bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changing patterns of postural hip muscle activity during recovery from stroke
Authors: Kirker Stephen GB , Jenner John R , Simpson Dorothy S , Wing Alan M 
Published: August 2005

Objective: To describe the recovery of neurophysiological responses to perturbation of standing balance after stroke. Methods: Surface electromyography (EMG) from hip abductors and adductors and ground reaction forces (GRF) were measured in response to 20 sideways pushes applied to the pelvis by a linear motor. Each subject's data from pushes in each direction were averaged and the presence of a muscle EMG response was assessed visually. Subjects: Thirteen acute hemiplegic patients were tested as soon as they could stand after stroke (median six weeks) and serially during recovery. Results: Four patterns of hip muscle activity were seen: (1) no response at all, (2) no response in hemiparetic muscles but compensation by contralateral muscles, (3) an appropriate, if delayed, response in the hemiparetic abductor but not adductor muscles, and (4) a relatively normal pattern in both hemiparetic muscles. Nine of 13 patients showed a change in pattern of hip muscle activity during recovery. All patients who initially resisted the sideways pushes solely with muscles of the unaffected leg later regained use of the hemiparetic hip abductors Conclusions: The pattern of hip muscle activation changed towards normal during recovery from stroke in most patients. Use of compensatory strategies early after stroke in these subjects did not prevent return of normal patterns of muscle activation later.
An evaluation of a new pattern of electrical stimulation as a treatment for urinary stress incontinence: a randomized, double-blind, controlled trial
Authors: Jeyaseelan S M , Haslam E J , Winstanley J , Roe B H , Oldham J A 
Published: August 2005

Objective: To evaluate a new pattern of electrical of electrical stimulation as a treatment for stress incontinence. Design: A randomized, double-blind, controlled trial. Setting: The study took place on three clinical sites. Subjects: Patients (n= 27) with urodynamically proven stress incontinence recruited via consultant referral. Interventions: Patients were randomly allocated to one of two groups: the new pattern of stimulation or sham stimulation. Main outcome measures: Patients were assessed pre, mid and post treatment using: perineometry, digital assessment and pad testing. The following were only used pre and post treatment: seven-day frequency/ volume chart, SF-36, the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Results: No significant between-group differences were highlighted except when quality of life was assessed with the Urogenital Distress Inventory (p= 0.01). A significant reduction in scores was observed in the stimulation group (p= 0.03) However, improvements were seen in both the strength and endurance characteristics of the pelvic floor musculature, although these changes were not translated into a reduction in symptoms. Conclusion: Although promising, the improvement in pelvic floor function did not result in a reduction in symptoms in all patients. Further research is required to investigate the effects of the new stimulation in combination with pelvic floor exercises and to compare the new stimulation pattern with existing forms of electrical stimulation.
Measurement of severity of sports injuries: an epidemiological study
Authors: Dekker R , Kingma J , Groothoff J W , Eisma W H , Duis H J Ten 
Published: August 2005

Objective: To evaluate the severity of sports injuries in relation to the severity of injuries due to other causes and in relation to type of sport, using generally applied measures of injury severity. Subjects: A total of 12 403 patients, 4–50 years old, who were treated in the trauma department of the Groningen University Hospital for a sports injury, from January 1990 until January 1997. Method: All patients treated because of an injury entered the study. A distinction was made between injuries caused by playing sports, home and leisure accidents, traffic accidents and violence. The severity of the injuries was assessed by using the criteria of rate of admission, Injury Severity Scale (ISS). Finally the sports injuries were analysed with regard to type of sport. Results: In total, 57 760 injuries were registered. After injuries due to home and leisure accidents (44%; 25 228) sports injuries (21%; 12 403) were the most frequent cause of injury. Of the patients with a sports injury, 7.9% (980) were admitted, which is more than with home and leisure accidents (6.7%; 1690) but less than with traffic accidents (21.5%; 2202) and violence (9.3%; 364). In a majority of cases, admission was related to a limited number of types of sport. The mean ISS of sports injuries was low, as with injuries following home and leisure accidents and violence. The percentage of sports injuries with an ISS higher than or equal to 16 and the percentage mortality were both low in comparison to injuries due to violence or traffic accidents. Conclusions: Sports injuries rank second highest in terms of cause of injury, after home and leisure accidents; and rank third in terms of severity, after traffic accidents and violence. Even though the ISS is low, sports injuries may have serious consequences.
Assessment of emotional problems in people with multiple sclerosis
Authors: Nicholl Catherine R , Lincoln Nadina B , Francis Valerie M , Stephan Talal F 
Published: August 2005

