bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost–Effectiveness of Helicopter Transport of Stroke Patients for Thrombolysis
Authors: Silbergleit Robert , Scott Phillip A. , Lowell Mark J. , Silbergleit Richard 
Published: September 2003

Abstract Objectives: Treatment with intravenous (IV) or intra‐arterial (IA) thrombolysis in patients with acute ischemic stroke demands careful patient selection and specialized institutional capabilities. Physicians at hospitals without these resources may prefer patient transfer for acute treatment. Helicopter transport for these patients has been described but without analysis of the effects of its additional cost. The authors examined the cost–effectiveness of helicopter transport for patients with acute stroke. Methods: Costs per additional good outcome and per quality‐adjusted life‐year (QALY) were calculated using a computer model. Input variables included flight, thrombolytic agent, and angiography costs; annual cost per patient for long‐term care of symptomatic stroke; percentage of transported patients treated; percentage of patients receiving IV versus IA therapy; discount rate; absolute probability of good outcome; annual mortality with and without treatment; and quality‐of‐life modifier. Sensitivity analysis was performed. Results: Helicopter transport of acute stroke patients to tertiary care centers for thrombolytic therapy costs $35,000 per additional good outcome and $3,700 per QALY for the reference case. Cost–effectiveness was sensitive to the effectiveness of thrombolysis but minimally sensitive to most other input values. Cost per QALY ranged from $0 to $50,000, as the absolute increase in good outcomes (minimal or no deficit) ranged from 20% to 5%. Cost–effectiveness was not sensitive to ranges of helicopter flight costs or the proportion of flown patients undergoing treatment. Conclusions: This model indicates helicopter transfer of patients with suspected acute ischemic stroke for potential thrombolysis is cost‐effective for a wide range of system variables.
Bench to Bedside: The Role of Mitochondrial Medicine in the Pathogenesis and Treatment of Cellular Injury
Authors: Watts John A. , Kline Jeffrey A. 
Published: September 2003

AbstractInterest in the study of mitochondria has undergone a revival. The term mitochondrial medicine developed around evidence pointing to the mitochondria as a logical target for therapy. This article reviews the normal functions of mitochondria and integration of mitochondrial processes in cells. Changes in mitochondria that occur in ischemia and reperfusion, production of reactive oxygen species by mitochondria, stimulation of apoptosis, and roles of mitochondria in sepsis also are reviewed. The authors also review therapies that are based on targeting drugs to mitochondria, regulating calcium availability, substrate preferences, and activation of poly (ADP‐ribose) polymerase and apoptosis. The purpose of this article is to provide a framework for emergency medicine academicians to understand the roles of mitochondria in pathology and to facilitate the transition of this information into therapeutic strategies based on mitochondrial medicine. For individuals interested in the biochemistry of mitochondria, knowledge of this fundamental organelle is expanding at a rapid rate.
Resolution of Delayed Altered Mental Status Associated with Hydrogen Peroxide Ingestion Following Hyperbaric Oxygen Therapy
Authors: Heide Stuart J. Vander , Seamon Jason P. 
Published: September 2003

Abstract Case Report: An 82‐year‐old women presented with altered mental status, seizure, and apnea after an accidental ingestion of concentrated hydrogen peroxide. Ingestion of concentrated peroxide can result in gas embolism of the cerebral vasculature. After hyperbaric treatment, the patient had prompt and full neurologic recovery. To the best of the authors' knowledge, this is the first reported case of reversal of significant altered mental status associated with hydrogen peroxide ingestion in temporal relation with hyperbaric oxygen therapy. Emergency physicians need to be aware of the dangers of peroxide ingestion and may wish to consider hyperbaric oxygen as a potential additional treatment for severe cases.
Adolescent Foley Catheter Technique for Visualizing Hymenal Injuries in Adolescent Sexual Assault
Authors: Jones Jeffrey S. , Dunnuck Chris , Rossman Linda , Wynn Barbara N. , Genco Michael 
Published: September 2003

