bluuebunny/crossref_metadata_2025_split huggingface dataset:
CULTURE AND VOLUNTARY INFORMED CONSENT IN AFRICAN HEALTH CARE SYSTEMS
Authors: FRIMPONG‐MANSOH AUGUSTINE 
Published: July 2008

AbstractThis paper discusses how to apply a collective decision model of the principle of voluntary informed consent in African communitarian culture, in a culturally sensitive way, in order to protect research candidates from potential exploitations and abuses. Dismissing cultural and ethical skepticism surrounding the global application of the principle of voluntary informed consent, the paper ultimately concludes that international collaboration on diagnostic and therapeutic medical research in Africa, especially HIV vaccine trials, is a moral imperative.
Carbamazepine and phenytoin induced Stevens‐Johnson syndrome is associated with HLA‐B*1502 allele in Thai population
Authors: Locharernkul Chaichon , Loplumlert Jakrin , Limotai Chusak , Korkij Wiwat , Desudchit Tayard , Tongkobpetch Siraprapa , Kangwanshiratada Oratai , Hirankarn Nattiya , Suphapeetiporn Kanya , Shotelersuk Vorasuk 
Published: July 2008

SummaryPurpose: Previous studies found a strong association between HLA‐B*1502 and carbamazepine (CBZ)‐induced Stevens‐Johnson syndrome (SJS) in Han Chinese, but not in Caucasian populations. Even in Han Chinese, the HLA‐B*1502 was not associated with CBZ‐induced maculopapular eruptions (MPE). This study seeks to identify whether HLA‐B*1502 is associated with CBZ‐ or phenytoin (PHT)‐induced SJS or MPE in a Thai population.Methods: Eighty‐one Thai epileptic patients between 1994 and 2007 from the Chulalongkorn Comprehensive Epilepsy Program were recruited. Thirty‐one subjects had antiepileptic drug (AED)‐induced SJS or MPE (6 CBZ‐SJS, 4 PHT‐SJS, 9 CBZ‐MPE, 12 PHT‐MPE), and 50 were AED‐tolerant controls.Results: For the first time, a strong association between HLA‐B*1502 and PHT‐induced SJS was found (p = 0.005). A strong association was also found between the HLA‐B*1502 and CBZ‐induced SJS (p = 0.0005), making Thai the first non‐Chinese population demonstrating such an association. Some patients, who were HLA‐B*1502 and suffered from CBZ‐induced SJS, could be tolerant to PHT and vice versa. This suggests that HLA‐B*1502 may be a common attribute required for a Thai patient to develop SJS from these two AEDs; other different elements, however, are also needed for each AED. In addition, no association between HLA‐B alleles and CBZ‐ or PHT‐induced MPE was found.Conclusions: CBZ‐ and PHT‐induced SJS, but not MPE, is associated with HLA‐B*1502 allele in Thai population.
Anticonvulsant hypersensitivity syndrome: Is there a role for immunomodulation?
Authors: Cumbo‐Nacheli Gustavo , Weinberger Jarrett , Alkhalil Michel , Thati Neelima , Baptist Alan P. 
Published: July 2008

SummaryThe anticonvulsant hypersensitivity syndrome (AHS) is an idiosyncratic immunologic reaction to certain anticonvulsant medications, in which internal organ involvement may lead to fatal multisystemic failure. This syndrome has been associated with the use of aromatic ring‐containing agents such as phenytoin, carbamazepine, or phenobarbitone. Clinically, this condition presents with the classic triad of fever, rash, and lymphadenopathy. We review the existing literature on AHS pathogenesis and illustrate a case complicated by liver dysfunction where the use of N‐acetylcysteine (N‐AC) and intravenous immunoglobulin (IVIG) may have altered the course of the disease. The rationale of suggesting N‐AC and IVIG for the treatment of this syndrome relies on the theoretical synergistic effects of the two agents. Although treatment for this syndrome remains controversial and relies heavily on anecdotal evidence, the progression of hepatic injury may be prevented by the addition of N‐AC. The scavenging properties of N‐AC may palliate and possibly prevent free radical‐mediated liver damage. In addition, IVIG may effectively modulate the overreactive immune system in AHS. We discuss the possible role of using immunomodulating agents for the treatment of this syndrome and suggest that alternative regimens should be given special consideration especially in those critical clinical situations where supportive measures appear to be unsuccessful.
Decreasing Lab Turnaround Time Improves Emergency Department Throughput and Decreases Emergency Medical Services Diversion: A Simulation Model
Authors: Storrow Alan B. , Zhou Chuan , Gaddis Gary , Han Jin H. , Miller Karen , Klubert David , Laidig Andy , Aronsky Dominik 
Published: July 2008

