bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hyperpyrexia in the emergency department
Authors: McGugan Elizabeth A 
Published: March 2003

AbstractThe differential diagnosis of the hyperpyrexic patient in the emergency department is extensive. It includes sepsis, heat illness including heat stroke, neuroleptic malignant syndrome, malignant hyperthermia, serotonin syndrome and thyroid storm. Each of these possible diagnoses has distinguishing features that may help to differentiate one from another. However, establishing the correct diagnosis is a challenge in the setting of the obtunded emergency patient who gives no history and where there may be limited access to any past medical or drug history. This paper presents such a case and reviews the features of the differential diagnoses and management of the hyperpyrexic patient.
A study of triage of paediatric patients in Australia
Authors: Durojaiye Linda , O’Meara Matthew 
Published: March 2003

AbstractObjectives:To describe the triage of children in a sample of mixed and paediatric emergency departments in Australia in 1999 and to measure the inter‐rater reliability of the National Triage Scale when used by triage nurses for the triage of paediatric patients.Methods:A questionnaire was sent to 11 hospitals, including one paediatric and one mixed emergency department, in each state studied. Triage nurses were asked to assess 25 paediatric patient profiles and to assign appropriate triage categories to each profile. The number of responses within the modal triage category (concurrence), the percentage of responses with a concurrence of at least 50% and the number of responses within one triage category of the modal response (spread) of responses were measured. Triage data for 1999 from the same emergency departments were collected and numbers of children seen and admitted in each triage category were described. The patterns of distribution of triage categories for specific paediatric diagnoses (triage ‘footprints’) were also described. Data from mixed emergency departments were grouped and compared with data from paediatric emergency departments and any differences were described.Results:Seventy‐eight nurses in 10 hospitals responded to the questionnaire. Sixty‐three per cent of all responses had a concurrence of greater than 50%. Ninety‐four per cent of patient profiles were triaged to within one triage category of their modal response. Nurses in paediatric emergency departments (concurrence greater than 50% for 79% of responses) were significantly more consistent in their use of the National Triage Scale compared with nurses in mixed emergency departments (concurrence greater than 50% for 50% of responses). Paediatric emergency department triage nurses were more likely to use the full range of the National Triage Scale and were fourfold as likely to allocate triage categories 4 and 5 to patient profiles. Paediatric hospitals allocated patients to triage categories 4 and 5 for an average of 71% of presentations compared with 47% for mixed emergency departments. Specific diagnoses had characteristic distributions of triage categories, with similar differences seen when comparisons were made between mixed and paediatric emergency departments.Conclusion:Use of the National Triage Scale for the triage of paediatric patients by triage staff is not consistent and there are significant differences between the triage practices of paediatric and mixed emergency departments.
A review of the accuracy of references in the journal Emergency Medicine
Authors: O’Connor Alan E 
Published: March 2003

AbstractObjective: To assess the accuracy of references in articles published in Emergency Medicine, and to categorize these errors.Methods: All the references in Volume 12 of Emergency Medicine were listed and numbered consecutively. A sample of 100 references was then selected. Each reference was then checked, initially on an electronic database, with the original article being used as the gold standard.Results: 1469 citations were included in the study. A random sample of 100 was taken and examined in detail. 35 papers were shown to have at least one error, and a total of 41 errors were found. The maximum number of errors in one paper was 3. These errors are analysed in detail.Conclusion: Poor reference accuracy is a common problem in medical literature, and Emergency Medicine is not immune to these failings. Authors need to take more care to ensure that the accuracy of citations improves.
Nurse‐initiated intravenous morphine in the emergency department: Efficacy, rate of adverse events and impact on time to analgesia
Authors: Fry Margaret , Holdgate Anna 
Published: March 2003

