bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of a Hypertext‐based Curriculum for Emergency Medicine on the World Wide Web
Authors: Savitt Daniel L. , Steele Dale W. 
Published: September 2008

ABSTRACTThis project reports the publication of a variety of existing curricular resources for emergency medicine on the global Internet in a format that allows hypertext links between related material, timely updates, and end‐user feedback. Curricular elements were converted to Hypertext Markup Language with extensive links between related content. The completed document contains instructions for curriculum development, specific curricula for subspecialty areas within a residency, reading lists for subspecialty curricula, banks of images, and board‐type questions with answers. Users are provided with a mechanism to provide immediate feedback to section editors with suggestions for changes, including new references. Access to all or part of the document can be controlled via passwords, but is potentially available to anyone with an Internet connection and a World Wide Web browser. The document may be viewed on the World Wide Web at: http:www.brown.eduAdministrationEmergency‐Medicinecurr.html
Evaluation of Pre‐ and Posttreatment Pulse Oximetry in Acute Childhood Asthma
Authors: Wright Robert O. , Santucci Karen A. , Jay Gregory D. , Steele Dale W. 
Published: September 2008

ABSTRACTObjectives: To evaluate the utility of pre‐ and posttreatment O2 saturation (SpO2) for prediction of admission or relapse after ED release in acute asthma exacerbations using a standardized treatment protocol.Design: A prospective, double‐blind, observational study was performed at a pediatric ED. Children with acute asthma were enrolled upon ED presentation. SpO2 was measured prior to treatment and after disposition decision. Two experienced physicians determined disposition based on history and physical examination alone, while blinded to SpO2. Relapse of released patients was determined by telephone follow‐up.Results: A pretreatment room‐air SpO2 of ≤91% had a sensitivity of 0.24, a specificity of 0.86, and a likelihood ratio of 1.77 to predict admission/relapse. A posttreatment room‐air SpO2 of ≤91% had a sensitivity of 0.34, a specificity of 0.98, and a likelihood ratio of 16.43 to predict admission/relapse.Conclusions: As opposed to some previous studies, this study found pretreatment SpO2 to be a relatively poor predictor of admission. A posttreatment SpO2 of ≤91% occurred in a minority (32%) of patients, but increased the odds of admission 16‐fold and may be used as an adjunct to objectively confirm the need for admission.
Medical Clearance and Screening of Psychiatric Patients in the Emergency Department
Authors: Olshaker Jonathan S. , Browne Brian , Jerrard David A. , Prendergast Heather , Stair Thomas O. 
Published: September 2008

ABSTRACTObjectives: To study the frequency of medical complaints and need for routine ED medical, laboratory, and toxicologic clearance for patients presenting with psychiatric chief complaints.Methods: A retrospective, observational analysis of psychiatric patients seen in an urban teaching hospital ED over a 2‐month period was performed. The individual sensitivities of history, physical examination, vital signs, and complete blood counts and chemistry panels for identifying medical problems were determined. The sensitivities and predictive values of patient self‐reporting of recent illicit drug and ethanol use were also determined.Results: 352 patients were seen with psychiatric chief complaints. A complete data set was available for 345 patients (98%). Of those with complete data, 65 (19%) had medical problems of any type. History, physical examination, vital signs, and laboratory testing had sensitivities of 94%, 51%, 17%, and 20%, respectively, for identifying these medical problems. Screening without universal laboratory testing would have missed 2 asymptomatic patients with mild hypokalemia. Patient self‐reporting had a 92% sensitivity, a 91% specificity, an 88% positive predictive value (PPV), and a 94% negative predictive value (NPV) for identifying those with a positive drug screen, and a 96% sensitivity, an 87% specificity, a 73% PPV, and a 98% NPV for identifying those with a positive ethanol level.Conclusion: The vast majority of medical problems and substance abuse in ED psychiatric patients can be identified by initial vital signs and a basic history and physical examination. Universal laboratory and toxicologic screening of all patients with psychiatric complaints is of low yield.
Comparison of Patient Satisfaction and Practitioner Satisfaction with Wound Appearance after Traumatic Wound Repair
Authors: Singer Adam J. , Church Adam L. , Forrestal Kerry , Werblud Marc , Valentine Sharon M. , Hollander Judd E. 
Published: September 2008

