bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effects of Combined Intravenous and Inhaled Steroids (Beclomethasone Dipropionate) for the Emergency Treatment of Acute Asthma
Authors: Guttman Alex , Afilalo Marc , Colacone Antoinette , Kreisman Harvey , Dankoff Jerrald ,   Asthma ED Study Group
Published: September 2008

ABSTRACTObjective: To compare the efficacy of high‐dose inhaled steroids in conjunction with IV steroids with that of IV steroids alone in the emergency treatment for acute asthma.Methods: A double‐blind, placebo‐controlled, randomized trial was conducted on 60 ED patients presenting with acute asthma. All patients received nebulized salbutamol, and IV methylprednisolone, 80 mg at baseline and 40 mg at 6 hours. In addition to the above therapy, the experimental group received beclomethasone dipropionate (BDP) 7 mg over 8 hours via a metered‐dose inhaler (MDI) attached to a holding chamber, while the control group received a placebo administered in the same fashion. Patients were treated on the protocol for 12 hours with the primary outcome measure being the change in % predicted FEV1.Results: Of 60 patients, 30 were randomized to BDP (age: 42 ± 16 years; FEV1: 0.97 ± 0.42 L) and 30 were randomized to placebo (age: 37 ± 18 years; FEV1: 0.98 ± 0.35 L). Spirometry and dyspnea measured by the Borg Scale improved significantly in both groups compared with baseline (p < 0.001). Changes in spirometry measures, dyspnea, and vital signs did not differ between treatment groups over the 12 hours of study (p > 0.05).Conclusion: Inhaled BDP added to the standard regimen of IV methylprednisolone, and β‐agonist did not further improve flow rates or dyspnea scores measured for up to 12 hours after presentation to the ED.
Color Doppler Ultrasonography by Emergency Physicians for the Diagnosis of Acute Deep Venous Thrombosis
Authors: Jolly B. Tilman , Massarin Elizabeth , Pigman E. Cary 
Published: September 2008

ABSTRACTObjectives: To assess the feasibility of emergency physicians' (EPs') performing color‐flow Doppler ultra‐sonographic vascular studies in the ED to diagnose deep venous thrombosis (DVT), after a modest training program.Methods: A retrospective observational review was performed of the performance of color‐flow Doppler ultrasonographic vascular studies by EPs. Prior to the study period, venous Doppler studies were not available at off‐hours. Two attending EPs were trained by the hospital's vascular laboratory by observing studies and then performing 25–30 studies successfully. They were then available to examine all patients presenting to the ED at off‐hours who were suspected of having DVT. Patients were admitted or released from the ED based on the examination results. All patients were to have formal vascular laboratory studies the next day. The study was performed at a university hospital ED and evaluated all patients who underwent off‐hour examinations from January 1993 to February 1994. The examiners were aware of the clinical scenario. Results: Of 23 eligible patients, 15 completed the protocol with a follow‐up next‐day study. Based on the follow‐up study, the ED examination was 100% sensitive (7 true positives) and 75% specific (6 true negatives). The 2 false‐positive studies were for patients with old DVT. The 8 patients without follow‐up studies were not included in the analysis, although 4 of these patients had negative studies and unremarkable clinical outcomes.Conclusions: These preliminary findings suggest that Doppler ultrasonographic studies of the lower extremity veins by EPs can be used to make admission decisions when formal studies are not available. Confirmatory studies should be performed. EPs may overread acute thrombosis in the setting of old venous disease. Issues of cost and logistics remain to be resolved.
Multiphasic Anaphylaxis: An Uncommon Event in the Emergency Department
Authors: Brady William J. , Luber Samuel , Carter C. Thomas , Guertler Andrew , Lindbeck George 
Published: September 2008