AbstractObjectives: The objectives of this study were: (i) to measure the analgesic efficacy and frequency of adverse events following autonomous nurse‐initiated intravenous morphine in patients presenting with acute pain, awaiting medical assessment; and (ii) to determine whether such a process would improve the time to analgesia.Methods: A prospective convenience sample of patients presenting in acute pain received titrated intravenous morphine by experienced emergency nurses. Pain scores on a 10.0 cm visual analogue scale and predetermined adverse events defined by physiological parameters were measured at regular intervals over the following 60 min. Demographic, diagnostic and waiting time data were also recorded.Results: Three hundred and forty nine patients were enrolled over a 12‐month period. The median initial pain score was 8.5 cm, with a reduction to 4.0 cm at 1 h. Respiratory rate, oxygen saturation, heart rate and blood pressure all showed small but statistically significant reductions over 60 min. There were 15 predefined adverse events, 10 episodes of hypotension and five episodes of oxygen desaturation. No intervention other than supplemental oxygen was required. There were no episodes of bradycardia, bradypnoea or reduced level of consciousness. The median time to narcotic was 18 min and the median time to be seen by a doctor was 52 min.Conclusion: Experienced emergency nurses can initiate effective intravenous narcotic analgesia for patients in acute pain awaiting medical assessment, with minimal change in physiological parameters. This process can improve the time to analgesia for patients in acute pain.
The Canadian Triage and Acuity Scale: A Canadian perspective on emergency department triage
Authors: J Murray Michael 
Published: March 2003

AbstractThe Canadian Triage and Acuity Scale has received widespread acceptance in Canada as a reliable and valid tool for emergency department triage. The importance of accurate triage becomes more apparent as emergency department volumes increase, and resources shrink. The need to ensure that those patients requiring more urgent care receive care first is the basis for all triage scales. Through the Canadian Triage and Acuity Scale National Working Group, the scale became the recommended triage tool for Canadian emergency departments. Work has been done on the interrater reliability of Canadian Triage and Acuity Scale among health care providers. There is a need to further assess the validity of the scale. This scale has now been applied in the out of hospital setting by paramedics and is being used in measurements of emergency physician workload. The future may see an electronic triage tool develop for emergency department use to reduce variability in its application. The Canadian Triage and Acuity Scale has become an integral component of Canadian emergency departments.
Evaluation of Hyphecan (1‐4,2‐acetamide‐deoxy‐B‐D‐glucan polymer) on wound healing in a rodent model
Authors: Ho Wai‐Sun , Ying Shun‐Yuen , Choi Paul Cheung‐Lung 
Published: March 2003

Objective: To evaluate the effect of an artificial skin Hyphecan (1‐4,2‐acetamide‐deoxy‐B‐D‐glucan polymer) on wound healing in a rodent model.Materials and Method: The prospective study was conducted at a basic science laboratory at a tertiary teaching hospital. Two 4 cm × 4 cm full‐thickness wounds were created on the dorsal surface of 10 Spraque–Dawley rats and covered with Hyphecan and Kaltostat, respectively. Wounds were examined and measured on days 4, 10, 21 and 28, and would continue after day 28 until healed up completely. Punch biopsies (3 mm) were taken on days 4, 10 and 28 for histological examination of the response of healing and repair.Results: Despite the fact that the wound healing rate was similar for both groups on days 4, 10, 21 and 28, the average healing time for the Hyphecan group (29.1 ± 1.7 days) was significantly shorter statistically (P = 0.03) than the Kaltostat group (30.7 ± 2.8 days). Conversely, the marked healing response elicited by Hyphecan on day 4 persisted on days 10 and 28 in contrast to Kaltostat, which had only a mild degree of healing response on days 10 and 28. The study suggests that wounds treated by Hyphecan heal faster than Kaltostat.Conclusion: The findings provide basic scientific evidence supporting the clinical use of Hyphecan in different wounds and might also reduce the cost of wound management as Hyphecan is cheaper than Kaltostat and requires a shorter treatment time.
Long‐term real‐time monitoring of adeno‐associated virus‐mediated gene expression in the rat retina
Authors: Rolling Fabienne , Shen Wei‐Yong , Barnett Nigel L , Tabarias Hyacinth , Kanagasingam Yogesan , Constable Ian , Rakoczy Piroska E 
Published: March 2003