ABSTRACTIntroduction: Existing cosmetic scales for wounds are based only on practitioners' evaluations. They have not been validated using the patient's assessment.Objective: To validate a previously developed wound cosmesis scale by determining the relationship between patient and practitioner assessments of cosmetic outcome following traumatic wound repair. Methods: A convenience sample of patients with lacerations repaired in an ED were evaluated at the time of suture removal. Practitioners assigned 0 or 1 point each for the presence or absence of a step‐off of borders; contour irregularities; margin separation; edge inversion; excessive distortion; and overall appearance. A total cosmetic score was calculated by adding the categories above. As previously defined, a score of 6 was considered optimal; < s6 was considered “suboptimal.” Patients, blinded to the physician score, assessed their degrees of satisfaction with the cosmetic outcome of the wounds using a 100‐mm visual analog scale (VAS). Because VAS scores were not normally distributed, practitioner scores were compared with patient satisfaction scores using a Mann‐Whitney U test.Results: 125 patients were enrolled, of whom 64% were male; the median age was 19.5 years (interquartile range = 8–33 years). Wounds were located predominantly on the face, scalp, or neck (47%) and upper extremity (35%), and had a median length of 2 cm. The 86 lacerations given optimal practitioner scores had a median patient satisfaction score of 97 mm; the 39 “suboptimal” lacerations had a median patient satisfaction score of 87 mm (p = 0.0006).Conclusion: Lacerations that practitioners ponsidered to have optimal cosmetic appearances at the time of suture removal received higher patient satisfaction scores than did lacerations considered to be suboptimal. This provides a measure of validity to this 6‐item categorical cosmetic scale.
Respiratory Isolation of Patients with Suspected Pulmonary Tuberculosis in an Inner‐city Hospital
Authors: Gaeta Theodore J. , Webheh Webheh , Yazji Monzir , Ahmed Javid , Yap Wilson 
Published: September 2008

ABSTRACTObjective: To identify clinical factors that predict which patients presenting to the ED with pneumonia will require respiratory isolation for suspected tuberculosis and to evaluate a protocol for rapid identification of patients at risk for pulmonary tuberculosis (PTB).Methods: To identify potential clinical indicators of PTB, a case‐control study was performed using patients admitted to an urban teaching hospital with the ED diagnosis of pneumonia (derivation sample). These predictors were then evaluated in a separate prospective observational study of 103 patients admitted to the same institution from July 1994 to February 1995. Adult patients with the admitting diagnosis of pneumonia were admitted to a respiratory isolation bed if they met 1 of the following criteria: 1) HIV‐positive or unknown HIV status with a history of injection drug use; 2) chest x‐ray consistent with PTB; or 3) pneumonia with 1 of the following: PPD conversion within 2 years, recent exposure to PTB, previous PTB, or hemoptysis. Patients who did not meet isolation criteria were admitted to the medical ward and had a PPD and anergy panel placed. Those who were anergic or PPD‐positive were transferred to respiratory isolation. Results: Predictor variables identified during the first study phase were incorporated into the isolation guidelines noted above. Only 36 of 50 (72%) PTB patients were admitted to an isolation bed during this phase. During the second phase, 103 patients were admitted with the ED diagnosis of pneumonia‐rule out PTB; 22 patients (22%) were culture‐confirmed positive for PTB. The guidelines predicted PTB as follows: sensitivity, 0.96 (95% CI, 0.88–1.0); specificity, 0.14 (95% CI, 0.08–0.24); positive predictive value, 0.23 (95% CI, 0.17–0.35); and negative predictive value, 0.92 (95% CI, 0.77–1.0). The 1 patient who was not isolated was found to be anergic after 48 hours and subsequently isolated.Conclusion: Respiratory isolation guidelines for patients admitted from the ED with pneumonia were developed and validated. These guidelines provide satisfactory guidance for isolation of patients at risk for PTB in a high‐PTB‐prevalence population.
Statistical Methodology: II. Reliability and Validity Assessment in Study Design, Part B
Authors: Karros David J. 
Published: September 2008

