bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cerebral Cortical Aquaporin‐4 Expression in Brain Edema following Cardiac Arrest in Rats
Authors: Xiao Feng , Arnold Thomas C. , Zhang Shu , Brown Carlos , Alexander J. Steven , Carden Donna L. , Conrad Steven A. 
Published: October 2004

Abstract Objectives: Brain edema occurs following clinical as well as experimental cardiac arrest (CA) and predicts a poor neurologic outcome. The objective of this study was to determine the expression of cerebral cortex aquaporin (AQP)‐4, a member of a family of membrane water‐channel proteins, in brain edema formation following normothermic or hypothermic CA. Methods: Twenty‐four rats were subjected to time‐matched normothermic (N‐Sham, 37.5°C ± 0.5°C, n= 6) or hypothermic (H‐Sham, 34°C ± 0.5°C, n= 6) sham experiments and normothermic (N‐CA, n= 6) or hypothermic (H‐CA, n= 6) CA induced by asphyxiation for 8 minutes. Hypothermia was induced before CA. The animals were resuscitated with cardiopulmonary resuscitation, ventilation, and epinephrine administration. Brain edema was determined by brain wet‐to‐dry weight ratio at one hour of resuscitation. AQP4 immunoactivity in the cerebral cortex was determined using immunohistochemical staining and was semiquantified as an intensity of staining with an automated cell imaging system. Results: Mild hypothermia in the sham experiments did not alter cerebral cortex AQP4 immunoactivity (mean ± SD) (55.0 ± 3.7 in H‐Sham vs. 53.3 ± 1.7 in N‐Sham, p > 0.05). N‐CA resulted in a significant increase in AQP4 immunoactivity (61.8 ± 4.5) compared with N‐Sham (p = 0.01) and H‐Sham (p = 0.03). H‐CA attenuated AQP4 compared with N‐CA (53.4 ± 1.3, p = 0.01). Brain wet‐to‐dry weight ratios were 4.41 ± 0.07 in N‐Sham, 4.40 ± 0.08 in H‐Sham (p > 0.05 vs. N‐Sham), 4.55 ± 0.04 in N‐CA (p = 0.004 vs. N‐Sham; p = 0.005 vs. H‐Sham), and 4.43 ± 0.09 in H‐CA (p = 0.02 vs. N‐CA; p > 0.05 vs. N‐Sham and H‐Sham). Conclusions Cerebral cortical AQP4 expression is up‐regulated after normothermic CA, which is attenuated by hypothermia induced before CA.
Rapid Emergency Medicine Score Can Predict Long‐term Mortality in Nonsurgical Emergency Department Patients
Authors: Olsson Thomas , Terent Andreas , Lind Lars 
Published: October 2004

Abstract Objectives: To examine the Rapid Emergency Medicine Score (REMS) as a predictor of long‐term (4.7 years) mortality in the nonsurgical emergency department (ED). Methods: This was a prospective cohort study. A total of 12,006 nonsurgical patients consecutively presenting to an adult ED at a 1,200‐bed university hospital during a period of one year were enrolled. REMS (including blood pressure, respiratory rate, pulse rate, Glasgow Coma Scale score, peripheral oxygen saturation, and patient age) was calculated for all patients admitted to the ED. The statistical associations between REMS and long‐term mortality were examined. Results: REMS could predict mortality over 4.7 years (hazard ratio, 1.26; p < 0.0001). Similar results were obtained in the major patient groups (chest pain, stroke, coma, dyspnea, and diabetes). Conclusions: REMS was a powerful predictor of long‐term mortality in patients attending the ED for a wide range of common nonsurgical disorders.
Confronting the Ethical Challenges to Informed Consent in Emergency Medicine Research
Authors:   SAEM Ethics Committee, Schmidt Terri A. , Salo David , Hughes Jason A. , Abbott Jean T. , Geiderman Joel M. , Johnson Catherine X. , McClure Katie B. , McKay Mary Pat , Razzak Junaid A. , Schears Raquel M. , Solomon Robert C. 
Published: October 2004

