bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sensory stimulation of brain-injured individuals in coma or vegetative state: results of a Cochrane systematic review
Authors: Lombardi Francesco , Taricco Mariangela , De Tanti Antonio , Telaro Elena , Liberati Alessandro 
Published: October 2002

Objectives: To assess the effectiveness of sensory stimulation programmes in patients in coma or vegetative state. Design: Systematic review of randomized control trials (RCT) and nonrandomized controlled clinical trials (CCT) comparing any type of stimulation programmes with standard rehabilitation in patients in coma or vegetative state. The Injuries Group specialized register, the Cochrane Controlled trial register, EMBASE, MEDLINE, CINAHL, PSYCHLIT from 1966 to January 2002 were searched without language restriction. Reference lists of articles were scanned and experts in the area contacted to ”nd other relevant studies. Abstracts and papers found were initially screened by one reviewer. Three reviewers independently identi”ed relevant studies, extracted data and assessed study quality, resolving disagreement by consensus. Outcome measures: Duration of unconsciousness (including coma and vegetative state) de”ned as the time between trauma and objective recovery of the ability to respond to verbal commands; level of consciousness, as measured by the Glasgow Coma Scale (GCS); level of cognitive functioning (LCF); functional outcomes, as measured by Glasgow Outcome Scale (GOS) or by Disability Rating Scale; negative effects (e.g. increased intracranial pressure). Results: Three studies (one RCT and two CCTs) with 68 traumatic brain-injured patients in total, most of whom were road accident victims, met the inclusion criteria. The overall methodological quality was poor and studies differed widely in terms of study design and conduct. Moreover, due to the diversity in reporting of outcome measures, a quantitative metanalysis was not possible. None of the three studies provided useful and valid results on outcomes of clinical relevance for coma patients.
A randomized controlled trial of the effects of weights on amplitude and frequency of postural hand tremor in people with Parkinson's disease
Authors: Meshack Rubia P , Norman Kathleen E 
Published: October 2002

Objective: To evaluate the effects of weights on postural hand tremor related to self-feeding in subjects with Parkinson's disease (PD). Design: In a repeated-measures design, postural hand tremor was recorded three times in each of three weight conditions in a single session for each subject. The order of all recording conditions was randomized. Setting: Intervention was applied and measurement was conducted in a university-based motor performance laboratory. Subjects: Fourteen men and two women diagnosed with PD and having hand tremor participated (mean age 67.1 years, mean duration of PD 4.6 years). All were community-dwelling. Intervention: The control condition consisted of holding a built-up spoon (108 g). There were two experimental conditions: holding a weighted spoon (248 g); and holding the built-up spoon while wearing a weighted wrist cuff (470 g). Main outcome measures: Three measures of tremor amplitude and two measures of tremor frequency were calculated from recordings of displacement of the spoon obtained from laser displacement sensors. Results: Repeated-measures analyses of variance revealed no signi”cant differences across conditions in any measure of tremor amplitude or in either measure of tremor frequency. Correlational and Mann–Whitney U-test analyses revealed that none of age, disease duration or medication intake had any signi”cant relationship with tremor amplitude in the control condition or with whether amplitude was altered by weights. Conclusions: The ”ndings suggest that there is no support for the clinical recommendation of using weighted utensils or weighted wrist cuffs to alleviate postural hand tremor in PD.
A randomized, controlled comparison of home versus institutional rehabilitation of patients with hip fracture
Authors: Kuisma Raija 
Published: October 2002