SUMMARYValidity measures the correspondence between a test and other purported measures of the same or similar qualities. When a reference standard exists, a criterion‐based validity coefficient can be calculated. If no such standard is available, the concepts of content and construct validity may be used, but quantitative analysis may not be possible. The Pearson and Spearman tests of correlation are often used to assess the correspondence between tests, but do not account for measurement biases and may yield misleading results. Techniques that measure intertest differences may be more meaningful in validity assessment, and the κ statistic is useful for analyzing categorical variables.Questionnaires often can be designed to allow quantitative assessment of reliability and validity, although this may be difficult. Inclusion of homogeneous questions is necessary to assess reliability. Analysis is enhanced by using Likert scales or similar techniques that yield ordinal data. Validity assessment of questionnaires requires careful definition of the scope of the test and comparison with previously validated tools.
Toxic Ingestions in Pregnancy: Abortifacient Use in a Case Series of Pregnant Overdose Patients
Authors: Perrone Jeanmarie , Hoffman Robert S. 
Published: September 2008

ABSTRACTObjectives: To profile young, pregnant patients with an overdose reported to an urban poison center; and to characterize the ingestions and short‐term outcomes of these overdose patients.Methods: A prospective, observational study of female overdose patients was performed from November 1, 1994, through March 31, 1995. Consecutive cases were identified from all calls to the regional poison center (annual call volume = 70,000) regarding intentional overdose in women between the ages of 12 and 30 years. Pregnancy tests were recommended by the poison center during the study period in female patients aged 12—30 years who presented to a health care facility (usually an urban ED) with an intentional overdose. Pregnant patients were then followed during their hospitalizations, and the results of toxicology studies and maternal and short‐term fetal outcomes were recorded.Results: Pregnancy tests were obtained for 371 (32%) of 1,142 eligible patients. Of patients with pregnancy tests, 43 (11.6%) were pregnant. Although most cases were comparable to general adult intentional ingestions, 5 of the 43 pregnant patients ingested known abortifacients. Most pregnant patients (35/43, 81%) had toxicity at or below American Association of Poison Control Centers (AAPCC) criteria for minimal toxicity, and all patients recovered completely.Conclusion: Pregnancy was a common finding in this sample of young, female, intentional overdose patients reported to our regional poison control center. Frequent use of abortifacients for toxic ingestions has not been previously reported. A pregnancy test should be obtained for all female patients of childbearing age with an intentional ingestion to address the potential association of the ingestion with an unanticipated or undesired pregnancy.
A Survey of Adolescents' Knowledge Regarding Toxicity of Over‐the‐counter Medications
Authors: Huott Michael A. , Storrow Alan B. 
Published: September 2008

ABSTRACTObjective: With prior research suggesting that up to 17% of adolescents believe that acetaminophen (APAP) cannot cause death at any dose, this study surveyed adolescents regarding their knowledge of over‐the‐counter (OTC) medication toxicity.Methods: A convenience sample of 13‐ to 18‐year‐olds presenting to the acute care clinic or ED at 2 teaching hospitals were given a survey requesting demographic data and information regarding common OTC medications. The respondents were asked to identify those OTC medications found at home, those they thought poisonous or lethal when taken in overdose, and those they thought contain alcohol. They also were asked to indicate whether they ever had made a suicidal overdose gesture.Results: There were 203 of 210 (96% response rate) surveys completed. Recognition of the potential for overdose lethality with specific OTC medications was limited: aspirin (63%), APAP (57%), antihistamines (46%), iron (24%), camphor (22%), methyl salicylate (21%), and bismuth subsalicylate (19%). Additionally, adolescents commonly believed many OTC medications generally considered nonlethal would be fatal in an overdose: ibuprofen (51%), decongestants (45%), guaifenesin (29%), mouthwash (25%), kaolin‐pectin (22%), antacids (21%), and vitamin C (12%). More than half of the respondents correctly identified agents that normally contain alcohol. Also, of the 5 respondents who previously made suicidal gestures, 4 indicated the ingested item could kill them, reflecting serious intent.Conclusion: Surveyed adolescents possess poor knowledge of the lethal potential of OTC medications; the fact that many adolescents believe several of these OTC medications are benign is concerning. Emergency physicians should adjust their assessments of individual overdose patients' suicidal intents accordingly.
The Development and Evaluation of a Geriatric Emergency Medicine Curriculum
Authors: Witzke Donald B. , Sanders Arthur B. ,   for the SAEM Geriatric Emergency Medicine Task Force
Published: September 2008