AbstractThe Society for Academic Emergency Medicine believes that protection of human subjects is vital in emergency medicine research and that, whenever feasible, informed consent is at the heart of that protection. At the same time, the emergency setting presents unique barriers to informed consent both because of the time frame in which the research is performed and because patients in the emergency department are a vulnerable population. This report reviews the concept of informed consent, empirical data on patients' cognitive abilities during an emergency, the federal rules allowing exemption from consent under certain circumstances, issues surrounding consent forms, and the new Health Insurance Portability and Accountability Act regulations as they relate to research. The authors conclude that, in many circumstances, informed consent is possible if the researcher is diligent and takes time to adequately explain the study to the potential subject. In cases in which it is possible to obtain consent, precautions must be taken to ensure that subjects have decision‐making capacity and are offered time to have their questions answered and their needs met. Sometimes resuscitation and other emergency medicine research must be conducted without the ability to obtain consent. In these cases, special protections of subjects under the exception from consent guidelines must be followed. Protection of research subjects is the responsibility of every researcher in emergency medicine.
An Evaluation of a Blind Rotational Technique for Selective Mainstem Intubation
Authors: Bair Aaron E. , Doherty Melissa J. , Harper Richart , Albertson Timothy E. 
Published: October 2004

Abstract Objectives: Although rare, massive hemoptysis and major bronchial disruptions are associated with high mortality. Selective ventilation of the uninvolved lung can increase the likelihood of survival. Specialized devices used for single lung ventilation are often not readily available and can be difficult to place in the emergency department. The authors evaluated a blind rotational technique for selective mainstem intubation using either a standard endotracheal tube (ET) or a directional‐tip endotracheal tube (DTET). Methods: This was a prospective, randomized trial on 25 human cadavers. The desired side of mainstem intubation was determined by randomization. Each cadaver was used for four ET, four DTET, and four control intubations. In the ET group, the trachea was intubated. The tube was then rotated 90° in the direction of the desired placement and advanced until resistance was met. In the DTET group, the technique was identical, except the trigger was activated to flex the tip during advancement. In the control group, an ET was advanced in neutral alignment until resistance was met. A bronchoscopist blinded to the desired placement determined tube position. Comparison testing was performed using Pearson's chi‐square test. Results: When attempting to intubate the left mainstem, use of the ET with the rotational technique was successful 72.3% of the time (95% confidence interval [95% CI] = 57% to 84%). Intubation of the left mainstem using the DTET was successful 68.5% of the time (95% CI = 54% to 81%; p = 0.67). Attempts to selectively intubate the right mainstem using the rotational technique were highly successful in both groups: 94% for the ET (95% CI = 84% to 99%) versus 97.8% for the DTET (95% CI = 89% to 100%). Among controls, the right mainstem was intubated 93% of the time (95% CI = 86% to 97%). Conclusions: In a cadaveric model, the left mainstem bronchus can be selectively intubated with moderate reliability using this rotational technique. Use of a DTET confers no significant advantage. The ability to generalize these findings to living subjects is unknown.
Characteristics and Admission Patterns of Patients Presenting with Syncope to U.S. Emergency Departments, 1992–2000
Authors: Sun Benjamin C. , Emond Jennifer A. , Camargo Carlos A. 
Published: October 2004

Abstract Objectives: To describe the characteristics and admission patterns of patients with syncope presenting to U.S. emergency departments (EDs). Methods: The ED portion of the National Hospital Ambulatory Medical Care Survey, 1992–2000, was analyzed. Nationally representative weighted estimates for incidence and admission rates were estimated and stratified by demographic variables. Presence of cardiovascular diagnoses on ED discharge was noted. Results: Of the 865 million ED visits during the nine‐year study period, an estimated 6.7 million (0.77%; 95% confidence interval [95% CI] = 0.69% to 0.85%) were related to syncope. Higher incidences of ED visits for syncope were found in elder, female, and non‐Hispanic patients compared with their reference groups. The overall admission rate was 32% (95% CI = 28% to 36%). Older, male, and white patients were admitted more frequently than their counterparts. Of patients older than 80 years of age, 58% (95% CI = 49% to 67%) were admitted. Associated cardiovascular International Classification of Diseases, Ninth Revision (ICD‐9), codes for ischemic, structural, and arrhythmic heart disease were noted in 10% (95% CI = 8% to 13%) of patients, and 66% (95% CI = 56% to 76%) of these patients were admitted. Conclusions: Syncope is a frequent reason for ED visits and admissions. Elders and patients with associated cardiovascular diagnoses are frequently discharged, and admission practices appear to deviate from consensus panel guidelines.
The Association between White Blood Cell Count and Acute Myocardial Infarction In‐hospital Mortality: Findings from the National Registry of Myocardial Infarction
Authors: Grzybowski Mary , Welch Robert D. , Parsons Lori , Ndumele Chiadi E. , Chen Edmond , Zalenski Robert , Barron Hal V. 
Published: October 2004