Objective: To investigate the occurrence of emotional problems in multiple sclerosis (MS) patients. The utility of rating scales used to measure such problems was studied to make recommendations for clinical practice. Design: Questionnaires were both sent by post and completed with an assistant psychologist at a home visit. Subjects: Ninety-six MS patients in contact with a rehabilitation consultant. Measures: Patients were assessed using the Guy's Neurological Disability Scale (GNDS), Extended Activities of Daily Living Scale (EADL), Hospital Anxiety and Depression Scale (HAD), Beck Anxiety and Depression Scales (BAI, BDI), Clinical Outcomes in Routine Evaluation Measure (CORE) and the Brief Symptom Inventory (BSI). Results: Rates of anxiety and depression ranged from 16% to 48% according to the measures used. All mood scales were highly significantly correlated with each other. Disability as measured by the GNDS, but not the EADL, was significantly correlated with all mood measures. Kappa values showed poor correspondence in the classification of cases. Receiver operating characteristic curves indicated an optimum cut-off point of 7/8 on the HAD and 2/3 on the General Health Questionnaire (GHQ-12). Conclusions: Rates of emotional problems were low given the highly disabled population studied. The HAD was relatively insensitive in comparison with the BAI and BDI. The GHQ-12 was sensitive and therefore recommended as a short screening measure. An alternative short screen, ‘Emotional GNDS’, was proposed.
Risk factors for burn-out in caregivers of stroke patients, and possibilities for intervention
Authors: van den Heuvel Elisabeth TP , Witte Luc P de , Schure Lidwien M , Sanderman Robbert , Jong Betty Meyboom-de 
Published: August 2005

Objective: To identify which caregivers of stroke patients living at home experience the highest levels of strain and are at risk of burn-out, and to investigate how support for caregivers of stroke patients could best be organized, and when this support should be offered. Design and setting: Caregivers of stroke patients were recruited in four regions of the Netherlands. A total of 212 caregivers were interviewed. Multiple stepwise regression analysis was performed to determine the effects of patient and caregiver characteristics, resources, coping strategies and duration of the caregiver role on caregiver strain, mental well-being and vitality. Subjects:The majority of the caregivers were female spouses. Their mean age was 64 years, and their socioeconomic status middle class. Stroke had occurred about 3.5 years ago on average. Main outcome measures:The following main outcome measures were used: the Caregiver Strain Index, and two scales of the Short Form-36 to measure caregivers’ mental well-being and vitality. Results: Severe cognitive, behavioural and emotional changes in the patient constitute the main risk factors for caregiver burn-out. Women, younger caregivers and caregivers in poor physical health were also identified as risk groups. Caregivers with high perceived self-efficacy, satisfied with social support, and frequently using the coping strategy confronting, experience less strain, higher mental well-being and greater vitality. Duration of the caregiver role does not influence caregivers’ strain, mental well-being or vitality. Conclusions: Women, younger caregivers, caregivers in poor physical health, and caregivers of patients with severe changes are at risk of burn-out. Support programmes should focus on self-efficacy, social support, and the coping strategy confronting. No specific moment could be identified at which support programmes should be offered.
Community rehabilitation in the United Kingdom
Authors: Enderby Pam , Wade Derick T 
Published: August 2005

