bluuebunny/crossref_metadata_2025_split huggingface dataset:
Presentation and management of aural foreign bodies in two Australian emergency departments
Authors: Ryan Caroline , Ghosh Angajendra , Wilson‐Boyd Brian , Smit DeVilliers , O’Leary Stephen 
Published: June 2006

AbstractObjective:  To survey and compare the type and management of foreign bodies found in adult and paediatric ears presenting to an Australian otorhinolaryngology and a general ED.Methods:  Retrospective case study with data collated from two centres. Chart reviews of a total of 330 patients presenting with aural foreign bodies to the ED of the Royal Victorian Eye and Ear Hospital and the ED of The Bendigo Hospital, both situated in the state of Victoria, Australia, were surveyed for patient demographics, foreign body description and referral and removal pattern.Results:  Two hundred and seventeen adults and 113 children were included in the study. The most common foreign bodies in children were beads, cotton tips, insects and paper, and in adults cotton tips, insects, cotton wool and silicone ear plugs. Flying insects were far more common in the Australian population than cockroaches found in surveys in other countries. Children were significantly more likely to have initially been seen by their Local Medical Officer than adults (P < 0.001) and to require a general anaesthetic for removal of the object(s) (P < 0.001). Adults were more likely to have associated otitis externa at the time of presentation (P < 0.05).Conclusions:  Aural foreign bodies are a frequent presentation to the ED. Recognition of patients requiring early specialist referral is important. Adults present with a different profile of aural foreign objects to children and require different management. The use of cotton tips or cotton wool in the external ear canal and silicone ear plugs should be discouraged.
Emergency nurse practitioner care and emergency department patient flow: Case–control study
Authors: Considine Julie , Martin Roslyn , Smit DeVilliers , Winter Craig , Jenkins Jane 
Published: June 2006

AbstractObjective:  The present study aimed to compare ED waiting times (for medical assessment and treatment), treatment times and length of stay (LOS) for patients managed by an emergency nurse practitioner candidate (ENPC) with patients managed via traditional ED care.Methods:  A case–control design was used. Patients were selected using the three most common ED discharge diagnoses for ENPC managed patients: hand/wrist wounds, hand/wrist fractures and removal of plaster of Paris. The ENPC group (n = 102) consisted of patients managed by the ENPC who had ED discharge diagnoses as mentioned above. The control group (n = 623) consisted of patients with the same ED discharge diagnoses who were managed via traditional ED care.Results:  There were no significant differences in median waiting times, treatment times and ED LOS between ENPC managed patients and patients managed via traditional ED processes. There appeared to be some variability between diagnostic subgroups in terms of treatment times and ED LOS.Conclusion:  Patient flow outcomes for ENPC managed patients are comparable with those of patients managed via usual ED processes.
Redesigning emergency department patient flows: Application of Lean Thinking to health care
Authors: King Diane L , Ben‐Tovim David I , Bassham Jane 
Published: June 2006

AbstractObjective:  To describe in some detail the methods used and outcome of an application of concepts from Lean Thinking in establishing streams for patient flows in a teaching general hospital ED.Methods:  Detailed understanding was gained through process mapping with staff followed by the identification of value streams (those patients likely to be discharged from the ED, those who were likely to be admitted) and the implementation of a process of seeing those patients that minimized complex queuing in the ED.Results:  Streaming had a significant impact on waiting times and total durations of stay in the ED. There was a general flattening of the waiting time across all groups. A slight increase in wait for Triage categories 2 and 3 patients was offset by reductions in wait for Triage category 4 patients. All groups of patients spent significantly less overall time in the department and the average number of patients in the ED at any time decreased. There was a significant reduction in number of patients who do not wait and a slight decrease in access block.Conclusions:  The streaming of patients into groups of patients cared for by a specific team of doctors and nurses, and the minimizing of complex queues in this ED by altering the practices in relation to the function of the Australasian Triage Scale improved patient flow, thereby decreasing potential for overcrowding.
Inhaled methoxyflurane as a prehospital analgesic in children
Authors: Babl Franz E , Jamison Sarah R , Spicer Maureen , Bernard Stephen 
Published: June 2006