ABSTRACT Purpose: Previous studies have demonstrated that adeno‐associated virus (AAV) efficiently transduced retinal pigmented epithelial (RPE) cells. The goal of this study was to further evaluate and characterize transgene expression within the RPE cells over time in vivo. Methods: Adeno‐associated virus‐mediated gene transfer was monitored and quantified by retinal photography following subretinal injection of a recombinant AAV encoding the green fluorescent protein gene (rAAVCMV‐gfp) into rat eyes. Retinal function of transduced rat eyes was measured by electroretinography. Results: The maximum level of transgene expression was reached at 8 weeks postinjection followed by a gradual decrease throughout the experimental period. Interestingly, it was observed that while gfp expression was stable in some RPE cells, gfp fluorescence completely disappeared in other cells over the duration of the experiment. The expression of AAV‐mediated gfp in RPE cells did not alter the retinal function for over 1 year. Conclusions: These results confirm the importance of this direct visualization system to study vector transgene expression in vivo and support the use of AAV for diseases treatable by targeting RPE cells. Key words: adeno‐associated virus, gene transfer, green fluorescent protein, retinal photography, retinal pigmented epithelium.
Penetrating keratoplasty for silicone oil keratopathy
Authors: Lee Graham A , Shah Peter , Cooling Robert J , Dart John KG , Bunce Catey 
Published: March 2003

ABSTRACT Purpose: Penetrating keratoplasty for silicone oil keratopathy is associated with high risks and limited visual prognosis. This study examined the outcomes and factors influencing graft failure. Methods: A retrospective, non‐comparative, interventional case series of patients attending Moorfields Eye Hospital, London. Results: A total of 24 penetrating keratoplasties were performed in 17 patients (13 men and four women) from 1991 to 2000. The mean age of patients undergoing surgery was 43.6 years (range 17–84 years, SD ± 21.0). Silicone oil was removed before or during the time of initial penetrating keratoplasty in nine patients (52.9%) and left in situ in eight patients (47.1%). Ten out of 24 grafts survived (41.7%). The median duration of graft survival was 21 months (range 2 weeks–98 months) with median duration of follow up 33 months (range 2–100 months). At final follow up, the number of patients with a clear graft who had oil removed before or during the time of penetrating keratoplasty was seven out of 10 (70.0%). Risk factors for graft failure included hypotony, multiple keratoplasty, corneal neovascularization, rejection episode, silicone oil left in situ and postoperative glaucoma. Conclusions: Management of these complex patients requires a combined approach from anterior segment and vitreoretinal subspecialties. The long‐term success of the graft can be improved if silicone oil is removed prior or during the time of penetrating keratoplasty.
Relationship between the concentration of copper and iron in the aqueous humour and intraocular pressure in rabbits treated with topical steroids
Authors: Lqbal Zafar , Muhammad Zia , Shah M Tahir , Bashir Shumaila , Khan Taous , Khan Muhammed Daud 
Published: March 2003

Abstract Purpose: To evaluate the concentration of copper and iron in the aqueous humour of steroid‐treated eyes, particularly to study the concentration of these metals in relation to steroid‐induced increases in intraocular pressure (IOP). Methods: Adult rabbits of both sexes were selected in order to study the effect of steroids on the concentrations of copper and iron in the aqueous humour and on IOP. The rabbits were acclimatised for 2 weeks prior to the instillation of various drugs into the eyes. Then a steroid (dexamethasone, betamethasone or fluoromethalone) was instilled in both eyes of the rabbits, for about 1 month. Intraocular pressure was measured twice a week. When IOP was significantly increased, the animals were killed. The aqueous humour was collected and analysed for copper and iron using atomic absorption spectrophotometry coupled with graphite furnace. Results: After about 30 days of steroid
treatment the mean (± SD) IOP in dexamethasone,
betamethasone and fluoromethalone treated groups was 17.5 (± 4.81)
mmHg, 18.48 (± 4.5) mmHg and 21.8 (± 5.7)
mmHg, respectively. These values were significantly higher compared
to the control group where the mean IOP was 11.6 (± 2.2) mmHg.
The concentration of copper in the aqueous humour of steroid‐treated
rabbits was significantly lower (P < 0.001) compared to the control group. However, the concentration of iron was not significantly different between the control and steroid treated rabbits. Conclusion: A greater increase in IOP was observed in the fluoromethalone‐treated group compared to the dexa­methasone and betamethasone‐treated groups, but the difference was not significant. The lower concentrations of copper in aqueous humour in steroid‐treated eyes may play an important role in the maintenance of IOP. The concentration of iron was not significantly different compared to the control group. These results may help to explain the role of these metals in the pathogenesis of open angle glaucoma.
TRENDS IN THE CAUSES AND OUTCOME OF LIVER CIRRHOSIS DIAGNOSED BY LAPAROSCOPY IN OSAKA, JAPAN DURING THE PAST THREE DECADES
Authors: Habu Daiki , Shiomi Susumu , Lee Chulyoo , Kadoya Hirokazu , Morikawa Hiroyasu , Enomoto Masaru , Tamori Akihiro , Sakaguchi Hiroki , Seki Shuichi , Kuroki Tetsuo 
Published: March 2003