Objective: To investigate the extent and nature of community rehabilitation services within the United Kingdom. Design: A postal survey starting with the Community Rehabilitation Network and extending to any other teams identified or making contact. Setting: The National Health Service within the UK. Subjects: Any team who identified themselves as a community rehabilitation service that worked ‘primarily with adults with physical disability’ within the UK. Intervention: A questionnaire was sent to each team identified with follow-up telephone contact to clarify answers and/or to encourage replies. Results: One hundred and fifty-two organizations were sent questionnaires and 145 replied, but 47 were excluded for various reasons leaving 98 valid replies. Four types of team were identified: community rehabilitation teams, young disabled community teams, community teams for older adults, and specific client group teams. There were huge variations in management arrangements, team composition, goals of the services and likely lifespan of the service. Conclusions: Community rehabilitation in the UK is currently characterized by small, often short-term teams with poor identity and the term has no clear or consistent meaning.
A survey of services provided by community neurorehabilitation teams in South East England
Authors: McMillan T M , Ledder H 
Published: August 2005

Objective: To survey the role, function and staffing of community rehabilitation teams in London and the South East NHS Region of England who work with neurologically disabled people, with emphasis on services provided for traumatic brain injury. Design: Telephone survey using a structured interview with team leaders. Setting: London and South East NHS Regions of England (population 15.6 million). Subjects: Community rehabilitation teams. Main outcome measures: A structured interview about service provision. Results: Thirty-five teams were found in 25 Health Authorities serving 14 million people. In a further five Health Authorities, another five teams did not participate. There were fewer than 1.5 community team professionals for 4000–5000 neurologically disabled. Teams had seen less than 3% of disabled traumatic brain injuries. Most focused on physical disability. Only two teams specialized in consequences of cognitive impairment or personality change. Stroke and multiple sclerosis were the most common referrals. Sixty per cent of teams had no clinical psychologist. The composition of teams is described, as is caseload, clinical role, outcome measures used, professional links, work practice and staffing issues. Conclusions: Community physical disability teams seem insufficiently resourced to provide a comprehensive service for the neurologically disabled. There are not enough teams generally, and too few specialize in psychosocial problems. All teams should include a clinical psychologist, should have specialist resources for cases from ethnic minorities and formal policies for staff security. There needs to be clarity over the range of services provided and to whom, and this linked to prevalence of disability and team resourcing.
“My Two‐week‐old Daughter Is Throwing up Blood”
Authors: Moustafa M.H. , Taylor Myiesha , Fletcher Laura 
Published: August 2005

AbstractSwallowed maternal blood at the time of delivery or from cracked nipples during breastfeeding is the most common cause of suspected gastrointestinal bleeding in the neonate. In this case, the Apt–Downey test is a useful diagnostic tool. The Apt–Downey test can effectively differentiate neonatal from maternal hemoglobin based on the conversion of oxyhemoglobin to alkaline globin hematin when mixed with alkali.
Implementation of Community‐based Public Access Defibrillation in the PAD Trial
Authors: Richardson Lynne D. , Gunnels Mary D. , Groh William J. , Peberdy Mary Ann , Pennington Sarah , Wilets Ilene , Campbell Venard , Van Ottingham Lois , McBurnie Mary Ann ,   The PAD Trial Investigators
Published: August 2005

Abstract Background: The Public Access Defibrillation (PAD) Trial was a randomized, controlled trial designed to measure survival to hospital discharge following out‐of‐hospital cardiac arrest (OOH‐CA) in community facilities trained and equipped to provide PAD, compared with community facilities trained to provide cardiopulmonary resuscitation (CPR) without any capacity for defibrillation. Objectives: To report the implementation of community‐based lay responder emergency response programs in 1,260 participating facilities recruited for the PAD Trial in the United States and Canada. Methods: This was a descriptive study of the characteristics of participating facilities, volunteers, and automated external defibrillator (AED) placements compiled by the PAD Trial, and a qualitative study of factors that facilitated or impeded implementation of emergency lay responder programs using focus groups of PAD Trial site coordinators. Results: The PAD Trial enrolled 1,260 community facilities (14.8% residential), with 20,400 lay volunteers (mean ± standard deviation = 13.4 ± 10.7 per facility) trained to respond to OOH‐CA. The 598 locations randomized to receive AEDs required 2.7 ± 1.8 AEDs per facility. Volunteer attrition was high, 36% after two years. Barriers to recruitment and implementation included identification of appropriate “at‐risk” facilities, lack of interest or fear of litigation by a facility key decision maker, lack of motivated potential volunteer responders, training and retraining resource requirements, and lack of an existing communication/response infrastructure. Conclusions: These data indicate that implementation of community‐based lay responder programs is feasible in many types of facilities, although these programs require substantial resources and commitment, and many barriers to implementation of effective PAD programs exist.
Choosing Outcome Assessment Instruments for Trauma Registries
Authors: Gabbe Belinda J. , Williamson Owen D. , Cameron Peter A. , Dowrick Adam S. 
Published: August 2005