AbstractBackground:  The effect of decreasing lab turnaround times on emergency department (ED) efficiency can be estimated through system‐level simulation models and help identify important outcome measures to study prospectively. Furthermore, such models may suggest the advantage of bedside or point‐of‐care testing and how they might affect efficiency measures.Objectives:  The authors used a sophisticated simulation model in place at an adult urban ED with an annual census of 55,000 patient visits. The effect of decreasing turnaround times on emergency medical services (EMS) diversion, ED patient throughput, and total ED length of stay (LOS) was determined.Methods:  Data were generated by using system dynamics analytic modeling and simulation approach on 90 separate days from December 2, 2007, through February 29, 2008. The model was a continuous simulation of ED flow, driven by real‐time actual patient data, and had intrinsic error checking to assume reasonable goodness‐of‐fit. A return of complete laboratory results incrementally at 120, 100, 80, 60, 40, 20, and 10 minutes was compared. Diversion calculation assumed EMS closure when more than 10 patients were in the waiting room and 100% ED bed occupancy had been reached for longer than 30 minutes, as per local practice. LOS was generated from data insertion into the patient flow stream and calculation of time to specific predefined gates. The average accuracy of four separate measurement channels (waiting room volume, ED census, inpatient admit stream, and ED discharge stream), all across 24 hours, was measured by comparing the area under the simulated curve against the area under the measured curve. Each channel’s accuracy was summed and averaged for an overall accuracy rating.Results:  As lab turnaround time decreased from 120 to 10 minutes, the total number of diversion days (maximum 57 at 120 minutes, minimum 29 at 10 minutes), average diversion hours per day (10.8 hours vs. 6.0 hours), percentage of days with diversion (63% vs. 32%), and average ED LOS (2.77 hours vs. 2.17 hours) incrementally decreased, while average daily throughput (104 patients vs. 120 patients) increased. All runs were at least 85% accurate.Conclusions:  This simulation model suggests compelling improvement in ED efficiency with decreasing lab turnaround time. Outcomes such as time on EMS diversion, ED LOS, and ED throughput represent important but understudied areas that should be evaluated prospectively. EDs should consider processes that will improve turnaround time, such as point‐of‐care testing, to obtain these goals.
A Theme‐based Hybrid Simulation Model to Train and Evaluate Emergency Medicine Residents
Authors: Noeller Thomas P. , Smith Michael D. , Holmes Laura , Cappaert Melissa , Gross Andrew J. , Cole‐Kelly Kathy , Rosen Kathleen R. 
Published: July 2008

AbstractObjectives:  The authors sought to design an integrated theme‐based hybrid simulation experience to educate and evaluate emergency medicine (EM) residents, to measure the Accreditation Council for Graduate Medical Education (ACGME) competencies using this simulation model, to measure the impact of the simulation experience on resident performance on written tests, and to measure resident satisfaction with this simulation experience.Methods:  A theme‐based hybrid simulation model that takes advantage of multiple simulation modalities in a concentrated session was developed and executed to both educate and evaluate EM residents. Simulation days took place at an integrated simulation center and replaced one 5‐hour didactic block per quarter. Modified competency checklists were used to evaluate residents based on ACGME competencies. Written tests were administered before, during, and after simulation days. Residents were given the opportunity to evaluate the simulation days using standard residency program evaluation tools.Results:  The model was proven feasible. Core competencies were measured using the model, which was executed on four occasions in 2007. Most residents met expectations based on objective checklist criteria and subjective assessment by an observing faculty member. Data from the written tests showed no overall difference in scores measured before, during, or after the simulation days. The simulation model was rated highly useful by the residents.Conclusions:  With the use of a highly developed simulation center and an organized, theme‐based, hybrid simulation model that takes advantage of multiple simulation modalities, the authors were able to successfully develop an educational model to both train and evaluate EM residents with a high degree of resident satisfaction.
Building a Simulation‐based Crisis Resource Management Course for Emergency Medicine, Phase 1: Results from an Interdisciplinary Needs Assessment Survey
Authors: Hicks Christopher M. , Bandiera Glen W. , Denny Christopher J. 
Published: July 2008