ABSTRACTObjective: To summarize the processes used to develop a curriculum and model of care for the emergency medical treatment of elder patients and to assess the efficacy of the teaching material in a pilot course.Methods: A survey of emergency medicine (EM) residency directors and geriatric fellowship directors was used to identify key topics for inclusion in the didactic material. An interdisciplinary consensus process was used to develop didactic as well as teaching material in geriatric EM. Pretests and posttests were administered to 46 participants in the initial course to assess knowledge gain. Subjective course evaluations were also done.Results: Test scores significantly increased from 54% correct on the pretest to 77% correct on the posttest (p < 0.001). Significant improvement in knowledge as judged by pretest and posttest results occurred in 6 of the 7 teaching modules. Subjective evaluations demonstrated good to excellent ratings for each module as well as the overall workshop.Conclusions: The process of developing a curriculum for geriatric EM is described. The initial training of instructors was effective in improving participants' knowledge of geriatric issues in EM. Participants considered the training to be effective. The effect of the training on the emergency care of elder persons remains to be determined.
Academic Associate Program: Integrating Clinical Emergency Medicine Research with Undergraduate Education
Authors: Hollander Judd E. , Valentine Sharon M. , Brogan Gerard X. 
Published: September 2008

ABSTRACTAn educational program that teaches undergraduate students about clinical research related to emergency medicine is described. The students work as research assistants within the ED, thus providing a departmental framework for the enrollment of patients in clinical studies. Volunteers interested in the program undergo a physical examination, vaccination history, and standard serologic testing, and sit through a formal blood and body fluid exposure course offered by the university prior to their clinical research participation. A didactic curriculum on clinical research concepts and course examinations is provided. Over the 4 years since the department established its departmental research goals and this educational program, the departmental publication rate has increased from 2 to 20 manuscripts. While there was only 1 faculty member with a research publication in 1992, there were 9 faculty with manuscripts accepted for publication in the first 6 months of 1996. Similarly, more nurses and ancillary staff have become involved in prospective clinical research. Much of this success is attributed to the novel use of resources through the academic associate program.
The Use of Antibiotics to Prevent Serious Sequelae in Children at Risk for Occult Bacteremia: A Meta‐analysis
Authors: Bulloch Blake , Craig William R. , Klassen Terry P. 
Published: September 2008

ABSTRACTObjective: To determine whether antibiotics prevent serious bacterial infections in children at risk for occult bacteremia.Methods: Meta‐analysis of randomized controlled trials involving children aged 3 months to 36 months without a focus of infection and randomized into 2 treatment groups: 1) no antibiotic vs antibiotic or 2) IM ceftriaxone vs oral antibiotic.Results: The use of either an oral antibiotic or IM ceftriaxone did trend toward a reduced risk of serious infection, although neither reached statistical significance (OR = 0. 60; 95% CI 0. 10, 3. 49; and OR = 0. 38; 95% CI 0. 12, 1. 17, respectively). It would be necessary to treat 414 patients to prevent 1 serious bacterial infection. When only children with proven occult bacteremia were analyzed, the use of IM ceftriaxone was statistically significant in preventing serious bacterial infections (OR = 0. 25; 95% CI 0. 07, 0. 89).Conclusions: Clinical judgment should not be replaced by widespread antibiotic use in the approach to a child with fever. If rapid methods to identify children with occult bacteremia, such as polymerase chain reaction, could be improved and become widely available, then antibiotics could be used judiciously on initial visits. Antibiotic use in all children at risk for occult bacteremia implies the treatment of many children unlikely to benefit from such therapy.
Recurrent Near‐syncope with Flushing
Authors: Suchard Jeffrey R. 
Published: September 2008