Abstract Objectives: To determine the usefulness of the Foley catheter balloon technique for visualizing injuries of the estrogenized hymen in adolescent sexual assault victims compared with supine labial traction. Methods: A prospective clinical trial of 20 adolescent (age 13–16 years old) victims of sexual assault evaluated at a free‐standing Nurse Examiner Clinic was conducted over a four‐month study period. The clinic, affiliated with an emergency medicine residency program, is staffed by registered nurses who have been specially trained to perform medicolegal examinations using colposcopy with digital imaging. The Foley catheter technique uses an inflated balloon in the distal vaginal vault to expand the estrogenized hymen to its full capacity so that the edge may be readily visualized for signs of trauma. The Foley technique was compared with gross inspection, using supine labial traction, to photodocument hymenal abnormalities. Photographs of the hymen were obtained using the labial traction technique and then with the Foley technique. Three emergency physicians independently examined each pair of photographs with high interrater agreement for the presence of injury (κ= 0.88). Results: Twenty adolescent sexual assault victims volunteered for the study; mean age was 14.8 years. Gross inspection of the hymen using supine labial traction identified hymenal injuries in three patients (15%). Use of the Foley catheter balloon technique allowed identification of hymenal abnormalities in nine additional cases (60%). The common injuries to the hymen included lacerations (30%), followed by ecchymosis and abrasions. One patient (5%) voiced discomfort (mild pressure sensation) during inflation of the balloon. Conclusions: The Foley catheter balloon technique is a simple method allowing improved photodocumentation of hymenal trauma in adolescent sexual assault victims compared with supine labial traction.
Heart Rate Response to Intravenous Catheter Placement
Authors: Bartfield Joel M. , Janikas John S. , Lee Ryan S. 
Published: September 2003

Abstract Objective: To investigate the relationship between change in heart rate and pain and anxiety caused by intravenous catheter (IV) placement. Methods: An observational study was performed in a university‐based tertiary care emergency department. Patients who required IV placement as part of their management were considered as possible subjects. Heart rates were recorded at the following times: baseline, tourniquet placement, and IV placement. Immediately after IV placement, subjects recorded pain and anxiety scores using 100‐mm visual analog scales. Percentage change in heart rate (compared with baseline) was calculated at time of tourniquet placement (anxiety) and IV placement (pain). Simple linear regression analyses were performed comparing pain scores with percent change in heart rate at the time of IV and tourniquet placement. Significance was defined as p < 0.05. Results: Ninety subjects were enrolled. Subjects had a mean age of 48 years, and 54% were women. There was a normal distribution of heart rate changes, with greater than 80% of all subjects having a 10% or less change in heart rates. The results of the analysis of pain scores versus percentage change in heart rate at IV placement yielded a Pearson correlation coefficient of 0.13 (p = 0.2). The results of the analysis of anxiety scores versus percentage change in heart rate at tourniquet placement yielded a Pearson correlation coefficient of 0.014 (p = 0.9). Conclusions: Changes in heart rate do not correlate with pain and anxiety associated with IV placement.
Predictors of Academic Productivity in Emergency Medicine
Authors: Henderson Sean O. , Brestky Philip 
Published: September 2003

Abstract Objectives: Emergency medicine (EM), as a young specialty, has few measures of academic productivity beyond the traditional National Institutes of Medicine ranking, which is not applicable to most academic EM programs. This study was undertaken to identify factors associated with number of publications per academic institution in an attempt to predict keys to success. Methods: Retrospective study for a seven‐year period using a MEDLINE search with Emergency in the Institution field. All publications were included except Letters and Abstracts. The Society for Academic Emergency Medicine (SAEM) website was queried for program descriptors that were analyzed as independent predictors of publication success. A multivariate predictive model was constructed to evaluate the independent variables found to be significant univariate modifiers. Results: Although total emergency department census, postgraduate years, fellowship opportunities, residency research requirement, hospital census, the year the program was established, and SAEM region were not associated with increased publications, faculty size and program location (region) were statistically associated with increased publications. The Western United States had the highest number of total publications per program (mean 39.6 [95% confidence interval = 25.8 to 53.5]). Faculty size was an independent predictor of publication, with each additional faculty member adding 0.58 publications for the entire seven‐year period under review. No other demographic descriptors were significantly associated with publications. Conclusions: Only program location and faculty size were associated with the number of publications for a specific institution. Factors such as patient care load did not seem to influence such productivity.
Auxiliary power system technology using a hydrodynamic clutch
Authors: Hirtz N , Althaus J 
Published: September 2003