AbstractIntroduction:  Emergency department (ED) resuscitation requires the coordinated efforts of an interdisciplinary team. Human errors are common and have a negative impact on patient safety. Although crisis resource management (CRM) skills are utilized in other clinical domains, most emergency medicine (EM) caregivers currently receive no formal CRM training.Objectives:  The objectives were to compile and compare attitudes toward CRM training among EM staff physicians, nurses, and residents at two Canadian academic teaching hospitals.Methods:  Emergency physicians (EPs), residents, and nurses were asked to complete a Web survey that included Likert scales and short answer questions. Focus groups and pilot testing were used to inform survey development. Thematic content analysis was performed on the qualitative data set and compared to quantitative results.Results:  The response rate was 75.7% (N = 84). There was strong consensus regarding the importance of core CRM principles (i.e., effective communication, team leadership, resource utilization, problem‐solving, situational awareness) in ED resuscitation. Problems with coordinating team actions (58.8%), communication (69.6%), and establishing priorities (41.3%) were among factors implicated in adverse events. Interdisciplinary collaboration (95.1%), efficiency of patient care (83.9%), and decreased medical error (82.6%) were proposed benefits of CRM training. Communication between disciplines is a barrier to effective ED resuscitation for 94.4% of nurses and 59.7% of EPs (p = 0.008). Residents reported a lack of exposure to (64.3%), yet had interest in (96.4%) formal CRM education using human patient simulation.Conclusions:  Nurses rate communication as a barrier to teamwork more frequently than physicians. EM residents are keen to learn CRM skills. An opportunity exists to create a novel interdisciplinary CRM curriculum to improve EM team performance and mitigate human error.
A Comparison of Door‐to‐balloon Times and False‐positive Activations between Emergency Department and Out‐of‐hospital Activation of the Coronary Catheterization Team
Authors: Youngquist Scott T. , Shah Atman P. , Niemann James T. , Kaji Amy H. , French William J. 
Published: July 2008

AbstractObjectives:  The objectives were to compare the proportion of false‐positive activations and intervention times between emergency department (ED) and field‐based activation of the coronary catheterization laboratory (cath) team for emergency medical services (EMS) patients identified by out‐of‐hospital (OOH) 12‐lead electrocardiogram (ECG) with ST‐segment elevation myocardial infarction (STEMI).Methods:  This was a retrospective review of prospectively collected continuous quality improvement data at a single, urban, academic medical center. By protocol, weekday activation of the cath team occurred based on OOH notification of a computer‐interpreted OOH ECG indicating potential STEMI. Night and weekend activation occurred at the discretion of the attending emergency physician (EP) after advanced ED notification and after patient arrival and assessment. Basic demographic information and cardiac risk factors were recorded, as well as door‐to‐balloon (DTB) and ultimate diagnosis.Results:  From May 2007 through March 2008, there were 23 field activations and 33 ED activations. There was no difference in demographic or clinical characteristics between the two groups. In the field activation group, 9/23 (39%) were false‐positives, while 3/33 (9%) were false‐positives in the ED activation group (30% higher absolute difference in the field activation group, 95% confidence interval [CI] = 8% to 52%, p = 0.02). OOH times and time spent in the ED were similar between the two groups. DTB times were 77 minutes for field activation and 68 minutes for ED activation, respectively (difference 9 minutes, 95% CI = −9 to 27).Conclusions:  Emergency physician activation of the cath team results in a lower proportion of false‐positive activations without clearly sacrificing DTB time when compared to field activation based solely on the results of the OOH ECG.
Predictors of Mortality in Patients with Delirium Tremens
Authors: Khan Ayesha , Levy Phillip , DeHorn Steve , Miller Wendi , Compton Scott 
Published: July 2008