Abstract Objectives: Although cross‐sectional and prospective studies have shown that the white blood cell (WBC) count is associated with long‐term mortality for patients with ischemic heart disease, the role of the WBC count as an independent predictor of short‐term mortality in patients with acute myocardial infarction (AMI) has not been examined as extensively. The objective of this study was to determine whether the WBC count is associated with in‐hospital mortality for patients with ischemic heart disease after controlling for potential confounders. Methods: From July 31, 2000, to July 31, 2001, the National Registry of Myocardial Infarction 4 enrolled 186,727 AMI patients. A total of 115,273 patients were included in the analysis. Results: WBC counts were subdivided into intervals of 1,000/mL, and in‐hospital mortality rates were determined for each interval. The distribution revealed a J‐shaped curve. Patients with WBC counts >5,000/mL were subdivided into quartiles, whereas patients with WBC counts <5,000/mL were assigned to a separate category labeled “subquartile” and were analyzed separately. A linear increase in in‐hospital mortality by WBC count quartile was found. The unadjusted odds ratio (OR) for the fourth versus the first quartile showed strong associations with in‐hospital mortality among the entire population and by gender: 4.09 (95% confidence interval [95% CI] = 3.83 to 4.73) for all patients, 4.31 (95% CI = 3.93 to 4.73) for men, and 3.65 (95% CI = 3.32 to 4.01) for women. Following adjustment for covariates, the magnitude of the ORs attenuated, but the ORs remained highly significant (OR, 2.71 [95% CI = 2.53 to 2.90] for all patients; OR, 2.87 [95% CI = 2.59 to 3.19] for men; OR, 2.61 [95% CI = 2.36 to 2.99] for women). Reperfused patients had consistently lower in‐hospital mortality rates for all patients and by gender (p < 0.0001). Conclusions: The WBC count is an independent predictor of in‐hospital AMI mortality and may be useful in assessing the prognosis of AMI in conjunction with other early risk‐stratification factors. Whether elevated WBC count is a marker of the inflammatory process or is a direct risk factor for AMI remains unclear. Given the simplicity and availability of the WBC count, the authors conclude that the WBC count should be used in conjunction with other ancillary tests to assess the prognosis of a patient with AMI.
Ethanol and Illicit Drugs Do Not Affect the Diagnostic Utility of Base Deficit and Lactate in Differentiating Minor from Major Injury in Trauma Patients
Authors: Zehtabchi Shahriar , Baron Bonny J. , Sinert Richard , Yadav Kabir , Lucchesi Michael 
Published: October 2004

Abstract Objectives: Base deficit (BD) and lactate are valuable screening tools for injured patients. They reflect the degree of oxygen debt and have been shown to predict outcome. Intake of ethanol and illicit drugs may further derange acid–base status. The authors evaluated the effect of blood alcohol level (BAL) and illicit drugs on admission BD and lactate levels in trauma patients.Methods: Prospective, observational study of trauma patients in a Level 1 trauma center. Patients with penetrating or blunt trauma were included in the study. Patients were further stratified into major or minor categories. Major was defined by an Injury Severity Score >15, blood transfusions, or a decrease in hematocrit of more than ten points. Injury categories were further divided into several subgroups based on presence or absence of ethanol (BAL ≥0.08 g/dL) or positive urine toxicology screen (Utox).Results: A total of 520 patients (84% male) with a mean (±SD) age of 33 (±15) years were studied. Compared with the minor injury categories, BD and lactate levels were significantly higher in the major injury categories in all different intoxication subgroups. Testing the diagnostic performance of BD and lactate in detecting major injury, the authors observed significant (p < 0.05) differences between the areas under the receiver operating characteristic curves for these two diagnostic tests compared with baseline in both intoxicated (BAL ≥0.08 g/dL and/or positive Utox) and nonintoxicated (BAL <0.08 g/dL and negative Utox) patients.Conclusions: The presence of ethanol and/or illicit drugs did not affect the ability of BD or lactate to identify patients with major injuries.
A Multicasualty Event: Out‐of‐hospital and In‐hospital Organizational Aspects
Authors: Avitzour Malka , Libergal Meir , Assaf Jacob , Adler Jakov , Beyth Shaul , Mosheiff Rami , Rubin Amir , Feigenberg Zvi , Slatnikovitz Ruth , Gofin Rosa , Shapira Shmuel Chaim 
Published: October 2004