ABSTRACTObjective: To determine the rate of clinically significant recurrence of symptoms in patients treated for anaphylaxis in the ED.Methods: Retrospective chart review of out‐of‐hospital, ED, and hospital records over a 4.5‐year period (July 1991 to December 1995) at a university hospital ED with an annual patient volume of 60,000. Subjects were ED anaphylaxis patients with ≥2 of the following 3 organ systems involved: cutaneous, respiratory, and cardiovascular. The major outcome criterion was recurrence of symptoms after ED release. Recurrences were sought at the primary treatment hospital and at surrounding hospitals (radius of 75 miles from the primary institution) within a 7‐day period from the initial visit. Review of the state death registry also was made to verify the absence of out‐of‐hospital deaths.Results: The medical records of 1,261 allergic reaction patients were reviewed, with 67 (5.3%) cases of anaphylaxis identified. Symptoms and signs in patients during the ED phase included: dyspnea, 42 (63%); pruritus, 38 (57%); emesis, 27 (41%); throat/chest tightness, 25 (37%); orthostatic complaints, 12 (18%); urticaria, 47 (70%); circulatory shock, 32 (48%); upper airway angioedema, 7 (33%); stridor, 11 (16%); and bronchospasm, 20 (30%). Of the 67 patients, 93% had immediate resolution and remained asymptomatic for a mean time of 4.2 hours in the ED. Protracted reaction occurred in 5 cases (3 using β‐adrenergic blocking agents). For 19 (28%) patients admitted to hospital, the mean hospital length of stay was 63 hours. Only 2 (3%) recurrent cases were identified, both manifested solely by urticaria.Conclusion: Recurrent anaphylactic reactions were rare, occurring in 3% of cases and without life threat in this patient population. Selective outpatient management of patients with severe anaphylactic reactions that promptly respond to therapy with complete, rapid resolution may be reasonable. Further study of this medical emergency is required to develop criteria to guide the choice of an outpatient disposition.
Herbal Preparation Use among Urban Emergency Department Patients
Authors: Hung Oliver L. , Shih Richard D. , Chiang William K. , Nelson Lewis S. , Hoffman Robert S. , Goldfrank Lewis R. 
Published: September 2008

ABSTRACTObjective: To determine the prevalence of herbal preparation use among patients presenting to an urban teaching hospital ED.Methods: A prospective anonymous survey on herbal preparation use was performed. Consecutive, acutely ill or injured adult (≥8 years old) ED patients were offered the survey over a 1‐month period. The survey also asked for information related to patient age, ethnicity, gender, employment, education, cigarette smoking history, ethanol consumption, use of illicit drugs, chief complaint, and HIV status.Results: Of 2,473 eligible subjects, 623 (25%) participated. The overall reported prevalence of herbal preparation use among the participants was 21.7%. Women were more likely to use herbal preparations than men (28.5% vs 17.2%, p = 0.013). Prevalence rates in different ethnic populations were: whites, 18.2%; Hispanics, 13.9%; blacks, 26.4%; and Asians, 36.8%. Asians had a significantly higher use rate than the other ethnic groups (p = 0.039). Neither HIV positivity, educational level, employment status, nor age was significantly associated with herbal preparation use. The most commonly reported herbal preparations were goldenseal tea, garlic, and ginger. Several of the herbal preparations reported as used by patients in this study have been associated with severe systemic toxicity in the medical literature.Conclusion: Although the survey response rate was low, the prevalence of herbal preparation use among acutely ill or injured patients presenting to this urban ED remains significant. A directed history toward specific herbal preparation use may provide relevant pharmacologic information and uncover cases of herbal‐preparation‐induced toxicity.
Research Subject Enroller Program: A Key to Successful Emergency Medicine Research
Authors: Cobaugh Daniel J. , Spillane Linda L. , Schneider Sandra M. 
Published: September 2008

ABSTRACTObjective: To describe the successful use and impact of individuals paid to enroll clinical research subjects in support of emergency medicine (EM) research.Program Description: Paramedics and college students were hired to identify/enroll subjects in EM research studies 14 hours/day, 7 days/week. Potential subjects were identified by monitoring emergency medical services radios, routine rounding in the ED, and communication with the ED attending and charge nurse. Enrollers were trained in phlebotomy, obtaining ECGs, obtaining consent in appropriate studies, and post‐ED follow‐up. They supported ED prospective studies and multicenter clinical trials, as well as departmental surveys and retrospective studies. Survey support included mailing list development, mailing completion, survey database design, and data entry.Program Outcomes: Over 18 months, 17 prospective studies and 8 surveys/retrospective studies were completed. 2,175 subjects were enrolled in prospective studies and 6,500 surveys/retrospective reviews were completed. In the year prior to enroller program initiation, <100 subjects were enrolled in 3 departmental studies.Conclusion: Use of paid, clinical research subject enrollers supports successful recruitment of study subjects and the completion of EM research studies.
Morganella morganii: A Newly Reported, Rare Cause of Neonatal Sepsis
Authors: Salen Philip N. , Eppes Stephen 
Published: September 2008