AbstractObjectives:  The objectives were to identify factors that may help predict mortality for patients with delirium tremens (DT).Methods:  The authors conducted a 1:1 gender‐ and age‐matched case–control study of patients hospitalized for DT. Using McNemar chi‐square tests and conditional logistic regression (CLR), risk factors for death, including demographics, location of diagnosis, vital sign derangements, treatment methods, and comorbid conditions, were evaluated. Crude and adjusted odds ratios (OR) and 95% confidence intervals (CI) are reported.Results:  Thirty‐five patients with DT died between January 2000 and June 2006. The majority (31; 88.6%) were male with a mean (±standard deviation [SD]) age of 51.7 (±7.6) years. Hyperthermia in the first 24 hours of DT diagnosis (OR = 10.0, 95% CI = 2.3 to 42.7), persistent tachycardia (OR = 24.0, 95% CI = 3.3 to 177.4), and use of restraints (OR = 7.50, 95% CI = 1.7 to 32.8) were associated with increased mortality by univariate analysis, while an emergency department (ED) diagnosis of DT (OR = 0.18, 95% CI = 0.05 to 0.6) and use of clonidine (OR = 0.10, 95% CI = 0.01 to 0.78) were associated with decreased mortality. In the CLR model, restraint use and hyperthermia were the only variables that remained significant (OR = 5.8, 95% CI = 1.0 to 32.2; and OR = 6.1, 95% CI = 1.2 to 30.4, respectively).Conclusions:  The use of restraints and hyperthermia is associated with increased odds of death for patients with DT. This study highlights the need for further research into modifiable factors influencing mortality from DT.
Simulation in Graduate Medical Education 2008: A Review for Emergency Medicine
Authors: McLaughlin Steve , Fitch Michael T. , Goyal Deepi G. , Hayden Emily , Kauh Christine Yang , Laack Torrey A. , Nowicki Thomas , Okuda Yasuharu , Palm Ken , Pozner Charles N. , Vozenilek John , Wang Ernest , Gordon James A. ,   on behalf of the SAEM Technology in Medical Education Committee and the Simulation Interest Group
Published: July 2008

AbstractHealth care simulation includes a variety of educational techniques used to complement actual patient experiences with realistic yet artificial exercises. This field is rapidly growing and is widely used in emergency medicine (EM) graduate medical education (GME) programs. We describe the state of simulation in EM resident education, including its role in learning and assessment. The use of medical simulation in GME is increasing for a number of reasons, including the limitations of the 80‐hour resident work week, patient dissatisfaction with being “practiced on,” a greater emphasis on patient safety, and the importance of early acquisition of complex clinical skills. Simulation‐based assessment (SBA) is advancing to the point where it can revolutionize the way clinical competence is assessed in residency training programs. This article also discusses the design of simulation centers and the resources available for developing simulation programs in graduate EM education. The level of interest in these resources is evident by the numerous national EM organizations with internal working groups focusing on simulation. In the future, the health care system will likely follow the example of the airline industry, nuclear power plants, and the military, making rigorous simulation‐based training and evaluation a routine part of education and practice.
Feeding habits as determinants of early childhood caries in a population where prolonged breastfeeding is the norm
Authors: Mohebbi S. Z. , Virtanen J. I. , Vahid‐Golpayegani M. , Vehkalahti M. M. 
Published: July 2008

Abstract –  Objectives:  To investigate the impact of feeding habits and daytime sugar intake on the prevalence of early childhood caries in a population where prolonged breastfeeding is a norm.Methods:  A cross‐sectional study was carried out at 18 of 102 public health centers in Tehran. During a 4‐day period at each center, between 20 and 35 children aged 1–3 years were enrolled, resulting in a sample of 504 children. In structured interviews, mothers were asked to give information about their child’s feeding habits, daytime sugar intake, and their family’s background. Sugar intake during the night was operationalized as separately calculated burdens of nighttime breastfeeding and bottle‐feeding. Clinical dental examinations followed the World Health Organization criteria. Data analysis included chi‐square test, t‐test, anova, and logistic regression modeling.Results:  Of the children, 56% were solely breastfed (mean duration 16.6 months; 95% CI 16.0–17.2), 42% were both breastfed and bottle‐fed, and 2% were solely bottle‐fed. Mean duration of breastfeeding for the solely breastfed 24‐ to 36‐month olds was 22.8 months (95% CI 21.8–23.9). At bedtime, 69% were breastfed, 11% bottle‐fed, and 20% were not fed at all. With respect to feeding during the night, 72% of children were breastfed, 12% were bottle‐fed with milk, 1% received a bottle with water, while 15% were not fed. Early childhood caries (ECC) occurred in 3–26% of the children, depending on age group (P < 0.001). The burden of milk‐bottle feeding at night was a clear determinant for ECC (OR = 5.5) whereas breastfeeding per se, its duration, the burden of breastfeeding at night, and daytime sugar intake were not.Conclusion:  On account of its association with ECC, milk‐bottle feeding at night should be limited, whereas prolonged breastfeeding appears to have no such negative dental consequences.
A community study on the relationship of dental anxiety with oral health status and oral health‐related quality of life
Authors: Ng Sam K. S. , Leung W. Keung 
Published: July 2008