Objective: To compare ambulation outcomes between home and institutional rehabilitation of patients with hip fracture. Design: Randomized controlled clinical equivalence trial. Setting: The Queen Elizabeth Hospital in Hong Kong. Subjects: Eighty-one patients with hip fracture. Intervention: Study group patients (40) were discharged directly home from the acute hospital and visited by a physiotherapist an average of 4.6 times. The control group subjects (41) were discharged to a rehabilitation centre for further treatment lasting on average 36.2 days (SD 14.6) and they received physiotherapy daily. Main outcome measures: Ambulation ability measured on a categorical scale. Results: The mean age of the subjects was 75 years (SD 8.3 years). Females comprised 60% of all the subjects and majority were retired or home makers. Both groups of patients improved in their ambulation ability during their rehabilitation period but neither group achieved their pre-ambulatory status by the time of completion of the study. The study group achieved significantly higher ambulation scores ( p < 0.05) for community and household ambulation compared with the control group by the end of the study, a year after operation. Conclusion: Five visits by a physiotherapist in the patient's home after discharge from an acute hospital after surgical treatment for hip fracture yielded better results in ambulation ability than one month of conventional institution-based rehabilitation.
Characterization of CD3+CD4-CD8- (double negative) T cells in patients with systemic lupus erythematosus: activation markers
Authors: Anand A , Dean G S , Quereshi K , Isenberg D A , Lydyard P M 
Published: October 2002

Systemic lupus erythematosus (SLE) is characterized by B cell hyperactivity and the production of autoantibodies, some of which (antibodies to dsDNA) are thought to be pathogenic. T helper cells drive the production of autoantibodies and the aim of this study is to characterize phenotypically a subpopulation of T cells (the CD3+CD4-CD8-, double negative (DN) T cells) previously identified as helping to enhance anti-DNA antibodies in patients with SLE. Data were obtained using FACS staining of DN T cells that had been purified from PBMCs by magnetic bead separation. The percentage of TCR ab‡ DN T cells was found to be significantly higher in patients with SLE as compared with controls (P ^ 0.02), although there was no significant increase in total percentage of DN T cells, which includes TCR gd ‡ cells. Activation markers HLA-DR and CD69, the costimulatory molecule CD28 and CTLA-4 were all expressed on the surface of a higher percentage of DN T cells in patients with SLE than in patients with rheumatoid arthritis (RA) or healthy controls (HC). More DN T cells from patients with SLE were of CD45RA phenotype than was found in controls, while CD45RO-expressing cells were reduced. In addition, DN T cells from patients with SLE expressed significantly higher levels of HLA-DR (P ^ 0.006), CD28 (P ^ 0.05), CTLA4 (P ^ 0.03) and CD45RA (P ^ 0.05) on the cell surface than those from the CD4=8 population. Correlation of expression of the markers measured with various parameters of disease activity and severity showed that high levels of HLA-DR expression correlated with high circulating serum C3 (> 0.9 IU/ml), indicating that an activated phenotype is consistent with severe disease.
Associations between premorbid intellectual performance, early-life exposures and early-onset schizophrenia
Authors: Gunnell David , Harrison Glynn , Rasmussen Finn , Fouskakis Dimitris , Tynelius Per 
Published: October 2002

BackgroundImpaired intellectual performance is associated with an increased risk of schizophrenia.AimsTo investigate whether this association is due to the influence of prenatal and early childhood exposures on both intellectual development and the risk of schizophrenia.MethodCohort of 197 613 Swedish male conscripts with linked birth, census and hospital admission data together with five measures of verbal and non-verbal intellectual performance recorded at conscription.Results109 643 subjects had complete data; over a mean 5-year follow-up, 60 developed schizophrenia and 92 developed other non-affective psychoses. Poor scores for each of the five tests were associated with 3-to 14-fold increased risk of psychosis, particularly schizophrenia. Controlling for birth-related exposures, including birth weight, and parental education did not attenuate these associations.Results109 643 subjects had complete data; over amean 5-year follow-up,60 developed schizophrenia and 92 developed other non-affective psychoses. Poor scores for each of the five testswere associatedwith 3-to 14-foldincreasedrisk of psychosis, particularly schizophrenia. Controlling for birth-related exposures, including birthweight, and parental education didnot attenuate these associations.ConclusionsPoor intellectual performance at 18 years of age is associated with early-onset psychotic disorder. Associations do not appear to be confounded by prenatal adversity or childhood circumstances, as indexed by parental education.
Deconstructing current comorbidity: data from the Australian National Survey of Mental Health and Well-Being
Authors: Andrews Gavin , Slade Tim , Issakidis Cathy 
Published: October 2002