A hydraulic clutch used for Auxiliary Power Unit (APU) drives provides a flexibility in adapting its characteristic to the requirements of the typical application. In comparison to a mechanical clutch, the hydrodynamic clutch is able to engage dynamically both unloaded and loaded. In particular, the dynamic engagement can be varied very easily by controlling the oil flow into the clutch. This paper describes the general function of the APU system and explains the advantages of the hydrodynamic clutch with respect to the system requirements. The clutch working principle and its design for the special application are presented. Measurement results illustrate the clutch performance in engaged and disengaged mode. The optimization of the APU starting procedure, which benefits significantly from the smooth clutch behaviour, is explained in detail.
The ‘tumble’ departure mode in weightshift-controlled microlight aircraft
Authors: Gratton G , Newman S 
Published: September 2003

The cost of private or recreational flying is high for most conventional aircraft types. During the last 25 years, however, an alternative has become available in the form of the microlight aircraft. It has a relatively low cost of ownership and has opened up flying to a greater audience. However, there have been a number of accidents, usually fatal, to this class of aircraft, which could not be explained through any conventional understanding. The reason for these accidents, which involve a departure from controlled flight followed by aircraft structural failure (generally including mechanical failure of the basebar, wingtips and leading edge), has become known as the “tumble”, owing to the basic motion of the aircraft. This paper analyses the tumble mode, from its initiation through to the steady rotation condition. History has shown that the tumble mode has always resulted in the destruction of an aircraft. In consequence, it is the authors' opinion that consideration of the tumble during the approval of new designs should concentrate upon avoidance, since there is no identifiable recovery mechanism from the established mode without the use of an external safety device. A programme of research into this phenomenon was initiated in 1997. The peculiar nature of the tumble motion has required the aerodynamic modelling to address the effects of a high pitch rate, which has led to the introduction of unsteady aerodynamic effects. This paper sets out to describe and explain the mode, leading to a model that might reasonably be developed to produce relatively tumble resistant aircraft. Finally, the methods of possible entry are explained; it is intended that this information may be used in pilot training to ensure the avoidance of the tumble instability.
Gender Differences in NSAID Use among Older Adults with Osteoarthritis
Authors: Dominick Kelli L , Ahern Frank M , Gold Carol H , Heller Debra A 
Published: September 2003

BACKGROUND: Nonsteroidal antiinflammatory drugs (NSAIDs) are the most commonly prescribed medications for the treatment of osteoarthritis (OA). Little is known about whether there are important gender differences in NSAID use among patients with OA. OBJECTIVE: To examine gender differences in patterns of NSAID use among older adults (≥65 y) with OA. METHODS: Subjects (n = 11 298) were members of a statewide prescription drug plan who responded to a health-related quality-of-life (HRQOL) survey in 1997 and had a physician diagnosis of OA. Gender differences in patterns of NSAID use were examined over a 2-year period. RESULTS: Approximately one-third of the participants filled at least 1 NSAID prescription during the study. Women were significantly more likely to be prescribed an NSAID than men (37% vs. 30%), had a greater total days' supply of NSAIDs, and were more frequently prescribed NSAIDs with greater degrees of cyclooxygenase-2 selectivity. These gender differences persisted in statistical analyses controlling for demographic factors, HRQOL, and gastrointestinal (GI) risk factors. CONCLUSIONS: Results of this study showed significant gender differences in patterns of NSAID use, and these differences were independent of the risk for GI adverse effects and self-reported symptoms. Further research is needed to examine reasons for these gender variations, as well as their impact on the quality of symptom management.
Efficacy of Sulfonylureas with Insulin in Type 2 Diabetes Mellitus
Authors: Kabadi Mary U , Kabadi Udaya M 
Published: September 2003