ABSTRACTThis case report reviews the clinical course of an 11‐day‐old boy who developed late‐onset neonatal sepsis secondary to a rare neonatal pathogen, Morganella morganii. This gram‐negative enteric bacterium, within the Enterobacteriaceae family, has most commonly been a nosocomial pathogen in debilitated, postsurgical patients. Like many other Enterobacteriaceae, M. morganii has an inducible β‐lactamase and is resistant to multiple antibiotics. When caring for neonates with culture‐proven M. morganii sepsis, the authors recommend administering both a third‐generation cephalosporin and an aminoglycoside to ensure that both antibiotics are bactericidal and to reduce the induction of resistance.
Analysis of Factors Affecting U.S. Emergency Physician Workforce Projections
Authors: Holliman C. James , Wuerz Richard C. , Hirshberg Alan J. , Force SAEM Workforce Task 
Published: September 2008

ABSTRACTObjectives: To use existing data sources to refine prior estimates of the U.S. emergency medicine (EM) workforce and to estimate effects of proposed changes in the U.S. health care system on the EM workforce. Methods: Relevant data were extracted from the American College of Emergency Physicians (ACEP) 1995 Membership Activity Report, the American Medical Association (AMA) publication “1995/96 Physician Characteristics and Distribution in the U.S.,” the American Hospital Association (AHA) 1994 hospital directory, a written survey of each state's medical licensing board and state medical society, and the American Board of Emergency Medicine (ABEM) annual activity report for 1995. These data were used to project workforce supply and demand estimates applicable to workforce models.Results: None of the available information sources had complete data on the number and distribution of emergency physicians (EPs) currently practicing in the United States. Extrapolating the limited reliable statewide EP numbers to make nationwide projections reveals a shortage of EPs needed to fully staff the nation's existing EDs. At least 22 states had an average ratio of <5 EPs per existing ED. Additional national projections incorporating a decreasing number of U.S. EDs indicate that the current annual number of EM residency graduates will not eliminate the deficit of EPs for at least several decades, given that projected numbers of retiring EPs annually will soon equal the total annual EM residency graduate production. Conclusions: Although the current data on EPs in practice in the United States are incomplete, the authors project a relative shortage of EPs. More accurate and complete information on the numbers and distribution of EPs in America is needed to improve workforce projections.
Does reactivity to stress cosegregate with subclinical psychosis? A general population twin study
Authors: Lataster T. , Wichers M. , Jacobs N. , Mengelers R. , Derom C. , Thiery E. , Van Os J. , Myin‐Germeys I. 
Published: September 2008

Objective:  This study assessed the relationship between stress reactivity (trait 1) and psychosis (trait 2) across genetically related persons (cross‐twin, cross‐trait design) to examine whether stress reactivity is an uncontaminated and unconfounded familial marker of psychosis risk.Method:  Reactivity to stress and subclinical psychotic experiences were assessed in 289 female, general population twin‐pairs. Cross‐trait, within‐twin associations investigating the association between stress reactivity and subclinical psychotic experiences in each person, were calculated. In addition, cross‐trait, cross‐twin associations were calculated to assess whether stress reactivity in one twin was moderated by subclinical psychotic experiences in the co‐twin.Results:  Cross‐trait, within‐twin analyses showed significant associations between stress reactivity and subclinical psychotic experiences in each person. In addition, the cross‐trait cross‐twin analyses showed that stress reactivity in twin 1 was significantly moderated by subclinical experiences in the co‐twin.Conclusion:  The results suggest that the psychosis phenotype cosegregates with increased emotional reactivity to stress in daily life.
Subjective and objective sleep among depressed and non‐depressed postnatal women
Authors: Dørheim S. K. , Bondevik G. T. , Eberhard‐Gran M. , Bjorvatn B. 
Published: September 2008

