bluuebunny/crossref_metadata_2025_split huggingface dataset:
Description and Evaluation of a Pilot Physician‐directed Emergency Medical Services Diversion Control Program
Authors: Shah Manish N. , Fairbanks Rollin J. , Maddow Charles L. , Lerner E. Brooke , Syrett James I. , Davis Eric A. , Schneider Sandra M. 
Published: December 2005

Abstract
Objectives:
To describe the characteristics and feasibility of a physician‐directed ambulance destination‐control program to reduce emergency department (ED) overcrowding, as measured by hospital ambulance diversion hours.
Methods:
This controlled trial took place in Rochester, New York and included a university hospital and a university‐affiliated community hospital. During July 2003, emergency medical services (EMS) providers were asked to call an EMS destination‐control physician for patients requesting transport to either hospital. The destination‐control physician determined the optimal patient destination by using patient and system variables as well as EMS providers' and patients' input. Program process measures were evaluated to characterize the program. Administrative data were reviewed to compare system characteristics between the intervention program month and a control month.
Results:
During the intervention month, 2,708 patients were transported to the participating hospitals. EMS providers contacted the destination‐control physician for 1,866 (69%) patients. The original destination was changed for 253 (14%) patients. Reasons for redirecting patients included system needs, patient needs, physician affiliation, recent ED or hospital care, patient wishes, and primary care physician wishes. During the intervention month, EMS diversion decreased 190 (41%) hours at the university hospital and 62 (61%) hours at the community hospital, as compared with the control month.
Conclusions:
A voluntary, physician‐directed destination‐control program that directs EMS units to the ED most able to provide appropriate and timely care is feasible. Patients were redirected to maximize continuity of care and optimally use available emergency health care resources. This type of program may be effective in reducing overcrowding.
Influence of Electromagnetic Fields on Function of Automated External Defibrillators
Authors: Fleischhackl Roman , Singer Florian , Nitsche Wolfgang , Gamperl Guenther , Roessler Bernhard , Arrich Jasmin , Fleischhackl Sabine , Losert Heidrun , Sterz Fritz , Mittlboeck Martina , Hoerauf Klaus 
Published: December 2005

Abstract
Objectives:
In this study, the authors tested whether electromagnetic interference (EMI) is able to impair correct electrocardiogram analysis and produce false‐positive shock advice from automated external defibrillators (AEDs) when the true rhythm is sinus.
Methods:
Nineteen healthy subjects were used to test five AEDs available on the Austrian market in a prospective, open, and sequence‐randomized study. The primary outcome variable was the absolute number of shocks advised in the presence of EMI. The secondary outcome was the number of impaired analyses caused by incorrectly detected patient movements or electrode failure.
Results:
Of 760 tests run, 18 (2.37%) cases of false‐positive results occurred, and two of five AEDs recommended shocks in the presence of sinus rhythm. Of 760 tests run, no electrode failures occurred. There were 27 occurrences (3.55%) of motion detected by an AED in the presence of strong electromagnetic fields.
Conclusions:
AED models differ in their response to EMI; it may be useful to consider specific safety requirements for areas with such fields present. Working personnel and emergency medical services staff should be informed about potential risks and the possible need for patient evacuation before AEDs are attached and shock recommendations are followed.
Accuracy of Mild Traumatic Brain Injury Case Ascertainment Using ICD‐9 Codes
Authors: Bazarian Jeffrey J. , Veazie Peter , Mookerjee Sohug , Lerner E. Brooke 
Published: December 2005

Abstract
Objectives:
To determine the accuracy of mild traumatic brain injury (TBI) case ascertainment using International Classification of Diseases, 9th Revision, Clinical Modification (ICD‐9‐CM) codes proposed by the Centers for Disease Control and Prevention (CDC) in a 2003 Report to Congress.
Methods:
This was a prospective cohort study of all patients presenting to an urban academic emergency department (ED) over six months in 2003. A real‐time clinical assessment of mild TBI was compared with the ICD‐9 codes assigned after ED or hospital discharge for a determination of sensitivity and specificity.
Results:
Of the 35,096 patients presenting to the ED, 516 had clinically defined mild TBI and 1,000 were assigned one or more of the mild TBI ICD‐9 codes proposed by the CDC. The sensitivity of these codes was 45.9% (95% confidence interval [95% CI] = 41.3% to 50.2%) with a specificity of 97.8% (95% CI = 97.6% to 97.9%).
Conclusions:
The identification of mild TBI patients using retrospectively assigned ICD‐9 codes appears to be inaccurate. These codes are associated with a significant number of false‐positive and false‐negative code assignments. Mild TBI incidence and prevalence estimates using these codes should be interpreted with caution. ICD‐9 codes should not replace a clinical assessment for mild TBI when accurate case ascertainment is required.
A Test to Detect Chest Tube Kinking
Authors: Adame Norberto , Horwood Bruce T. , Caruso Daniel , Wallace Ted , Velasco Louis 
Published: December 2005