AbstractIn a wedding celebration of 700 participants, the third floor of the hall in which the celebration was taking place suddenly collapsed. While the walls remained intact, all three floors of the building collapsed, causing Israel's largest disaster. Objectives: To study the management of a multicasualty event (MCE), in the out‐of‐hospital and in‐hospital phases, including rescue, emergency medical services (EMS) deployment and evacuation of casualties, emergency department (ED) deployment, recalling staff, medical care, imaging procedures, hospitalization, secondary referral, and interhospital transfer of patients. Methods: Data on all the victims who arrived at the four EDs in Jerusalem were collected through medical files, telephone interviews, and hospital computerized information. Results: The disaster resulted in 23 fatalities and 315 injured people; 43% were hospitalized. During the first hour, 42% were evacuated and after seven hours the scene was empty. Ninety‐seven basic life support ambulances, 18 mobile intensive care units, 600 emergency medical technicians, 40 paramedics, and 15 physicians took part in the out‐of‐hospital stage. At the hospitals, about 1,300 staff members arrived immediately, either on demand or voluntarily, a number that seems too large for this disaster. Computed tomography (CT) demand was over its capability. Conclusions: During this MCE, the authors observed “rotating” bottleneck phenomena within out‐of‐hospital and in‐hospital systems. For maximal efficiency, hospitals need to fully coordinate the influx and transfer of patients with out‐of‐hospital rescue services as well as with other hospitals. Each hospital has to immediately deploy its operational center, which will manage and monitor the hospital's resources and facilitate coordination with the relevant institutions.
Care in the Emergency Department: How Crowded Is Overcrowded?
Authors: Hwang Ula , Concato John 
Published: October 2004

Abstract Objectives: To examine how emergency department (ED) overcrowding has been defined in the medical literature. Methods: Using the National Library of Medicine's PubMed and MEDLINE databases (1966 to 2002), a comprehensive review of the English‐language medical literature was conducted to identify explicit criteria for defining ED overcrowding. Inclusion criteria were original articles, editorials, and reviews; news articles and letters to the editor were excluded. Using a standardized extraction form, publications were described as primary if the title or an objective statement in the introductory or methods paragraph referred to crowding or overcrowding; all other citations were categorized as secondary. Each report was then evaluated to determine whether crowding or overcrowding was defined explicitly or implicitly. Explicit definitions included phrases such as “Crowding was defined as …” or “Overcrowding occurred when …”; other definitions were characterized as implicit. Results: A total of 231 candidate articles were identified; 91 met inclusion criteria, and 53 (58%) were primary articles about ED crowding or overcrowding. Among these primary articles, 23 (43%) had explicit definitions of crowding or overcrowding. The definitions varied widely in content and focus, including ED, hospital, or external (nonhospital) factors. Conclusions: Although ED overcrowding has been a topic of frequent investigation, current definitions of the problem are often implicit or focus on factors outside of the ED itself. A more consistent approach to defining ED overcrowding would help to clarify the distinctions between causes, characteristics, and outcomes of overcrowding.
Advanced Opportunities for Student Education in Emergency Medicine
Authors: Pacella Charissa B. 
Published: October 2004