BACKGROUND: In subjects with type 2 diabetes mellitus, glycemic control deteroriates while patients use sulfonylurea drugs during the course of the disease. Adjunctive therapy with insulin at this stage requires a lesser daily insulin dose in comparison with insulin monotherapy while restoring desirable glycemic control. However, data regarding direct comparison between various sulfonylureas in this regard are lacking. OBJECTIVE: To examine comparative efficacies of adjunctive therapy with insulin in subjects with type 2 diabetes manifesting lapse of glycemic control while receiving various individual sulfonylurea drugs. METHODS: Four groups of 10 subjects, each presenting with glycosylated hemoglobin (HbA1C) >8.0% while using either tolazamide, glyburide, glipizide Gastrointestinal Therapeutic System (GITS), or glimepiride, were recruited. Two from each group were randomized to receive placebo; the others continued the same drug. Pre-supper subcutaneous 70 NPH/30 regular insulin was initiated at 10 units and gradually increased and adjusted as necessary to attain fasting blood glucose levels between 80 and 120 mg/dL and maintain the same range for 6 months. Fasting plasma glucose, plasma C-peptide, and HbA1C concentrations were determined prior to the addition of insulin and at the end of the study. Daily insulin dose and changes in body weight (BW) were noted at the end of the study, and the number of hypoglycemic events during the last 4 weeks of the study was determined. RESULTS: Daily insulin dose (units/kg BW), weight gain, and number of hypoglycemic events were significantly lower (p < 0.01) in subjects receiving sulfonylureas in comparison with placebo. However, the daily insulin dose alone was significantly lower (p < 0.05) with glimepiride (0.49 ± 0.10; mean ± SE) than with other sulfonylureas (tolazamide 0.58 ± 0.12, glyburide 0.59 ± 0.12, glipizide GITS 0.59 ± 0.14). Finally, a significant correlation (r = 0.68; p < 0.001) was noted between suppression of plasma C-peptide level and the daily insulin dose among all participants. CONCLUSIONS: By lowering the daily insulin dose, sulfonylurea drugs appear to improve the sensitivity of exogenous insulin in subjects with type 2 diabetes mellitus manifesting lapse of glycemic control. Moreover, glimepiride appears to possess a greater insulin-sparing property than other sulfonylureas.
Cardiorespiratory Effects of Naloxone in Children
Authors: Hasan Rashed A , Benko Amy S , Nolan Brian M , Campe Julie , Duff Jenny , Zureikat George Y 
Published: September 2003

BACKGROUND: Data on the cardiorespiratory changes and complications following administration of naloxone in children are limited. OBJECTIVE: To evaluate the cardiorespiratory changes and complications following naloxone treatment in children. METHODS: The maximal changes in respiratory rate (RR), heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure, and any complications within 1 and 2 hours following naloxone were tabulated. RESULTS: One hundred ninety-five children received naloxone over 3 years. The mean ± SD age was 9.7 ± 6 years. The total doses of naloxone ranged from 0.01 to 7 mg (0.001–0.5 mg/kg body weight), with a median dose of 0.1 mg. Group 1 patients consisted of 11 6 (60%) children who were postoperative and had been given naloxone by an anesthesiologist; group 2 patients consisted of 79 (40%) children who received naloxone in the emergency department or pediatric intensive care unit. Patients in group 1 were older: 10.6 ± 5.3 versus 8.2 ± 6.7 years (p < 0.006), but received significantly lower doses of naloxone (0.09 ± 0.2 vs. 1.1 ± 0.76 mg; p < 0.001). When the entire cohort was evaluated, a significant increase in RR (15 ± 7 vs. 21 ± 8 breaths/min; p < 0.001), HR (102 ± 29 vs.107 ± 29 beats/min; p < 0.001), SBP (109 ± 17 vs. 115 ± 15 mm Hg; p < 0.001), and DBP (56 ± 10 vs. 60 ± 13 mm Hg; p < 0.001) within 1 hour following naloxone was noted. When the 2 groups were compared, only the changes in RR were greater in group 2 patients (6.8 ± 7.9 vs. 4.7 ± 5 breaths/min; p < 0.001) following naloxone. Systolic hypertension occurred in 33 of 195 (16.9%) of all patients, while diastolic hypertension occurred in 13 (6.6%) of all patients after naloxone. Only the incidence of diastolic hypertension was higher in group 2 compared with group 1 patients following naloxone (16% vs. 2%; p < 0.001). Hypertension resolved spontaneously. One child developed pulmonary edema and required positive pressure ventilation for 22 hours. CONCLUSIONS: Moderate increases in RR, HR, and BP occur after naloxone administration to children, but development of more serious complications is rare.
Oral Terbinafine-Induced Bullous Pemphigoid
Authors: Aksakal Burhan A , Özsoy Esra , Arnavut Önder , Gürer Mehmet Ali 
Published: September 2003