AbstractObjective:  Despite widespread use of methoxyflurane as an inhaled analgesic by ambulance services in Australia there are no published data as to its use pattern, efficacy and safety in the prehospital setting. We set out to characterize methoxyflurane use in children in the prehospital setting.Methods:  An observational case series was conducted over an 8 month period. Children who received methoxyflurane while being transported to a tertiary children’s hospital by ambulance were enrolled. We analysed indications for use, verbal numerical pain scores, adverse events and depth of sedation based on paramedic, patient, parent and ED staff surveys and review of ambulance care records.Results:  During the study period 105 patients were enrolled with an age range of 15 months to 17 years (median age 11 years). Methoxyflurane was mainly used for extremity injuries (82%). Paramedic pain scores dropped from a mean of 7.9 (95% confidence interval [CI] 7.5–8.3) prior to methoxyflurane use to 4.5 (95% CI 3.9–5.0) at 2–5 min and to 3.2 (95% CI 2.8–3.7) at 10 min. There were no serious adverse events (one‐sided 97.5% CI 0–3%). Mild adverse events occurred in 38 patients (36.2%; 95% CI 27.0–46.1%). Five of 15 (33.3%) patients under 5 years of age were deeply sedated.Conclusion:  In the present paediatric case series methoxyflurane appears to be an efficacious analgesic with a low adverse events profile. In young children in particular it can briefly lead to deep sedation.
Paediatric advanced life support: Australian Resuscitation Council Guidelines 2006
Authors:   Australian Resuscitation Council
Published: June 2006

12.1 Introduction to Paediatric Advanced Life Support 12.2 Advanced Life Support for Infants and Children, Diagnosis and Management 12.3 Flowchart for the Sequential Management of Life‐Threatening Arrhythmias in Infants and Children 12.4 Medications & Fluids in Paediatric Advanced Life Support 12.5 Management of Specific Arrhythmias in Paediatric Advanced Life Support 12.6 Techniques in Paediatric Advanced Life Support 12.7 Management after Resuscitation in Paediatric Advanced Life Support
Correction of Penile Curvature by Rotation of the Corpora Cavernosa: A Case Report
Authors: Shaeer Osama 
Published: June 2006

ABSTRACT

Aim
We report on the corporal rotation technique, customized for the management of ventral curvature in patients without hypospadias.

Methods
A male patient with ventral curvature of 90 degrees was operated on. The neurovascular bundle was mobilized for a short distance at the point of maximum curvature. The corpora cavernosa were approximated to each other in the dorsal midline by suturing pairs of longitudinal parallel incisions. To avoid urethral narrowing, minimal dissection was used to develop the groove on either side of the corpus spongiosum, to release it from its attachment to the rotated corpora cavernosa.

Results
Full correction of the curvature was achieved, without shortening, erectile dysfunction, or micturition problems.

Conclusion
Corporal rotation can be applied for the correction of ventral penile curvature in patients with and without hypospadias, without sacrificing penile length.
Awareness and Use of Folic Acid Among Women in the Lower Mississippi Delta
Authors: Robbins James M. , Hopkins Sarah E. , Mosley Bridget S. , Casey Patrick H. , Cleves Mario A. , Hobbs Charlotte A. 
Published: June 2006