Objective:  Women sleep less in the postnatal period and it has been suggested that mothers diagnosed with depression alternatively could be suffering from the effects of chronic sleep deprivation.Method:  From a population‐based study, we recruited 42 women, of whom 21 scored ≥10 on the Edinburgh Postnatal Depression Scale. Sleep was registered by the Pittsburgh Sleep Quality Index (PSQI), sleep diaries and actigraphy 2 months after delivery.Results:  There were significant differences in subjective sleep measured retrospectively by the PSQI between depressed and non‐depressed women. In contrast, there were no significant differences in sleep measured prospectively by sleep diaries and actigraphy. Both depressed and non‐depressed women had impaired sleep efficiency (82%) and were awake for about 1.5 h during the night. Primipara had worse sleep, measured by actigraphy, compared with multipara.Conclusion:  Measured objectively and prospectively, women with depression did not have worse sleep than non‐depressed women.
Changes in serum interleukin‐6, C‐reactive protein and thrombomodulin levels under periodontal ultrasonic debridement
Authors: Ushida Yuka , Koshy Geena , Kawashima Yoko , Kiji Makoto , Umeda Makoto , Nitta Hiroshi , Nagasawa Toshiyuki , Ishikawa Isao , Izumi Yuichi 
Published: September 2008

AbstractAim: This study aimed to compare the effect of single‐visit full‐mouth mechanical debridement (FMD) and quadrant‐wise mechanical debridement (QMD) on the levels of serum interleukin (IL)‐6, C‐reactive protein (CRP) and soluble thrombomodulin.Material and Methods: Thirty‐six subjects with chronic periodontitis were randomly allocated to three groups: undergoing QMD, single‐visit FMD with povidone iodine or with water. Serum IL‐6 and soluble thrombomodulin were measured by enzyme‐linked immunosorbent assay, and serum CRP was measured by the latex‐enhanced nephelometric method.Results: Serum IL‐6 level increased significantly immediately after debridement in all the three groups, with this increase being greatest in the full‐mouth groups. However, the increase in the full‐mouth groups was not significantly higher than that of quadrant‐wise group. In the quadrant‐wise group, serum IL‐6 level decreased significantly 1 month after debridement compared with baseline. Serum‐soluble thrombomodulin decreased significantly in the full‐mouth groups but not in the quadrant‐wise group. Changes in CRP level were not significant at baseline or after debridement in all the three groups.Conclusions: FMD increased serum IL‐6 and reduced serum‐soluble thrombomodulin to a greater extent than QMD, suggesting that the former technique has stronger transient effects on systemic vascular endothelial functions than the latter.
Smoking behaviour and attitudes to periodontal health and quit smoking in patients with periodontal disease
Authors: Martinelli Elizabeth , Palmer Richard M. , Wilson Ron F. , Newton J. Tim 
Published: September 2008

AbstractObjective: The aim of this study was to assess oral health‐related beliefs and attitudes, health behaviour of smokers in relation to the Transtheoretical Model (TTM) of behaviour change, willingness to have smoking cessation provided together with periodontal treatment.Material and Methods: Postal questionnaire was sent to 500 referred patients. Part 1 looked at attitudes and beliefs about periodontal disease, Part 2 aimed at current smokers focused on the TTM and smoking cessation.Results: Response rate was 56% (n=277); 67% females, 33% males. Mean age was 44.9 years (SD 12.45); 24.5% current smokers, 30.3% past smokers, 45.5% never smokers. Fewer smokers reported “bleeding gums” (p=0.027), but more smokers reported “having loose teeth” (p=0.016). The TTM stages of change indicated that 31% of current smokers were in pre‐contemplation of quitting smoking, 46% were in contemplation and 23% were in preparation. Twenty‐three percent of the past smokers were in action and 77% in maintenance. Smokers showed differences in the “self‐re‐evaluation” (p=0.001) and “self‐liberation” (p=0.015) processes of change depending on their stage of change (pre‐contemplation or preparation). Nearly half (49%) of the current smokers who wanted to quit requested smoking cessation to be provided alongside their periodontal treatment.Conclusion: A large proportion of periodontal patient smokers may be considering quitting, and nearly half requested provision of smoking cessation intervention in conjunction with the periodontal treatment.
Cholelithiasis in thalassemia major
Authors: Origa Raffaella , Galanello Renzo , Perseu Lucia , Tavazzi Dario , Domenica Cappellini M. , Terenzani Laura , Forni Gian Luca , Quarta Giovanni , Boetti Tatiana , Piga Antonio 
Published: September 2008