BackgroundComorbidity in epidemiological surveys of mental disorders is common and of uncertain importance.AimsTo explore the correlates of current comorbidity.MethodData from the Australian National Survey of Mental Health and Well-Being were used to evaluate the relationships between comorbidity, disability and service utilisation associated with particular mental disorders.ResultsThe number of current comorbid disorders predicted disability, distress, neuroticism score and service utilisation. Comorbidity is more frequent than expected, which might be due to the effect of one disorder on the symptom level of another, or to the action of common causes on both. The combination of affective and anxiety disorders was more predictive of disability and service utilisation than any other two or three group combinations. When people nominated their principal disorder as the set of symptoms that troubled them the most, the affective and anxiety disorders together were associated with four-fifths of the disability and service utilisation.ConclusionsTo make clinical interventions more practical, current comorbidity is best reduced to a principal disorder and subsidiary disorders.
Fluoxetine v. placebo in prevention of relapse in post-traumatic stress disorder
Authors: Martenyi Ferenc , Brown Eileen B. , Zhang Harry , Koke Stephanie C. , Prakash Apurva 
Published: October 2002

BackgroundLittle is known about the effect of pharmacotherapy in the prevention of post-traumatic stress disorder (PTSD) relapse.AimsTo assess the efficacy and tolerability of fluoxetine in preventing PTSD relapse.MethodThis was a double-blind, randomised, placebo-controlled study. Following 12 weeks of acute treatment, patients who responded were re-randomised and continued in a 24-week relapse prevention phase with fluoxetine (n=69) or placebo (n=62). The primary efficacy assessment was the prevention of PTSD relapse, based on the time to relapse.ResultsPatients in the fluoxetine/fluoxetine group were less likely to relapse than patients in the fluoxetine/placebo group (P=0.027). There were no clinically significant differences in treatment-emergent adverse events between treatment groups.ConclusionsFluoxetine is effective and well tolerated in the prevention of PTSD relapse for up to 6 months.
Defining the Outcome Measures for Out‐of‐hospital Trials in Acute Pulmonary Edema
Authors: Welsford Michelle , Morrison Laurie J. 
Published: October 2002

Abstract Objective: Comparing studies of the effectiveness of out‐of‐hospital interventions in acute pulmonary edema (APE) is difficult due to the diversity of outcome measures used in the literature. The objective of this study was to define a set of clinically relevant outcome measures for future out‐of‐hospital trials in APE. Methods: A Medline search and hand‐search of bibliographies was undertaken to develop a list of APE outcome measures. A survey was mailed to a sample of 227 Canadian emergency physicians using the Dillman methodology, requesting that respondents select clinically relevant outcome measures from this list and rank them by importance. A selection frequency of ≥70% and a median ranking score were used to determine relevant outcome measures. Results: The Medline and bibliography search identified 21 APE outcome measures. The survey response rate was 71%. Outcome measures selected most frequently were heart rate, respiratory rate, respiratory distress scale, subjective dyspnea scale, out‐of‐hospital intubation, emergency department (ED) intubation, survival to discharge, and out‐of‐hospital mortality. The median ranking score identified a similar set of measures: heart rate, respiratory rate, respiratory distress scale, subjective dyspnea scale, out‐of‐hospital intubation rate, and ED intubation rate. There was no significant difference in outcome selection between physicians who worked in communities with and without advanced out‐of‐hospital care. Conclusions: Clinically relevant out‐of‐hospital APE outcome measures were identified and endorsed by a representative survey of Canadian emergency physicians. Clinicians appear to favor short‐term and non‐mortality outcomes for out‐of‐hospital interventions. The use of this set of APE outcome measures may improve the design and comparability of future out‐of‐hospital trials.
Mental Status Screening of Emergency Department Patients: Normative Study of the Quick Confusion Scale
Authors: Irons M. Janie , Farace Elana , Brady William J. , Huff J. Stephen 
Published: October 2002