ABSTRACT:
Context: National and state efforts to increase folic acid awareness and use may not be reaching large segments of the population. Purpose: This study examines folic acid awareness and use among women of childbearing age in a representative, economically at‐risk rural sample and identifies factors that influence awareness and use. Methods: A cross‐sectional random digit dialing telephone survey was completed with a representative sample of 646 women aged 14‐45 years in 36 counties of the lower Mississippi Delta. Folic acid awareness and supplement use were estimated by percentages weighted to reflect the 36‐county population. Pregnancy intentions and the ability to become pregnant were used to predict awareness and use among a subsample of sexually active women. Findings: Compared to national samples, Delta women were less likely to have heard of folic acid (75% vs 64%) or to take a regular (5‐7 days/wk) folic acid supplement (34% vs 22%). The proportion of women who took regular folic acid supplements was very low among some subgroups: African Americans (14%), those 14‐19 years of age (12%), and those with low incomes (13%) and low educational levels (14%). Of the women who reported being sexually active, the ability to become pregnant more than doubled their likelihood of regular supplement use. Conclusions: The national folic acid campaign has not reached many women in the rural Mississippi Delta. A new mode of folic acid education is needed that is focused on low‐income and young women and women not planning pregnancies. In the Delta and similar geographic regions, health care providers, black church leaders, and youth group leaders could be valuable advocates for folic acid.
Academic Degrees and Clinical Practice Characteristics: The University of Washington Physician Assistant Program: 1969‐2000
Authors: Evans Timothy C. , Wick Keren H. , Brock Douglas M. , Schaad Douglas C. , Ballweg Ruth 
Published: June 2006

ABSTRACT:
Context: The physician assistant profession has been moving toward requiring master’s degrees for new practitioners, but some argue this could change the face of the discipline. Purpose: To see if there is an association between physician assistants’ academic degrees and practice in primary care, in rural areas, and with the medically underserved. Methods: Surveys were sent to 880 graduates of the first 32 University of Washington physician assistant classes through 2000. Respondents noted their academic degree at program entry and the highest degree attained at any time up to the time of survey. Relationships between practice characteristics and academic degree levels were tested by unadjusted odds ratios and logistic regression after controlling for year of graduation and sex. Results: Of the 478 respondents, 54% worked in primary care, about 30% practiced in nonmetropolitan communities, and 42% reported providing care for the medically underserved. Respondents with no degree (33% of total at entry, 24% at survey) were significantly more likely than degree holders to work in primary care and nonmetropolitan areas. Respondents with no degree at program entry were significantly more likely, and those with no degree at the time of the survey were marginally more likely, to self‐report work with the medically underserved. Conclusion: Respondents with no academic degree are significantly more likely to demonstrate a commitment to primary, rural, and underserved health care. These findings may inform the national debate about the impact of required advanced degrees on the practice patterns of nonphysician providers.
Availability of Diagnostic and Treatment Services for Acute Stroke in Frontier Counties in Montana and Northern Wyoming
Authors: Okon Nicholas J. , Rodriguez Daniel V. , Dietrich Dennis W. , Oser Carrie S. , Blades Lynda L. , Burnett Anne M. , Russell Joseph A. , Allen Martha J. , Chasson Linda , Helgerson Steven D. , Gohdes Dorothy , Harwell Todd S. 
Published: June 2006

ABSTRACT:
Context: Rapid diagnosis and treatment of ischemic stroke can lead to improved patient outcomes. Hospitals in rural and frontier counties, however, face unique challenges in providing diagnostic and treatment services for acute stroke. Purpose: The aim of this study was to assess the availability of key diagnostic technology and programs for acute stroke evaluation and treatment in Montana and northern Wyoming. Methods: In 2004, hospital medical directors or their designees were mailed a survey about the availability of diagnostic technology, programs, and personnel for acute stroke care. Findings: Fifty‐eight of 67 (87%) hospitals responded to the survey. Seventy‐nine percent (46/58) of responding hospitals were located in frontier counties, with an average bed size of 18 (11 SD). Of the hospitals in frontier counties, 44% reported emergency medical services prehospital stroke identification programs, 39% had 24‐hour computed tomography capability, 44% had an emergency department stroke protocol, and 61% had a recombinant tissue plasminogen activator protocol. Thirty percent of hospitals in frontier counties reported that they met 6‐10 of the criteria established by the Brain Attack Coalition to improve acute stroke care compared to 67% of hospitals in the nonfrontier counties. Conclusion: A stroke network model could enhance care and improve outcomes for stroke victims in frontier counties.
Barriers to Quality Care for Dying Patients in Rural Communities
Authors: Van Vorst Rebecca F. , Crane Lori A. , Barton Phoebe Lindsey , Kutner Jean S. , Kallail K. James , Westfall John M. 
Published: June 2006