AbstractWhile trauma registries have the potential to collect detailed information about patient outcomes, the most commonly reported outcome, mortality, only represents the outcome from a small proportion of the total trauma population. If trauma registries are to progress to routine monitoring of outcomes in trauma survivors, instruments that measure relevant outcomes in the remainder of the trauma population must be identified and implemented. This report provides an overview of the specific needs of trauma registries with respect to assessing patient outcomes other than mortality. The use of previously recommended outcome assessment instruments is discussed, with a focus on the utility of these instruments for use in routine monitoring of trauma outcomes other than mortality through trauma registries.
A System for Grouping Presenting Complaints: The Pediatric Emergency Reason for Visit Clusters
Authors: Gorelick Marc H. , Alpern Elizabeth R. , Alessandrini Evaline A. 
Published: August 2005

Abstract Objectives: To develop a set of chief complaint groupings for pediatric emergency department (ED) visits that is comprehensive, parsimonious, clinically sensible, and evidence‐based. Methods: Investigators derived candidate chief complaint clusters and ranked them a priori into three perceived severity categories. Pediatric visits were extracted from the National Hospital Ambulatory Medical Care Survey (NHAMCS); data for years 1998 and 2000 (n= 13,186) were used for derivation and data for year 1999 (n= 5,365) were used for validation. Visits were assigned to clusters based on the recorded complaints; clusters were combined to ensure adequate numbers for analysis (minimum n= 20), and the clusters were reviewed for clinical sensibility. Resource utilization was categorized in three levels: routine (examination only), ED treatment (tests or therapy in the ED but not admitted), and admission. Area under the receiver‐operating characteristic (ROC) curve (AUC) was used to demonstrate the discriminative ability of the clusters in predicting resource use. Results: There were 463 unique complaints in the derivation database; 95 (20%) had a single associated visit. Fifty‐two clusters were generated; only 2.4% of complaints were classified as other. The eight most common clusters encompassed 52% of the visits. The top five were fever (11%), extremity pain/injury, vomiting, cough, and trauma (unspecified). Complaint clusters were associated with actual resource utilization: for routine care, the AUC was 0.73 (0.74 in the validation set), and for admission, the AUC was 0.77 (0.74 in the validation set). Both resource utilization and triage classification increased with increased expert severity ranking (test for trend, p < 0.001). Conclusions: The proposed Pediatric Emergency Reason for Visit Cluster (PERC) system is a comprehensive yet parsimonious, clinically sensible means of categorizing pediatric ED complaints. The PERC system's association with measures of acuity and resource utilization makes it a potentially useful tool in epidemiologic and health services research.
Precise Formulation and Evidence‐based Application of Resource‐constrained Triage
Authors: Sacco William J. , Navin D. Michael , Fiedler Katherine E. , Waddell II Robert K. , Long William B. , Buckman Robert F. 
Published: August 2005