Abstract
Objectives:
To determine whether the Mac‐technique test can detect kinking of the chest tube upon thoracostomy tube placement.
Methods:
This was a prospective observational study that was conducted October 2000 through October 2001 in an urban Level 1 trauma center. There were 103 consecutive nonrandomized adult trauma patients who required immediate tube thoracostomy during their initial resuscitation who were entered into the study. The Mac‐technique test was performed during standard tube thoracostomy insertion to the appropriate depth. The test involved grasping the external portion of the thoracostomy tube, turning it clockwise 180°, and then releasing the tube. If the tube spontaneously spun back to its original position, the test was considered positive, and the tube was considered kinked. If the tube did not spontaneously spin back and stayed in position upon release, the test was considered negative. Regardless of the results of this test, the tube was secured, and a postprocedure chest radiograph was obtained. The criterion standard for determining a kinked chest tube was its appearance on this chest radiograph.
Results:
A total of 103 chest tubes were placed by using the Mac‐technique test. The test was positive in eight placements; four tubes were kinked on chest radiograph. The Mac‐technique test was negative in 95 placements; four tubes were kinked on chest radiograph. The Mac technique had a sensitivity of 50% (95% confidence interval [CI] = 15.7% to 84.3%), a specificity of 95.8% (95% CI = 89.6% to 98.8%), a positive likelihood ratio of 11.9, a negative likelihood ratio of 0.52, and an odds ratio using Yates correction of 20.3 (95% CI = 4.1 to 102.1).
Conclusions:
On the basis of this study, a positive Mac‐technique test is useful to detect chest tubes that are likely to be kinked after insertion and before securing.
Prehospital 12‐lead Electrocardiography Impact on Acute Myocardial Infarction Treatment Times and Mortality: A Systematic Review
Authors: Morrison Laurie J. , Brooks Steven , Sawadsky Bruce , McDonald Andrew , Verbeek P. Richard 
Published: December 2005

Abstract
Objectives:
Prehospital 12‐lead electrocardiogram (PHECG) interpretation and advance emergency department (ED) notification may improve time‐to‐treatment intervals for a variety of treatment strategies to improve outcome in acute myocardial infarction. Despite consensus guidelines recommending this intervention, few emergency medical services (EMS) employ this. The authors systematically reviewed the literature to report whether mortality or treatment time intervals improved when compared with standard care.
Methods:
The authors used the Cochrane strategy to search MEDLINE, EMBASE, Current Contents, Dissertation Abstracts, Cochrane Library, and Index of Scientific and Technical Proceedings. Bibliographies and grant‐agency Websites were reviewed, and primary investigators and industry were contacted for published and unpublished studies. Inclusion criteria included PHECG and advance ED notification versus standard EMS care; controlled trials; English only; and evaluation of treatment time intervals, all‐cause mortality, or both. Study selection was hierarchical, blinded, and independent. Agreement at each level of review was evaluated by using a kappa statistic. Study quality was measured with a validated scale and was interpreted by two independent reviewers.
Results:
A total of 1,283 citations were identified, and five studies met the inclusion criteria. The weighted kappa for selection was 0.61 (standard error [SE], 0.045) for titles, 0.63 (SE, 0.051) for abstracts, and 0.79 (SE, 0.146) for full articles. Mean study quality measures by two independent reviewers were 6.0/15 and 5.5/15 (correlation coefficient, 0.85; p = 0.06). PHECG and advance ED notification increased the weighted mean on‐scene time by 1.2 minutes (95% confidence interval [95% CI] =−0.84 to 3.2). The weighted mean door‐to‐needle interval was shortened by 36.1 minutes (95% CI = 9.3 to 63.0: range of means, 22–48 minutes vs. 50–97 minutes). One study reported all‐cause mortality, with a statistically nonsignificant reduction from 15.6% to 8.4%.
Conclusions:
For patients with AMI, the literature would suggest that PHECG and advanced ED notification reduces in hospital time to fibrinolysis. One controlled trial found no difference in mortality with this out‐of‐hospital intervention.
Simulation‐based Morbidity and Mortality Conference: New Technologies Augmenting Traditional Case‐based Presentations
Authors: Vozenilek John , Wang Ernest , Kharasch Morris , Anderson Britney , Kalaria Amit 
Published: December 2005