ABSTRACT:
Context: Barriers to providing optimal palliative care in rural communities are not well understood. Purpose: To identify health care personnel’s perceptions of the care provided to dying patients in rural Kansas and Colorado and to identify barriers to providing optimal care. Methods: An anonymous self‐administered survey was sent to health care personnel throughout 2 rural practice‐based research networks. Targeted personnel included clinicians, nurses, medical assistants, chaplains, social workers, administrators, and ancillary staff, who worked at hospice organizations, hospitals, ambulatory clinics, public health agencies, home health agencies, and nursing homes. Findings: Results from 363 completed surveys indicated that most health care personnel were satisfied with the palliative care being provided in their health care facilities (84%) and that most were comfortable helping dying patients transition from a curative to a palliative focus of care (87%). Yet, many reported that the palliative care provided could be improved and many reported that family members’ avoidance of issues around dying (60%) was a barrier to providing optimal care in rural health care facilities. Conclusions: Findings suggest that health care personnel perceive they are effective at providing palliative care in their rural health care facilities, yet face barriers to providing optimal end‐of‐life care. Results of this study suggest that differences in training and experience may influence health care personnel’s perceptions of the existing barriers. It may be important in rural areas to customize interventions to both the professional role and the site of care.
An Instrument for Assessing Public Health System Performance: Validity in Rural Settings
Authors: Driscoll David , Rojas‐Smith Lucia , Sotnikov Sergey , Gadsden‐Knowles Kim , Perry Natalie Brevard , Lenaway Dennis D. , Halverson Paul K. 
Published: June 2006

ABSTRACT:
Purpose: This study evaluated the validity and utility of the Local Public Health System Assessment Instrument (Local Instrument) of the National Public Health Performance Standards Program in rural settings. Methods: The study compared the Local Instrument scores of 6 rural local public health systems to external assessments of those public health systems. The 6 public health systems represented 3 states in which 1 of the 2 local jurisdictions had scored well below and the other well above the state median in a pilot test of the Local Instrument. The study design featured a case study approach consisting of an iterative and integrated combination of semistructured individual and focus group interviews along with the collection of archival materials provided by the 6 public health systems. Findings: Despite differences in Local Instrument scores, the representative public health systems in each state provided roughly the same levels of public health services. Sites varied tremendously in the percentage of survey items rated highly or less relevant. Conclusions: The National Public Health Performance Standards Program Local Instrument can provide a useful structure and process for assessing public health system performance at the local level. Key informants provided several recommendations to improve the Local Instrument, including clarification of difficult terminology and acronyms, and development of multiple instruments structured around subsets of survey items.
Connecting Allied Health Students to Rural Communities
Authors: Guion W. Kent , Mishoe Shelley C. , Taft Arthur A. , Campbell Carol A. 
Published: June 2006

ABSTRACT:
Context: Statewide studies indicate a continuing shortfall of personnel in several allied health disciplines in rural Georgia. National trends indicate lagging enrollment in allied health education programs, suggesting that the workforce shortages will worsen. Purpose: This article describes the efforts of the School of Allied Health Sciences at the Medical College of Georgia to increase allied health student participation in interdisciplinary health care services in rural areas of the state during fiscal years 2001‐2003. Methods: Brief program description and results from survey data provided by the student participants, program administrators, and clinical site supervisors. Results: Three‐year totals indicate that 98 students (70 female, 28 male) participated and 42% reported low‐income status. In line with the goals of the grant, the proportion of minority student participants steadily increased from 5% to 12% over the 3‐year period. Rotation locations included 62 designated Health Professional Shortage Area counties, 71 federally designated Rural Health Clinics, and 6 Community Health Clinics. At the conclusion of the students’ rural health care experience, 76% (55/72) responded positively when asked: If you had the opportunity, would you accept employment at the rotation health care site? Conclusions: The project appears to be positively affecting allied health students’ perceptions and opinions of rural health practices and willingness to work in rural areas. Although long‐term goals have yet to be accomplished, early indicators show benefits to the students and the community at‐large, suggesting that the current program strategies are appropriate connectors between allied health students and rural communities.
Lack of HIV Seropositivity Among a Group of Rural Probationers: Explanatory Factors
Authors: Oser Carrie B. , Smiley McDonald Hope M. , Havens Jennifer R. , Leukefeld Carl G. , Webster J. Matthew , Cosentino‐Boehm Abby L. 
Published: June 2006