Abstract Objective: In order to increase the utility of the Quick Confusion Scale (QCS), a six‐item, 15‐point instrument used in screening for impaired mental status in an emergency department (ED) setting, clinical norms were established for an ED patient population. Methods: The QCS was administered to ED patients of a university‐based hospital during a nine‐week period. All subjects scoring less than 15 on the QCS were also administered the Mini‐Mental State Examination (MMSE); 731 patients provided QCS scores for use in this study and 295 provided MMSE scores in addition to their QCS scores. Results: The internal consistency of the QCS was found to be within acceptable limits given that the briefness of the scale forced restriction in the variability coefficient. QCS scores were converted to a standardized metric (percentile ranks), population parameters were consulted, and two cutoff scores were established: one that suggests the likelihood of a cognitive impairment, signaling a need for further evaluation (QCS score of 11); and one that indicates an almost certain cognitive impairment (QCS score of 7). Percentile rank comparisons between subjects' scores on the MMSE and on the QCS provided additional validity for the cutoff scores. Conclusions: The QCS, in its focus on providing a quickly obtained, easily calculated, and readily interpreted score, presents a viable alternative to currently existing practices for assessing mental status in ED patients.
The Effect of Hypertension on Uncontrolled Hemorrhage in a Rodent Model
Authors: Sinert Richard , Spencer Matthew T. , Wilson Renee , Silverberg Mark , Patel Minal , Doty Christopher I. , Sapan Anat , Baron Bonny J. 
Published: October 2002

AbstractPatients with essential hypertension (EH) have higher mortality rates from hemorrhage. How the complex physiologic changes seen in EH affect the response to uncontrolled hemorrhage has yet to be adequately described. Objective: To test the null hypothesis that there would be no difference in the hemorrhage volumes and hemodynamic responses to uncontrolled hemorrhage between hypertensive rats (SHRs) and normotensive rats (WKYs). Methods: Twenty‐four adult rats (12 WKYs and 12 SHRs) were anesthetized with althesin via the intra‐peritoneal route. The femoral artery was cannulated by cutdown for mean arterial pressure (MAP) measurement and blood gas sampling. Twelve rats (6 WKYs and 6 SHRs) underwent uncontrolled hemorrhage by 50% tail amputation. Twelve rats (6 WKYs and 6 SHRs) served as non‐hemorrhage controls. The MAP, base excess (BE), and cumulative blood loss were measured pre‐hemorrhage and then every 15 minutes post‐hemorrhage for 90 minutes. Data were reported as mean ± standard error of the mean. Comparisons between control and uncontrolled hemorrhage groups were analyzed by analysis of variance (ANOVA) with repeated‐measures post‐hoc testing by Bonferroni. Statistical significance was defined by an alpha = 0.05. Results: Mortality rates were significantly higher (p < 0.05) for the SHRs (100%) as compared with the WKYs (33%). Changes in time‐averaged MAP post‐hemorrhage were significantly greater (p < 0.001) in the SHR group (88 ± 10 mm Hg) as compared with the WKY group (48 ± 4 mm Hg). Hemorrhage volume was significantly lower (p = 0.02) in the SHR group (3.7 ± 0.5 mL) as compared with the WKY group (6.1 ± 0.7 mL). Conclusions: Hypertensive rats had a higher mortality rate than normotensives from a comparable vascular injury with lower hemorrhage volumes.
Cervical Infections in Emergency Department Patients with Vaginal Bleeding
Authors: Hoffman Lance , Ma O. John , Gaddis Gary , Schwab Robert A. 
Published: October 2002