ABSTRACTEpisodic vasomotor instability with flushing is an uncommon presentation that is suggestive of an endocrine etiology. This report is the case of a 42‐year‐old woman who presented to the ED 5 times in a 2‐week period for recurrent, self‐limited episodes of light‐headedness associated with tachycardia, hypertension, and flushing. The patient's diagnosis eluded detection in both the outpatient and the inpatient settings for several months. The clinical diagnosis was ultimately confirmed by biochemical test samples obtained in the ED during a subsequent symptomatic event. The differential diagnosis of this patient's presentation includes pheochrom‐ocytoma, carcinoid syndrome, medullary thyroid carcinoma, systemic mastocytosis, and other endocrine and toxicologic diseases. ED management of the patient with transient yet significant vasomotor changes includes a workup for syncope, initiation of focused biochemical investigations, referral to the appropriate consultant, and consideration for admission.
Ankle Radiograph Utilization after Learning a Decision Rule: A 12‐month Follow‐up
Authors: Verbeek P. Richard , Stiell Ian G. , Hebert Guy , Sellens Cathy 
Published: September 2008

ABSTRACTObjective: To test whether the reduction in ankle radiograph ordering was sustained during a 12‐month period after a formal trial to introduce the Ottawa ankle rulesMethods: A before‐after clinical trial of ankle radiograph ordering practice was performed in a university‐based ED. All 1,884 (947 “during intervention,” 937 “postintervention”) adults seen with acute ankle injuries during 2 12‐month trial periods were evaluated. The behavioral intervention was the teaching of the Ottawa ankle rules and feedback of compliance with the rules during the intervention period. No further education about the ankle rules or feedback regarding compliance occurred during the postintervention year. Physicians were unaware of any postintervention surveillance. The primary outcome was the proportion of eligible patients referred for an ankle radiograph during the intervention and postintervention periods.Results: During the intervention period (January 1‐December 31, 1993), the proportion of patients who received an ankle radiograph [609 x‐rayed of 947 patients seen (64.3%; 95% Cl 61.2–67.4%)] did not differ from the proportion who received an x‐ray in the postintervention period (January 1‐December 31, 1994) [583 x‐rayed of 937 patients seen (62.2%; 95% Cl 59.1–65.3%), p = 0.65, power > 0.80 to detect a 10% increase in the radiograph ordering rate]. There was also no difference in the radiograph ordering rate in the first 3 months of the postintervention period compared with the last 3 months of the postintervention period (68.8% vs 64.7%, respectively, p > 0.30).Conclusions: Compliance with the Ottawa ankle rules was sustained during a 12‐month postintervention surveillance period when physicians did not know they were being observed. Physicians will continue to use a simple clinical guideline once it has been learned.
Effectiveness of Selective Use of Intravenous Pyelography in Patients Presenting to the Emergency Department with Ureteral Colic
Authors: Tasso Silvio R. , Shields Christopher P. , Rosenberg Carl R. , MD Diane M. Sixsmith. , Pang Dorothy S. 
Published: September 2008

ABSTRACTObjective: To determine whether IV pyelography (IVP) is required routinely for all patients presenting to the ED with ureteral colic.Methods: A randomized prospective study was conducted with 2 patient groups—a routine IVP group, in which all patients underwent IVP, and a selective IVP group, in which patients were treated, observed, and released without undergoing IVP unless they experienced continued symptoms. The study was performed in a large university‐affiliated, community hospital ED. Participants were patients aged 18–65 years with signs and symptoms consistent with ureteral colic.Results: Among the 40 patients enrolled in the routine IVP group, 26 had positive studies, 8 of which necessitated hospitalization. Among the 41 patients randomized to the selective IVP group, there were only 19 IVPs performed, of which 6 were positive and 4 necessitated hospitalization. Compared with the routine IVP group, there were 54% fewer FVPs performed and a 51 % lower admission rate in the selective IVP group.Despite the fact that fewer IVPs were performed in the selective IVP group, clinical outcomes in the 2 groups were similar, without significant complication in either group.Conclusions: IVPs do not need to be routinely performed for all patients presenting to the ED with ureteral colic. The decision to perform an IVP may be dictated by symptoms that persist after initial evaluation and treatment.