ABSTRACT:
Context: Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in rural America has been described as an epidemic, and the HIV prevalence rate among criminal justice populations is higher than the general population. Thus, criminally involved populations in Southern rural areas are at elevated risk for contracting HIV because of drug and sexual practices; however, little is known about HIV/AIDS in the fastest growing criminal justice population—probationers. Purpose: To examine possible explanations for the lack of HIV seropositivity found in a purposive sample of rural probationers. Methods: Data were examined from 800 felony probationers from 30 counties in Kentucky’s Appalachian region. Measures included HIV prevalence within the 30 counties, migration patterns, HIV knowledge, substance use, and sexual risk behaviors. Findings: These probationers had a high level of HIV knowledge, reported minimal injection drug use, practiced serial monogamy, and reported minimal engagement in transactional sex. However, these probationers also reported negligible condom use, and injection drug users shared needles and works. Conclusion: Findings suggest the importance of developing programs targeting safe sex practices in rural areas.
Trends in Controlled‐Release Oxycodone (OxyContin®) Prescribing Among Medicaid Recipients in Kentucky, 1998‐2002
Authors: Havens Jennifer R. , Talbert Jeffrey C. , Robert Walker , Cynthia Leedham , Leukefeld Carl G. 
Published: June 2006

ABSTRACT:
Context: Prescription opioid abuse has emerged as a public health problem, particularly in rural America. Purpose: To examine temporal and geographic trends in rates of controlled‐release oxycodone (OxyContin) prescribing for Kentucky Medicaid recipients. Methods: A cross‐sectional analysis was completed in which the state was divided into 3 regions (distressed Appalachia, Appalachia, and other Kentucky), and data from Medicaid pharmacy claims from 1998 to 2002 were analyzed. Claims were further stratified by disability status. Findings: Temporary Assistance for Needy Families Medicaid recipients in distressed Appalachia were more likely than those in other Kentucky regions to file controlled‐release oxycodone claims in 1999, 2001, and 2002. Even after adjusting for the proportion of Temporary Assistance for Needy Families recipients in each region, the distressed region still had significantly higher rates (P< .05) than the non‐Appalachian region of controlled‐release oxycodone prescription claims among Temporary Assistance for Needy Families recipients. Similar findings were observed for disabled Medicaid recipients in 2002. Conclusions: Higher rates of claims for controlled‐release oxycodone in the distressed Appalachian region of Kentucky suggest that economic and health factors unique to this area may be contributing to increased use of this product. The increased availability of controlled‐release oxycodone in distressed Appalachian regions may facilitate abuse.
Rural Women and Osteoporosis: Awareness and Educational Needs
Authors: Matthews Hollie L. , Laya Mary , DeWitt Dawn E. 
Published: June 2006

ABSTRACT:
Context: Little is known about rural women’s knowledge about osteoporosis. Purpose: To explore what women from high‐prevalence rural communities know about osteoporosis and to assess their learning preferences. Methods: We surveyed 437 women in rural Washington and Oregon. Findings: The response rate was 93% (N = 406). The mean age of respondents was 63 years (range 16‐95) and 74% (n = 301) of women were postmenopausal. While 27% over age 40 (n = 111) reported having a fracture as an adult, less than half of this group (42%, n = 47) considered themselves at risk for osteoporosis. Of the 42% (n = 171) who rated their knowledge of osteoporosis good or excellent, only 18% (n = 30) answered calcium and vitamin D questions correctly. About half (53%; n = 214) exercised 3 or more times per week. Reported sources of osteoporosis information included television, magazines, health care providers, and personal contacts. Over half of the women in this study wanted more information about osteoporosis, most wanted it before age 50, and health care providers were a preferred source. Less than half of participants reported having Internet access. Conclusions: While many participants underestimated their osteoporosis risk, most women wanted to learn more about osteoporosis and health care providers remain a preferred source of information.