AbstractThe authors describe the use of a high‐fidelity simulation laboratory to re‐create a patient encounter for the purposes of enhancing a morbidity and mortality conference. The use of two separate technologies were enlisted: a METI high‐fidelity patient simulator to re‐create the case in a more lifelike fashion, and an audience response system to collect clinical impressions throughout the case presentation and survey data at the end of the presentation. The re‐creation of the patient encounter with all relevant physical findings displayed in high fidelity, with relevant laboratory data, nursing notes, and imaging as it occurred in the actual case, provides a more engaging format for the resident–learner. This technological enhancement was deployed at a morbidity and mortality conference, and the authors report the impressions collected via the audience response system. Guidelines for those who wish to re‐create this type of educational experience are presented in the discussion.
Impact of Vascular Endothelial Growth Factor-A Expression, Thrombospondin-2 Expression, and Microvessel Density on the Treatment Effect of Bevacizumab in Metastatic Colorectal Cancer
Authors: Jubb Adrian M. , Hurwitz Herbert I. , Bai Wei , Holmgren Eric B. , Tobin Patti , Guerrero A. Steven , Kabbinavar Fairooz , Holden Scott N. , Novotny William F. , Frantz Gretchen D. , Hillan Kenneth J. , Koeppen Hartmut 
Published: December 2005

Purpose Bevacizumab is a monoclonal antibody to vascular endothelial growth factor-A (VEGF). In the pivotal trial in metastatic colorectal cancer (mCRC), addition of bevacizumab to first-line irinotecan, fluorouracil, and leucovorin (IFL) significantly prolonged median survival. The aim of these retrospective subset analyses was to evaluate VEGF, thrombospondin-2 (THBS-2), and microvessel density (MVD) as prognostic factors and/or predictors of benefit from bevacizumab. Patients and Methods In the pivotal trial, 813 patients with untreated mCRC were randomly assigned to receive IFL plus bevacizumab or placebo. Of 312 tissue samples collected (285 primaries, 27 metastases), outcome data were available for 278 (153 bevacizumab, 125 placebo). Epithelial and stromal VEGF expression were assessed by in situ hybridization (ISH) and immunohistochemistry on tissue microarrays and whole sections. Stromal THBS-2 expression was examined by ISH on tissue microarrays. MVD was quantified by Chalkley count. Overall survival was associated with these variables in retrospective subset analyses. Results In all subgroups, estimated hazard ratios (HRs) for risk of death were < 1 for bevacizumab-treated patients regardless of the level of VEGF or THBS-2 expression or MVD. Patients with a high THBS-2 score showed a nonsignificant improvement in survival following bevacizumab treatment (HR = 0.11; 95% CI, 0.02 to 0.51) compared to patients with a low score (HR = 0.65; 95% CI, 0.41 to 1.02); interaction analysis P = .22. VEGF or THBS-2 expression and MVD were not significant prognostic factors. Conclusion These exploratory analyses suggest that in patients with mCRC addition of bevacizumab to IFL improves survival regardless of the level of VEGF or THBS-2 expression, or MVD.
Postoperative Surveillance in Patients With Colorectal Cancer Who Have Undergone Curative Resection: A Prospective, Multicenter, Randomized, Controlled Trial
Authors: Rodríguez-Moranta Francisco , Saló Joan , Arcusa Àngels , Boadas Jaume , Piñol Virgínia , Bessa Xavier , Batiste-Alentorn Eduard , Lacy Antonio M. , Delgado Salvadora , Maurel Joan , Piqué Josep M. , Castells Antoni 
Published: December 2005