Abstract Objectives: To develop a precise mathematical formulation of resource‐constrained triage, denoted the Sacco triage method (STM), to develop an evidence‐based application to blunt trauma, and to compare the STM with the simple triage and rapid treatment (START) method. Methods: Resource‐constrained triage is modeled mathematically as a classic resource allocation problem. The objective is to maximize expected survivors given constraints on the timing and availability of resources. The model incorporates estimates of time‐dependent victim survival probabilities based on an initial assessment and expected deterioration. For application to blunt trauma, an “RPM” score, based on respiratory rate, pulse rate, and motor response, was used to predict survivability. Logistic function‐generated survival probability estimates for scene values of RPM were determined from 76,459 blunt‐injured patients from the Pennsylvania Trauma Outcome Study (PTOS). The Delphi method provided expert consensus on victim deterioration rates, and the model was solved using linear programming. STM was compared with START across various criteria of process and outcome. Outcome was measured by expected number of survivors in simulated resource‐constrained casualty incidents. Results: In this mathematical simulation, RPM was a more accurate predictor of survivability from blunt trauma than the Injury Severity Score and the Revised Trauma Score, as measured by calibration and discrimination statistics. STM resulted in greater expected survivorship than START in all simulations. Conclusions: Resource‐constrained triage is modeled precisely as an evidence‐based, outcome‐driven method that maximizes expected survivors in consideration of resources. The lifesaving potential and operational advantages over current methods warrant scrutiny and further research.
A Comprehensive, Unembalmed Cadaver‐based Course in Advanced Emergency Procedures for Medical Students
Authors: Tabas Jeffrey A. , Rosenson Jon , Price Daniel D. , Rohde Dana , Baird Carina H. , Dhillon Nripendra 
Published: August 2005

Abstract Background: Preparing medical students for residency in emergency medicine involves education in many areas of knowledge and skill, including instruction in advanced emergency procedures. Objectives: To outline the logistics involved in running a training course in advanced emergency procedures for fourth‐year medical students and to report students' perceptions of the impact of the course. Methods: The course is a cadaver‐based training laboratory that utilizes several teaching modalities, including a Web‐based syllabus and online streaming video, didactic lecture, hands‐on practice with models and ultrasound, and hands‐on practice with unembalmed (fresh) cadavers. The course focuses on seven emergent procedural skills, including deep venous access via the subclavian, internal jugular, and femoral veins; tube thoracostomy; saphenous vein cutdown; intraosseous line placement; and emergency cricothyrotomy. The course is taught by attending emergency physicians and anatomy department faculty. After completion of the course, students reported their self‐assessments on a five‐point Likert scale. Data were evaluated using a paired t‐test (two‐tailed). Results: Thirty‐three students completed the evaluation. The students reported a mean (± standard deviation [SD]) increase in their understanding of the indications for all procedures from 3.3 (± 1.1) before to 4.8 (± 0.4) after the course (p = 0.004, 95% CI = 0.7 to 2.0). The students reported a mean increase in their understanding of how to perform all procedures from 2.1 (± 0.9) before to 4.6 (± 0.6) after the course (p = 0.003, 95% CI = 1.9 to 3.0). The students reported a mean increase in their comfort level performing all procedures from 1.6 (± 0.8) before to 4.2 (± 0.7) after the course (p < 0.001, 95% CI = 2.0 to 2.9). Conclusions: These findings support the value of an advanced emergency procedural training course using an unembalmed cadaver‐based laboratory and incorporating several teaching modalities.
Father Involvement in Infancy: Influences of Past and Current Relationships
Authors: Shannon Jacqueline D. , Tamis‐LeMonda Catherine S. , Margolin Allan 
Published: August 2005

AbstractMen's childhood experiences with their parents, their current relationship with their partners, and demographic factors were examined in relation to father‐infant interactions. Participants were 60 racially and ethnically diverse, inner‐city men and their 6‐ to 11‐month‐old infants. Father‐infant interactions were videotaped during semistructured free play in participants' homes. The quality of men's interactions with their infants was assessed using Likert ratings of their responsive‐didactic and negative‐overbearing behaviors. Men engaged in significantly more responsive‐didactic behaviors than negative‐overbearing behaviors. A cumulative score of protective demographic factors (i.e., men residing with their infants, being married, completing high school, and obtaining income above the sample's median level) and men's experiences of childhood acceptance from their fathers uniquely predicted their responsive‐didactic behaviors. Men's relationships with their partners were homogeneously strong and unrelated to fathering behaviors. This study builds on extant literature by providing a broader conceptualization of father‐infant relationships and applying observational methods to the study of fathering in minority, low‐income men.