris , Vozenilek John A. 
Published: August 2008

AbstractObjectives:  Utilization of simulation‐based training has become increasingly prevalent in residency training. The authors compared emergency medicine (EM) resident feedback for simulation sessions to traditional lectures from an EM residency didactic program.Methods:  The authors performed a retrospective review of all written EM conference evaluations over a 29‐month period. Evaluation questions were scored on a 1–9 Likert scale.Results:  Lectures and simulation accounted for 77.6 and 22.4% of the conferences, respectively. Scored means (±standard deviations [SDs]) were as follows: overall, lecture 7.97 ± 0.74 versus simulation 8.373 ± 0.44 (p < 0.01); Question 1, lecture 7.97 ± 0.74 versus simulation 8.40 ± 0.43 (p < 0.005); Question 2, lecture 7.92 ± 0.74 versus simulation 8.34 ± 0.48 (p < 0.01); Question 3, lecture 8.01 ± 0.77 versus simulation 8.26 ± 0.51 (p < 0.15); and Question 4, lecture 8.00 ± 0.75 versus simulation 8.42 ± 0.46 (p < 0.01). There was no longitudinal decay of scores.Conclusions:  Emergency medicine residents scored simulation‐based sessions higher than traditional lectures. The scores over time suggest that this preference for simulation can be sustainable long term. Residents perceive simulation as more desirable teaching method compared to the traditional lecture format.
Stimulation of osteoblast activity by homocysteine
Authors: Herrmann Markus , Umanskaya Natalia , Wildemann Britt , Colaianni Graziana , Widmann Thomas , Zallone Alberta , Herrmann Wolfgang 
Published: August 2008

AbstractHomocysteine (HCY) has recently been linked to fragility fractures. Moreover, HCY activates osteoclasts. Little is known about the effect of HCY on activity of human osteoblasts (OBs). We hypothesized that HCY decreases the activity of OBs. Osteoblasts obtained from tra‐becular human bone specimens of eight donors were cultured with conditioned medium. Culture medium was adjusted to 0, 100, 500, 1000 and 2000 μM HCY. After 14 days alkaline phosphatase (AP) activity, pro‐collagen type I N‐terminal peptide (PINP) and osteocalcin (OC) secretion in the supernatant were measured. After 20 days the formation of mineralized matrix was analyzed. HCY‐stimulated AP activity gradually (100 μM HCY: 118%, P= 0.006; 500 μM HCY: 125%, P < 0.001). At 1000 and 2000 μM HCY the increase of AP activity was reversible (1000 μM HCY: 106%, P= 0.317; 2000 μM HCY: 102%, P < 0.737). The PINP secretion was also stimulated by HCY reaching a maximum of 260 ± 154 μg/l at 500 μmol/l versus 205 ± 94 μ,g/l in controls. After 20 days of culture the formation of bone matrix was increased at 100 and 500 μM HCY. OC secretion was not significantly changed. The results of the present study consistently demonstrate a moderate stimulation of primary human OB activity by increasing concentrations of HCY. However, the magnitude of this effect seems to be less pronounced than recent observations on primary human osteoclasts, suggesting a dysbalance between OBs and osteoclasts in favour of osteoclasts
A renin transcript lacking exon 1 encodes for a non‐secretory intracellular renin that increases aldosterone production in transgenic rats
Authors: Peters Jörg , Wanka Heike , Peters Barbara , Hoffmann Sigrid 
Published: August 2008