Background: Although various factors are assumed to have substantially altered the demographic characteristics of liver cirrhosis, few studies of patients with endoscopically confirmed cirrhosis have been done in Japan. We analyzed trends in causes and outcome of liver cirrhosis in Osaka, Japan during the past three decades.Method: The study group comprised 466 patients with cirrhosis of the liver who underwent laparoscopy at any time between 1969 and 1998. To analyze trends in the causes and outcome of cirrhosis, the study period was divided into three 10‐year intervals, variables included hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV) antibody, alcohol intake, causes of death and outcome.Results: Hepatitis C virus has remained the major cause of liver cirrhosis during the past 30 years. Hepatitis B virus has remained the cause of liver cirrhosis in about 20–25% in all three decades. Alcohol played a part in the development of liver cirrhosis in more than 30% of the study group, alone or with hepatitis viruses. Therefore, alcohol remains an important factor in the pathogenesis of cirrhosis. The outcome of cirrhosis has improved gradually during the past decade owing to more effective means of treatment for complications of cirrhosis.Conclusion: Hepatitis C virus has remained the major cause of liver cirrhosis for the past three decades. Improvement of outcome in patients with cirrhosis caused by HCV infection should be an important task in the next decade.
Evaluation of new plastic stents for malignant biliary obstruction
Authors: Uno Koji , Yasuda Kenjiro , Tanaka Kiyohito , Hayakumo Takanobu , Nakajima Masatsugu 
Published: March 2003

Background: A new plastic stent was designed for endoscopic biliary stenting to achieve a long and effective drainage period.Method: The Double layer stent is composed of Teflon as the inner layer and nylon as the outer layer divided with metallic mesh. This structure gives the stent several side‐flaps without side‐holes. Double layer stents were applied in 24 patients with inoperable malignant biliary obstruction.Results: The Double layer stents were successfully placed in all cases, and the effective drainage rate of these stents was 96%. The mean patency period evaluated by the Kaplan–Meier method without ineffective cases was 207 days, which was longer than the ordinary plastic stent of the same diameter. Concerning the complications related to inserting, we experienced dislocation was experienced in three patients.Conclusions: The authors regard this new device as an useful stent, which users can expect long patency period, easy exchange management, and reduced cost for the patients with inoperable obstruction in the biliary tract.
Economic analysis of recombinant interferon α 2b in the treatment of chronic hepatitis B and C
Authors: Guangbi Yao , Baoen Wang 
Published: March 2003