OBJECTIVE: To report a case of drug-induced bullous pemphigoid (BP) in an otherwise healthy elderly patient after taking terbinafine for 20 days. CASE SUMMARY: A 78-year-old man presented with distal subungual onychomycosis of the toenails. Oral terbinafine 250 mg/d was started for treatment. Twenty days after the beginning of the treatment, the patient presented with widespread pruritic blistering eruption, more severe on the extremities. He had not received terbinafine before and was not receiving any other drug. The diagnosis of BP was confirmed with histopathologic examination. The patient was treated successfully with oral steroids. DISCUSSION: Drug-induced BP is a well-known complication of many drugs and represents a spectrum from an acute and self-limited condition to a chronic disease. Terbinafine is frequently used in the elderly. It is known to have less drug interactions and adverse effects compared with the other antifungal agents. Use of the Naranjo probability scale indicated a probable relationship between BP and terbinafine treatment in this patient. CONCLUSIONS: To the best of our knowledge, this is the first report in the English-language literature of BP in a patient taking terbinafine. As with any other medication, oral terbinafine has the potential for severe adverse reactions. Healthcare professionals should be aware of this possibility.
Aripiprazole in an Adult with Asperger Disorder
Authors: Staller Jud A 
Published: September 2003

OBJECTIVE: To report a case of aripiprazole-responsive adult Asperger disorder. CASE SUMMARY: A 34-year-old white man with lifelong, disabling Asperger disorder and a 20-year history of failed psychotherapeutic and pharmacologic interventions was prescribed aripiprazole, with dramatic symptomatic improvement. DISCUSSION: Multiple prior pharmacologic efforts over several years aimed predominantly at altering serotonin and dopamine neurotransmission resulted in treatment failure due to intolerable adverse effects, exacerbation of underlying symptoms, or nonresponse. Aripiprazole, with a complex profile of neurotransmitter affinities, has produced significant core symptom changes. Improved sociability; increased self-awareness; reduced rigidity, anxiety, and irritability; and reduced preoccupation with circumscribed esoteric interests are among the effects noted. CONCLUSIONS: Previously intractable Asperger disorder symptoms in a 34-year-old man were ameliorated with aripiprazole.
Pharmacist Intervention Enhances Adherence to Orlistat Therapy
Authors: Malone Margaret , Alger-Mayer Sharon A 
Published: September 2003

BACKGROUND: Pharmacists, especially those in community practice, should increase their level of intervention in dealing with the nationwide epidemic of obesity since they interact with large numbers of the public on a regular basis. We hypothesized that patients who receive medication for weight loss may have an improved therapeutic outcome if they received additional support from their community pharmacist. OBJECTIVE: To evaluate the impact of pharmacist support on patient persistence with orlistat. METHODS: Pharmacists were trained in basic obesity management skills. Patients who were prescribed orlistat and attending an outpatient nutrition program were invited to participate in the study. All patients agreed to receive pharmaceutical care. Those who lived where the service was available were assigned to the intervention (I) group and those who did not were assigned to the control (C) group. All patients received usual care provided by the outpatient clinic. RESULTS: Thirty patients, 15 in the I group and 15 in the C group, were recruited. Both groups were predominantly women (87%) with a mean ± SD age of 43.8 ± 9.7 years. Patients in the I group had significantly greater persistence with orlistat therapy as assessed by duration of therapy (p = 0.006) and number of patients completing the 26-week study (7 I, 2 C; p = 0.046). There was no significant difference in percent of weight loss between groups (p > 0.05). CONCLUSIONS: In this pilot study, patients receiving pharmaceutical care took orlistat longer than the controls and had improved outcome with orlistat therapy.