AbstractRenin transcripts lacking exon 1 and thus the signal sequence for co‐translational transport to the endoplasmatic reticulum encode for a protein (exon[2‐9]renin), that is confined to the cytoplasm. The function of exon(2‐9)renin is currently unknown. Mitochondrial renin increases under conditions which stimulate aldosterone production. We hypothesized that exon(2‐9)renin (1) is translated into a functionally active protein in vivo, (2) is not secreted but remains within the cytoplasm and (3) stimulates aldosterone production. To test these hypotheses we generated transgenic rats overexpressing exon(2‐9)renin. Four transgenic lines were obtained expressing the transcript in various tissues including the heart and the adrenal gland. Renin was enriched particularly in the cytoplasm of transgenic rats. Renin was not elevated in plasma, indicating that exon(2‐9)renin is produced but not secreted. The ratio of aldosterone to renin concentrations in plasma (PAC/PRC) was elevated in all transgenic lines except line 307, which also did not exhibit elevated cytoplasmatic renin levels in the adrenal gland (PAC/PRC in controls: 2.8±2.3; line 307: 1.9±0.8; n. s.; line 284: 5.8±1.9; P<0.02; line 294: 5.0±2.3; P<0.001; line 276: 10.3±5.1; P<0.001). We conclude that the exon(1A‐9) renin transcript (1) is translated into a functionally active intracellular protein; (2) is targeted to the cytoplasm rather than being sorted to the secretory pathways and (3) is functionally active, regulating aldosterone production. The CX‐(exon2‐9)renin transgenic rat appears to be a useful model to study the role and the mechanisms of action of cytoplasmatic renin derived from exon(1A‐9) transcripts.
DTD, an anti‐inflammatory ditriazine, inhibits angiogenesis in vitro and in vivo
Authors: Martínez‐Poveda Beatriz , Muñoz‐Chápuli Ramón , Riguera Ricardo , Fernández Antonio , Ángel Medina Miguel , Quesada Ana R. 
Published: August 2008

AbstractThe ditriazine derivative DTD (4,10‐dichloropyrido[5,6:4,5]thieno[3,2‐d':3,2‐d]‐1,2,3‐ditriazine) has been previously reported to reduce the degree of granulomatous inflammation and vascular density in a murine air pouch granuloma model. The aim of this study was to test whether DTD affects angiogenesis. Our results show that DTD inhibits in vivo angiogenesis in the chorioallantoic membrane (CAM) assay at doses equal or lower than 0.3 nmol/egg. Different in vitro assays were used to study the potential effects of this compound on key steps of angiogenesis, namely, a colorimetric assay of cell proliferation/viability, a morphogenesis on Matrigel assay, zymographic assays for gelatinases and nuclear morphology and cell cycle analysis for apoptosis induction. Our data indicate that DTD inhibits proliferation but does not induce apoptosis in endothelial cells in vitro. DTD suppresses the endothelial capillary‐like chord formation at concentrations lower than those required to inhibit proliferation. DTD treatment inhibits the matrix metalloproteinase‐2 production in endothelial and fibrosarcoma cells, but does not affect the cyclooxygenase‐2 expression in endothelial cells, as assessed by western blot analysis. Taken together, results here presented indicate that DTD exhibits an anti‐angiogenic activity that is independent of inflammatory processes and make it a promising drug for further evaluation in the treatment of angiogenesis‐related pathologies.
Fate of amnion‐derived stem cells transplanted to the fetal rat brain: migration, survival and differentiation
Authors: Marcus A. J. , Coyne T. M. , Black I. B. , Woodbury D. 
Published: August 2008

AbstractWe have recently characterized a stem cell population isolated from the rodent amniotic membrane termed amnion‐derived stem cells (ADSCs). In vitro ADSCs differentiate into cell types representing all three embryonic layers, including neural cells. In this study we evaluated the neuroectodermal potential of ADSCs in vivo after in utero transplantation into the developing rat brain. A clonal line of green fluorescent protein‐expressing ADSCs were infused into the telencephalic ventricles of the developing embryonic day 15.5 rat brain. At E17.5 donor cells existed primarily as spheres in the ventricles with subsets fused to the ventricular walls, suggesting a mode of entry into the brain parenchyma. By E21.5 green fluorescent protein (GFP) ADSCs migrated to a number of brain regions. Examination at postnatal time points revealed that donor ADSCs expressed vimentin and nestin. Subsets of transplanted ADSCs attained neuronal morphologies, although there was no immunohistochemical evidence of neural or glial differentiation. Some donor cells migrated around blood vessels and differentiated into putative endothelial cells. Donor ADSCs transplanted in utero were present in recipients into adulthood with no evidence of immunological rejection or tumour formation. Long‐term survival may suggest utility in the treatment of disorders where differentiation to a neural cell type is not required for clinical benefit.