OBJECTIVE: To evaluate the long‐term economic impact and benefits of interferon α 2b (IFNα 2b) treatment in patients with chronic hepatitis B and C. METHODS: Data from 6500 patients with chronic hepatitis B and C from 12 teaching hospitals in different areas of China were collected and analyzed. Cohorts of these patients with either chronic hepatitis B (2198 cases) or chronic hepatitis C (756 cases) that were treated with IFNα 2b were compared with a non‐IFN‐ treated cohort (B, 2642 cases; C, 904 cases). Data from MEDLINE and Chinese Bio‐Medical Database (CBMD) searches regarding the natural course of the disease, progression, efficacy and cost of IFN therapy were also included. Using a decision analysis software program, Markov computer simulation was used to estimate the progression of the disease and perform economic analyses. RESULTS: The 30‐year disease progression to compensated and uncompensated cirrhosis and hepatocellular carcinoma in both chronic hepatitis B and C in the IFN‐treated cohort was significantly decreased in comparison with the non‐IFN‐treated cohort. The results suggest that IFN treatment could increase life expectancy by 5.32 years in chronic hepatitis B and 4.06 years in chronic hepatitis C. In the IFN‐treated group, life expectancy would increase by 5.41 and 4.27 quality‐adjusted life‐years (QALY), respectively. The cost to increase life expectancy by 1 QALY could be reduced by 5180 or 9066 yuan RMB in chronic hepatitis B or C patients treated with IFNα 2b, respectively. Over a 30‐year period, the total direct medical costs would be reduced by 42 820 and 65 440 yuan RMB in chronic hepatitis B and C patients treated with IFNα 2b, respectively. CONCLUSION: Interferon α 2b therapy can prolong life expectancy, improve quality of life and lower the medical costs for patients with chronic hepatitis B and C.
Effect of epidermal growth factor on pathological changes of the gastric mucosa in rats with chronic atrophic gastritis
Authors: Wu Jiaguo , Si Jianmin , Cao Qian , Lu Wen , Wang Jian , Lu Bingjian , Dai Ning 
Published: March 2003

OBJECTIVE: To study the effect of epidermal growth factor (EGF) on pathological changes of the gastric mucosa in rats with chronic atrophic gastritis (CAG). METHODS: The established CAG rat models were divided into groups A and B. The rats in group A received 10 μg/kg EGF subcutaneously. In group B, rats were subcutaneously injected with the same quantity of normal saline. Twelve weeks later, all rats were killed by cervical dislocation and their gastric mucosa were examined microscopically. RESULTS: The grading of the inflammatory cell infiltration in group A was lower than that in group B (P < 0.01). The thickness of the gastric mucosal gland layer was 215.0 ± 20.7 μm in group A and 139.2 ± 13.8 μm in group B (P < 0.01). The ratio of the thickness of the gastric mucosal glands to that of the muscularis mucosa (L1/L2) was 2.70 ± 0.34 in group A and 1.27 ± 0.27 in group B (P < 0.01). The number of gastric glands in a 1‐mm length of mucosal layer was 26.20 ± 1.27 in group A and 19.90 ± 1.78 in group B (P < 0.01). In group A, the gastric glands were rearranged, without signs of malignant proliferation. The width of gastric mucosa expressing proliferating cell nuclear antigen (PCNA) was larger in group A than in group B (77.70 ± 4.16 μm vs 54.40 ± 4.54 μm; P < 0.01). CONCLUSIONS: Epidermal growth factor plays a therapeutic role in reversing gastric mucosal atrophy in rats with CAG. It promotes the expression of PCNA, which induces a protective proliferation in gastric mucosal lesions in rats with CAG.
Vitality Index as a useful tool to assess elderly with dementia
Authors: Toba Kenji , Nakai Ryuhei , Akishita Masahiro , Iijima Setsu , Nishinaga Masanori , Mizoguchi Tamaki , Yamada Shizuru , Yumita Kiyoshi , Ouchi Yasuyoshi 
Published: March 2003

Background: The aim of the present paper was to establish a new objective scale to measure vitality related to activities of daily living in elderly patients with dementia.Methods: Cross‐sectional and longitudinal observational studies were carried out on patients and residents in long‐term care facilities. Reliability of the scale was examined by determining test–retest reliability, interrater reliability and internal consistency. Validity of the scale was evaluated with respect to criterion validity and predictive validity. Clinical usefulness of the scale was tested by measuring the time taken to perform scoring and evaluating the changes in the score before and after behavioral therapy for functional urinary incontinence.Results: The test–retest correlation coefficient was 0.98. Mean kappa coefficient
of Vitality Index was 0.63. Interrater coefficient of variation was 0.14. Cronbach
α of the Index was 0.88. Vitality Index was negatively correlated with Geriatric
Depression Scale (GDS) (P < 0.01). A low score was an independent risk
factor for survival. Behavioral therapy for functional urinary incontinence increased
Activities of Daily Living (ADL) (P < 0.05) and Vitality Index (P < 0.05).Conclusion: Vitality Index could be a new tool to assess patients with dementia.