AbstractMany medical students are excited about emergency medicine (EM) following a standard clerkship and seek out additional learning opportunities. An advanced EM elective may accomplish several educational goals, including development of clinical skills in evaluating the undifferentiated patient, broader exploration of the field of EM, and more focused study of one particular aspect of EM. Previously cited examples include pediatric EM, medical toxicology, occupational medicine, sports medicine, and EM research. Numerous other EM specialty courses for senior medical students are emerging, as reflected in the “Undergraduate Rotations” listings on the Society for Academic Emergency Medicine. A few examples drawn from the list include emergency ultrasound, international EM, wilderness medicine, disaster medicine, geriatric EM, and hyperbaric medicine. Educators aspiring to develop, or in the process of developing, an advanced EM elective may benefit from a brief overview of necessary course considerations, including didactic format, the clinical role of the medical student in the emergency department, and involvement with patient procedures. Suggestions are made regarding additional educational opportunities, including follow‐up of patients seen in the emergency department and development of an emergency department radiology case file. This article also addresses several related concerns, including suggested prerequisites, administration and cost considerations, appropriate didactic topics, and methods for evaluating students. Several EM subspecialty areas, namely pediatric EM, medical toxicology, and out‐of‐hospital care, are specifically discussed. Formal advanced cardiac life support training is also often included in an advanced EM elective and is briefly discussed. The overall intent of this article is to provide medical student educators with resources and ideas to assist them in developing a unique advanced EM elective.
GABAergic System Gene Expression Predicts Clinical Outcome in Patients With Neuroblastoma
Authors: Roberts Stephen S. , Mori Motomi , Pattee Patrick , Lapidus Jodi , Mathews Ravi , O'Malley Jean P. , Hsieh Yi Ching , Turner Mark A. , Wang Zhaohong , Tian Qi , Rodland Matthew J. , Reynolds C. Patrick , Seeger Robert C. , Nagalla Srinivasa R. 
Published: October 2004

Purpose Neuroblastoma (NB) is a common childhood malignancy characterized by heterogeneous clinical behavior. The purpose of this study was to identify potential NB biomarkers that may improve outcome prediction. Patients and Methods The suppression subtractive hybridization (SSH) technique was used to identify the genes differentially expressed between NB and control tissue. RNA isolated from 235 primary NB tumor samples obtained from the Children's Cancer Group was evaluated for expression of the candidate markers using quantitative reverse transcriptase polymerase chain reaction (Taqman assays). The association between the mRNA expression levels in the identified candidate genes and clinical outcome was evaluated. Results SSH analysis identified differential expression of members of the GABAergic gene family in NB. Lower levels of gamma-aminobutyric acid (GABA) receptor–associated protein (GABARAP) gene expression predict decreased survival among all patients. GABAA δ receptor subunit gene expression was predictive of a poor outcome among Evans stage IV-S patients. An index of five coexpressed GABAA receptor subunits was identified (GABAA profile [GAP score]). Patients with a higher GAP score (> −1) had a survival advantage. Multivariate analysis showed that GABARAP and GABAA α2 receptor subunit gene expression levels and GAP score remained predictors of clinical outcome after accounting for current prognostic indicators. Conclusion Dysregulation of the GABAergic system may constitute a fundamental event in the development of NB, and assessment of GABAergic system gene expression could provide improved patient stratification and potential new therapies.
Suicide Risk in Cancer Patients From 1960 to 1999
Authors: Hem Erlend , Loge Jon H. , Haldorsen Tor , Ekeberg Øivind 
Published: October 2004

Purpose Suicide risk is reportedly higher for cancer patients than for the general population, but estimates vary and analyses of trends are few. The aim of the present study was to determine whether cancer patients had a higher suicide risk between 1960 and 1999. Patients and Methods A cohort comprising patients from the Cancer Registry of Norway 1960 to 1997 was linked to suicide diagnosis in the Register of Deaths at Statistics Norway and observed during 1960 to 1999. The cohort consisted of all cancer patients registered in the Cancer Registry of Norway 1960 to 1997 (N = 490,245 patients with 520,823 cancer diagnoses). Suicide was defined according to death certificates based on the International Classification of Diseases (versions 7, 8, 9, and 10). Results During the period, 589 cancer patients (407 males and 182 females) committed suicide. The relative risk was elevated for males and females, with standardized mortality ratios (SMRs) of 1.55 (95% CI, 1.41 to 1.71) and 1.35 (95% CI, 1.17 to 1.56), respectively. Risk was highest in the first months after diagnosis. For both sexes, there was a significant decrease in the relative suicide risk over decades. The risk was markedly increased among male patients with cancer of respiratory organs (SMR, 4.08; 95% CI, 2.96 to 5.47). Otherwise, the SMRs varied from 0.76 to 3.67 across cancer types. Conclusion Cancer may be a risk factor for suicide, particularly shortly after diagnosis. However, the relative risk gradually decreased during the period 1960 to 1999.