Purpose Although systematic postoperative surveillance of patients with colorectal cancer has been demonstrated to improve survival, it remains unknown whether a more intensive strategy provides any significant advantage. This prospective, multicenter, randomized, controlled trial was aimed at comparing the efficacy of two different surveillance strategies in terms of both survival and recurrence resectability. Patients and Methods Patients with stage II or III colorectal cancer were allocated randomly to either a simple surveillance strategy including clinical evaluation and serum carcinoembryonic antigen monitoring, or an intensive strategy in which abdominal computed tomography or ultrasonography, chest radiograph, and colonoscopy were added. Results A total of 259 patients were included: 132 were observed according to the simple strategy and 127 were observed according to the intensive strategy. Both groups were similar with respect to baseline characteristics and rate and type of tumor recurrence. After a median follow-up of 48 months, there was no difference in the probability of overall survival in the whole series (hazard ratio [HR] = 0.87; 95% CI, 0.49 to 1.54; P = .62). However, the intensive strategy was associated with higher overall survival in patients with stage II tumors (HR = 0.34; 95% CI, 0.12 to 0.98; P = .045) and in those with rectal lesions (HR = 0.09; 95% CI, 0.01 to 0.81; P = .03), mainly due to higher rate of resectability for recurrent tumors. Colonoscopy was responsible for the detection of the highest proportion (44%) of resectable tumor recurrence in the intensive arm. Conclusion A more intensive surveillance strategy improves the prognosis of patients with stage II colorectal cancer or those with rectal tumors. Inclusion of regular performance of colonoscopy seems justified up to the fifth year of follow-up, at least.
Similar Outcomes Between African American and Non–African American Patients With Extensive-Stage Small-Cell Lung Carcinoma: Report From the Cancer and Leukemia Group B
Authors: Blackstock A. William , Herndon James E. , Paskett Electra D. , Miller Antonius A. , Lathan Christopher , Niell Harvey B. , Socinski Mark A. , Vokes Everett E. , Green Mark R. 
Published: December 2005

Purpose Among patients with small-cell lung carcinoma, African Americans have lower survival rates than non–African Americans. We investigated whether the disparity in survival would persist when patients were treated with similar therapies (ie, phase II/III Cancer and Leukemia Group B [CALGB] trials). Patients and Methods We assessed 995 patients (928 non–African American and 67 African American) receiving chemotherapy in CALGB studies for extensive-stage small-cell lung cancer (ES-SCLC). Clinical and demographic characteristics, treatment received, and survival data were obtained from the CALGB database. The Cox proportional hazards model was used to assess the effect of race/ethnicity on survival after adjustment for other known prognostic factors. All statistical tests were two sided. Results The unadjusted survival distribution of African American patients was not significantly different from that of non–African American patients; median survival was 11.5 months (95% CI, 9.4 to 13.4 months) for African American patients versus 9.9 months (95% CI, 9.6 to 10.3 months) for non–African American patients. Multivariable adjustment for the effect of treatment arm, histology, and metastatic site at presentation did not alter the outcome for African American patients. Survival was similar even though African American patients were more likely to have a poorer performance status, present with significant weight loss, and be Medicaid recipients (20% v 6%), which is an indicator of lower socioeconomic status. Conclusion African American patients tended to present with prognostic features associated with a worse survival. However, when offered equivalent therapy, the outcome for African American patients was the same as that observed for non–African American patients.
The Effect of Race on Invasive Staging and Surgery in Non–Small-Cell Lung Cancer
Authors: Lathan Christopher S. , Neville Bridget A. , Earle Craig C. 
Published: December 2005