Abstract –  Objective:  To investigate the relationship of dental anxiety with oral health status and oral health‐related quality of life (OHQoL) among dentate subjects living in Hong Kong.Methods:  One thousand Hong Kong residents who were aged 25–64 years and predominantly Chinese were asked to complete the Chinese short‐forms of the Dental Anxiety Inventory (SDAxI) and Oral Health Impact Profile (OHIP‐14S). Dental (DMFT index) and periodontal statuses [full‐mouth clinical attachment level (CAL)] were also assessed.Results:  Ninety‐six (9.6%; mean SDAxI, 9.6), 799 (79.9%; mean SDAxI, 15.0), and 105 (10.5%; mean SDAxI, 27.4) participants had low, average, and high dental anxiety, respectively. The mean DMFT/CAL scores of each SDAxI subgroup were 8.5/1.4, 9.3/1.9, and 9.8/3.6, respectively. The corresponding mean OHIP‐14S scores for each SDAxI subgroup were 4.0, 8.1, and 13.2, respectively. Post hoc analysis, adjusted for possible confounding factors, revealed statistically significant differences in DMFT and CAL scores in subjects with low versus high level of SDAxI, and significant differences in OHIP‐14S scores between all 3 SDAxI categories.Conclusion:  The trait disposition of dental anxiety may be a significant risk indicator of poor dental and periodontal status and is associated with a worse OHQoL.
Early Christian Archaeology: A State of the Field
Authors: Bowes Kim 
Published: July 2008

AbstractThis article considers the history and trajectory of early Christian archaeology. Focusing principally on the built environment, it addresses the status of research on third‐century Christiandomus ecclesiaeor house churches, urban topography, Christian euergetism, pagan/Christian temple conversion, monasticism and pilgrimage, parish churches, and rural Christianity. It suggests that this largely conservative field continues to wrestle with its relationship with Christian texts, and remains dominated by formalist and positivist paradigms. The expansion of the discipline into adjacent fields in recent years signals something of a shift, but more holistic studies are needed that contextualize Christian remains within their local topographic, social, ecclesiastical, and, above all, economic circumstances.
Anthropological Perspectives on Judaism: A Comparative Review
Authors: Brink‐Danan Marcy 
Published: July 2008

AbstractHow has the discipline of anthropology studied Judaism? This review provides a brief overview of the variety of approaches the discipline has taken to the subject of Jewish religion, society and culture. By situating these approaches in their historical, political and geographic locations, I offer a comparative look at the development of a sub‐discipline of the anthropology of religion. In addition to providing a comparative review of the sub‐discipline, I also highlight theoretical issues which remain central to the anthropological study of Judaism. These include: reflexivity in the writing of Jewish ethnography, the conceptual problem inherent in using ‘religion’ as the category through which many scholars define Judaism, the place of Judaism in anthropological theories of Diaspora and, lastly, the overemphasis on the notion of ‘memory’ in so many Jewish ethnographies.
The Comparative Method
Authors: Roscoe Paul 
Published: July 2008

AbstractThe comparative method is a formalization of the comparison that is unavoidable in any attempt at cross‐cultural analysis. Yet, the comparative method has generated considerable controversy in religious studies. This article reviews the issues raised about comparison in anthropology, the social science that has as its enduring goal a holistic understanding of all human societies and that consequently has made greater use of comparison – and accordingly has subjected it to greater scrutiny – than any other discipline.
Anticipatory Processes in Sentence Processing
Authors: Kamide Yuki 
Published: July 2008

AbstractAnticipation is an essential ability for the human cognitive system to survive in its surrounding environment. The present article will review previous research on anticipatory processes in sentence processing (comprehension). I start by pointing out past research carried out with inadequate methods, then move on to reviewing recent research with relatively new, more appropriate methods, specifically, the so‐called ‘visual‐world’ eye‐tracking paradigm, and neuropsychological techniques. I then discuss remaining unresolved issues, both methodological and theoretical.