AbstractObjectives:  Aim of this study was to evaluate prevalence and characteristics of cholelithiasis in a large population of patients with thalassemia major (TM).Methods:  Data from 858 consecutive patients with transfusion‐dependent thalassemia at five major Italian centers were analyzed. In these centers, a complete abdomen ultrasonography is performed yearly after the beginning of the transfusion regimen. The role of co‐inheriting Gilbert’s syndrome genotype was investigated studying the promoter region of the UGT1‐A1 gene by automated sequencing.Results:  Thirty percent of TM patients had gallstones. The Gilbert’s genotype [homozygosity for (TA)7 motif at UGT1A promoter gene], influenced both the prevalence of cholelithiasis and the age at which it developed.Conclusions:  Cholelithiasis has a remarkable frequency and precocity in patients with TM and especially in those with (TA)7/(TA)7 UGT1‐A1 genotype. An early biliary ultrasonography is recommended from childhood and a closer follow‐up in patients with thalassemia and associated Gilbert’s syndrome may be indicated.
Pitfalls in the design and analysis of paediatric clinical trials: a case of a ‘failed’ multi‐centre study, and potential solutions
Authors: Van Der Lee Johanna H , Tanck Michael WT , Wesseling Judit , Offringa Martin 
Published: September 2008

AbstractAim: To increase awareness of possible pitfalls in the design and analysis of a multi‐centre randomized clinical trial and to give an overview of alternative study designs and their consequences for power analyses in case of limited availability of trial participants.Methods: Investigation of the assumptions in the power calculation and re‐analysis of the original data of a ‘failed’ trial on the effect of dexamethasone on the duration of mechanical ventilation in young children with respiratory syncytial virus infection. Use of ‘boundaries approach’ is explored using the data from this trial. A comprehensive overview of the various modern solutions for the design of a subsequent trial in this field is given.Results: Two frequent major deficiencies of trial design and data analysis are reviewed in depth, i.e. too optimistic assumptions for the sample size calculation and failure to adjust for centre effects.Conclusion: Critical review of trial assumptions and if necessary sample size recalculation based on an internal pilot by a data monitoring committee is recommended to maximize the probability of obtaining conclusive results.
Vegetative Community Compositional Gradients of Tropical Hardwood Hammocks along the Florida Keys
Authors: Reardon Betty J. , Brooks Wesley R. 
Published: September 2008

ABSTRACTTropical hardwood hammocks, among the rarest and most threatened vegetative communities in the United States, occur throughout the 225‐km Florida Keys archipelago as it extends toward the Caribbean from the southeast tip of peninsular Florida. Compounding their critical conservation status, tropical hardwood hammocks and the dynamics that support their peculiar species diversity in the region are poorly understood. The goal of this study was to explore the dynamics of the species compositional gradient of the hammocks along the Florida Keys, and to identify significant ecological units within the gradient. The primary data for this research were assembled from the Institute for Regional Conservation's floristic database of South Florida. We were able to extract presence/absence data for 295 species from comprehensive surveys of 23 study sites. Nonmetric multidimensional scaling was used to deconstruct the compositional trends into a reduced ordination space. Cluster analysis was subsequently used to identify discrete ecological units. Additionally, we used vector fitting to interpret the significant correlated ancillary variables. Our main results were three well‐fitted nonmetric multidimensional scaling axes with three nonoverlapping ecological units. Of the ancillary variables, latitude, longitude, percent composition from biogeographical regions, richness, and area were correlated to the nonmetric multidimensional scaling results. These results increase our understanding of the community structure of the hammocks along the Florida Keys, and can contribute to increasing our ability to adequately protect and restore tropical hardwood hammocks and other similar tropical dry forest communities throughout the Caribbean.