Purpose Black patients with early-stage non–small-cell lung cancer (NSCLC) have worse overall survival than white patients. Decreased likelihood of resection has been implicated. To isolate the effect of decision making from access to care, we used receipt of surgical staging as a proxy for access and willingness to undergo invasive procedures, and examined treatments and outcomes by race. Patients and Methods We examined registry and claims data of Medicare-eligible patients with nonmetastatic NSCLC in areas monitored by the Surveillance, Epidemiology, and End Results program from 1991 to 2001. Patients who obtained invasive staging, defined as bronchoscopy, mediastinoscopy, or thoracoscopy, were included. Logistic regression and Cox modeling calculated the odds of having staging and surgery, and survival outcomes. Results A total of 14,224 patients underwent staging, and 6,972 had surgery for lung cancer. Black patients were less likely to undergo staging (odds ratio [OR] = 0.75; 95% CI, 0.67 to 0.83), and once staged, were still less likely to have surgery than whites (OR = 0.55; 95% CI, 0.47 to 0.64). Survival for blacks and whites was equivalent after resection (hazard ratio = 1.02; P = .06). Staged black patients were less likely to receive a recommendation for surgery when it was not clearly contraindicated (67.0% v 71.4%; P < .05), and were more likely to decline surgery (3.4% v 2.0%; P < .05). Conclusion Black patients obtain surgery for lung cancer less often than whites, even after access to care has been demonstrated. They are more likely not to have surgery recommended, and more likely to refuse surgery. Additional research should focus on the physician-patient encounter as a potential source of racial disparities.
Tumor Necrosis Factor-α–Induced Protein 3 As a Putative Regulator of Nuclear Factor-κB–Mediated Resistance to O6-Alkylating Agents in Human Glioblastomas
Authors: Bredel Markus , Bredel Claudia , Juric Dejan , Duran George E. , Yu Ron X. , Harsh Griffith R. , Vogel Hannes , Recht Lawrence D. , Scheck Adrienne C. , Sikic Branimir I. 
Published: December 2005

Purpose Pre-existing and acquired drug resistance are major obstacles to the successful treatment of glioblastomas. Methods We used an integrated resistance model and genomics tools to globally explore molecular factors and cellular pathways mediating resistance to O6-alkylating agents in glioblastoma cells. Results We identified a transcriptomic signature that predicts a common in vitro and in vivo resistance phenotype to these agents, a proportion of which is imprinted recurrently by gene dosage changes in the resistant glioblastoma genome. This signature was highly enriched for genes with functions in cell death, compromise, and survival. Modularity was a predominant organizational principle of the signature, with functions being carried out by groups of interacting molecules in overlapping networks. A highly significant network was built around nuclear factor-κB (NF-κB), which included the persistent alterations of various NF-κB pathway elements. Tumor necrosis factor-α–induced protein 3 (TNFAIP3) was identified as a new regulatory component of a putative cytoplasmic signaling cascade that mediates NF-κB activation in response to DNA damage caused by O6-alkylating agents. Expression of the corresponding zinc finger protein A20 closely mirrored the expression of the TNFAIP3 transcript, and was inversely related to NF-κB activation status in the resistant cells. A prediction model based on the resistance signature enabled the subclassification of an independent, validation cohort of 31 glioblastomas into two outcome groups (P = .037) and revealed TNFAIP3 as part of an optimized four-gene predictor associated significantly with patient survival (P = .022). Conclusion Our results offer strong evidence for TNFAIP3 as a key regulator of the cytoplasmic signaling to activate NF-κB en route to O6-alkylating agent resistance in glioblastoma cells. This pathway may be an attractive target for therapeutic modulation of glioblastomas.
Sampling Bias of Hook-and-Line Gear Used to Capture Rainbow Trout in Gertrude Creek, Alaska
Authors: Hetrick Nicholas J. , Bromaghin Jeffrey F. 
Published: December 2005

Abstract
Hook-and-line gear is commonly used for monitoring the size and abundance of resident fish populations in southwest Alaska. The selectivity of the gear, however, may contribute to bias in the catch, making it difficult to detect changes in population structure over time. This study assessed the potential bias in sampling a population of rainbow trout Oncorhynchus mykiss with angling gear. A bidirectional weir was operated on Gertrude Creek from 1997 to 1999 to intercept the annual upstream spring migration of rainbow trout into the stream. Captured fish were measured and tagged to establish a population of marked individuals with a known length distribution above the weir. The marked population was then sampled with angling gear on three occasions during each of three summers. A variety of terminal tackle was used, and types were selected to maximize the catch of rainbow trout. Size selectivity was evaluated by use of an exact Kolmogorov–Smirnov (KS) test of the hypothesis that the length distribution of all marked fish was equivalent to that of the subset of marked fish recaptured by anglers during a single recapture event. Test results were not significant for any of the recapture events, providing strong evidence that length selectivity did not exist for fish within the size range of the marked population. An exact KS test was also used to test length distribution equality between the marked population and all fish captured during an angling event. All of these KS tests were significant, suggesting that the marked group was a size-biased subset of the rainbow trout population in the drainage. The results of this study support the use of angling gear as a potentially viable sampling method for monitoring the size composition of rainbow trout in small southwest Alaskan streams.