AbstractTo the best of the authors' knowledge, no previous study has compared the prevalences of Chlamydia trachomatis (CT) or Neisseria gonorrhoeae (NG) cervical infection among pregnant and non‐pregnant patients presenting to the emergency department (ED) with vaginal bleeding. Objectives: To determine the prevalence of these infections in a simultaneously assembled cohort, and to determine whether pregnancy is associated with altered rates of CT or NG cervical infection among patients with vaginal bleeding. Methods: This was a prospective, seven‐month, cross‐sectional study of a convenience sample of patients (aged ≥ 15 years) who presented to an urban, teaching ED with the chief complaint of vaginal bleeding. A urine pregnancy test was administered to each patient. Cervical swab specimens were analyzed for CT or NG via polymerase chain reaction technology (DNA probe). The hospital laboratory's baseline 18% rate of positive tests was used for sample size planning. Chisquare analysis and Fisher's exact test, where appropriate, were used to compare pregnant and non‐pregnant patient groups. Results: Cervical infection rates did not differ between pregnant and non‐pregnant patients. Testing for CT showed that 13 of 114 (11%) of the pregnant patients were positive, while 11 of 147 (8%) non‐pregnant patients tested positive (χ2= 0.759, p = 0.384). Testing for NG revealed that seven of 114 (6%) pregnant patients tested positive, while 16 of 147 (11%) non‐pregnant patients tested positive (χ2= 1.256, p = 0.262). Combined testing showed that 18 of 114 (16%) of the pregnant patients and 25 of 147 (17%) of the non‐pregnant patients harbored a cervical infection with one or both pathogens (χ2= 0.009, p = 0.925). Conclusions: The prevalence of CT or NG cervical infection in pregnant patients presenting to the ED with vaginal bleeding is 16%. Pregnant and non‐pregnant patients with vaginal bleeding are at similar risks for having CT or NG cervical infection. Cervical swab specimens should be obtained in all patients with vaginal bleeding.
Ultrasound Guidance versus the Landmark Technique for the Placement of Central Venous Catheters in the Emergency Department
Authors: Miller Adam H. , Roth Brett A. , Mills Trevor J. , Woody Jay R. , Longmoor Charles E. , Foster Barbara 
Published: October 2002

Abstract Objective: To compare ultrasound (US)‐guided vs. landmark‐guided techniques for central venous access (CVA) in the emergency department. Methods: This was a prospective study of consecutive patients enrolled at a university teaching hospital with an annual census of approximately 100,000. On even days patients had CVA with ultrasonic assistance; patients presenting on odd days had CVA via traditional landmark techniques. Ultrasound users were emergency medicine faculty or residents who completed a one‐hour training session. A data collection tool with 17 variables was completed for each central line placed. Variables were compared using the independent t‐test, Fisher's exact test, and the non‐parametric Mann‐Whitney U test. Results: Between August 1, 2000, and February 1, 2001, data for 122 subjects (n = 51 for US, and n = 71 for landmark) were collected. Variables with statistically significant differences are as follows. Mean (±SD) time from skin puncture to blood flash was 115 (±184) seconds for the US group vs. 512 (±698) seconds for the landmark group (p < 0.0001). The mean number of CVA attempts in the US group was 1.6 (±1.0) vs. 3.5 (±2.7) in the landmark group (p < 0.0001). Acute complications were comparable between groups. Comparisons for time, number of CVA attempts, and complications were done specifically for a subset of patients considered to be “difficult stick” due to predefined criteria regarding body habitus or vascular disease. Patients considered to be “difficult sticks” required a significantly longer amount of time (p < 0.001) for CVA via the landmark technique than patients considered to be “difficult sticks” who had CVA with ultrasonic guidance. Time to line placement for the landmark group was 462.7 (±627) seconds vs. 93.3 (±176) seconds in the US group. Comparing the same subset also revealed an increase in number of required CVA attempts for the landmark technique group. The number of acute complications in the “difficult stick” patients did not show statistical significance (p = 1.00). The landmark group had 60%“difficult sticks,” while the ultrasound group had 80%, although the difference was not statistically significant (p = 0.08). Conclusions: Emergency physicians with limited training and experience are able to use ultrasound as an adjunct for central venous access. Ultrasound technology may decrease the number of CVA attempts required to cannulate a central vein and will decrease the amount of time required to cannulate the vein starting from the time when the needle is on the skin, after the ultrasound machine has been set up and turned on. These results are especially true for those patients considered to be “difficult sticks.”