bluuebunny/crossref_metadata_2025_split huggingface dataset:
Workplace factors leading to planned reduction of clinical work among emergency physicians
Authors: Crook Heather D , Taylor David McD , Pallant Julie F , Cameron Peter A 
Published: February 2004

AbstractObjective:  There is anecdotal evidence that ACEM Fellows are reducing or planning to reduce their clinical workload. We investigated the extent of, and reasons for, these reductions.Methods:  An anonymous, cross‐sectional postal survey utilizing a study‐specific questionnaire.Results:  Three hundred and twenty‐three Fellows (63.5%) responded. Most were recently graduated males. In the last 5 years, the mean number of clinical hours worked per week has reduced significantly (P < 0.001) for both junior (40.6–28.9 h) and senior Fellows (30.4–23.1 h). Further significant (P < 0.001) reductions are planned. The most frequently reported reasons for reducing clinical workload were excessive workload, family life and emotional health effects, shift work and work stress. The most stressful aspects of work reported were access block, dealing with management, insufficient staffing, workload pressures and staff supervision. Clinical work reportedly impacts most upon family life, social life and emotional health.Conclusions:  Fellows are significantly reducing their clinical workload largely in response to excessive workload and lack of resources. These findings have important implications for professional longevity and work force planning. Re‐evaluation of workplace practice, especially identified stressors, is indicated.
The psychological health of emergency physicians in Australasia
Authors: Taylor David McD , Pallant Julie F , Crook Heather D , Cameron Peter A 
Published: February 2004

AbstractObjective:  To evaluate the psychological health of ACEM Fellows and the important factors that impact on this health.Methods:  A cross‐sectional, mail survey utilizing validated psychological instruments.Results:  Three hundred and twenty‐three (63.5%) of 510 physicians responded. Most were recently graduated males. Compared to a general population sample, their psychological health was good with greater optimism and mastery (P < 0.001), less anxiety, depression and physical symptoms (P < 0.001), better life satisfaction (P = 0.04) and similar perceived stress (P = 0.20). The mean work stress score (1 = low, 10 = high) was 5.6 ± 2.1 (moderate stress) although 63 (19.5%) had very high scores (8–10). The mean work satisfaction score was 6.3 ± 2.1 (moderate satisfaction) although 43 (13.3%) had very low scores (1–3). Perceptions of control over hours worked and mix of professional activities were positively associated with work and life satisfaction (P < 0.001) and negatively associated with work stress and measures of wellbeing (P < 0.001). Most employed adaptive coping strategies. However, maladaptive strategies (alcohol/drugs, denial, disengagement) were positively associated with anxiety, depression and stress (P < 0.001).Conclusions:  Most physicians are psychologically healthy. However, there appears to be a subgroup that is not thriving. Workplace stress should be addressed promptly and greater flexibility provided over hours worked and mix of professional activities.
Pharmacological therapy of acute cardiogenic pulmonary oedema in the emergency department
Authors: Graham Colin A 
Published: February 2004

AbstractThis paper critically reviews the major drug types that are currently used in the management of acute cardiogenic pulmonary oedema. As decompensated heart failure becomes an increasingly common problem in emergency departments in the developed world, optimization of emergency drug therapy for these critically ill patients is essential. The evidence base for ‘routine therapy’ in the ED is considered. The review also briefly considers emerging pharmacological therapies that may have an impact on future management of cardiogenic pulmonary oedema.
Cyclooxygenase‐2 inhibitors: Do they have a role in emergency department prescribing?
Authors: Wilton Tanya 
Published: February 2004

AbstractCyclooxygenase‐2 selective inhibitors (COXIB or CSI) have been released with a fanfare as efficacious and safer alternatives to traditional non‐steroidal anti‐inflammatory drugs. They purport to offer equivalent degrees of analgesia and an improved safety profile. COXIB currently available in Australasia are celecoxib (Celebrex), rofecoxib (Vioxx) and etoricoxib (Arcoxia). This review discusses the pharmacology of these agents and reviews recent literature regarding their effectiveness and safety. It endeavours to answer the question ‘Should we be using COXIB in emergency departments in Australasia’?
Anaphylaxis to trimethoprim: An under‐appreciated risk in acute medical care
Authors: Nordstrand Indra AJ 
Published: February 2004

AbstractAnaphylaxis is a severe, systemic allergic reaction, which is frequently unexpected and carries a high mortality risk as a medical emergency. Anaphylaxis to trimethoprim is not a well recognized event. Since trimethoprim represents the leading antibiotic for the treatment of urinary tract infections, its potential to cause anaphylaxis needs to be recognized, whether alone or as the ‘active’ ingredient in cotrimoxazole (trimethoprim‐sulphamethoxazole combination), by those prescribing it and those providing acute care. A case of probable anaphylaxis following trimethoprim ingestion is presented with discussion supporting its potency including evidence at an immunological level highlighting its under‐appreciated risk in acute medical care.
Pilot study of metropolitan emergency department workload complexity
Authors: Sprivulis Peter 
Published: February 2004

AbstractObjective:  Assessment of emergency department (ED) patient complexity using the number of procedures, investigations or consultations (PICsum).Methods:  Retrospective analysis of 12 months of data from an adult metropolitan teaching hospital ED.Results:  A bimodal distribution of PICsum (modal peaks, PICsum 1 and 7) was observed in all Australasian Triage Scale, disposition, mode of arrival, age and referral source groups. Patients requiring a minimum of two procedures or a minimum of two investigations or a minimum of two consultations (Min2 patients) comprised 59% (95% CI 58.5–59.5) of total patients 93% (95% CI 92.5–93.8) of total PICsum. Age is highly correlated with Mean PICsum (Pearson r = 0.98, P < 0.001) and the proportion of Min2 patients (Pearson r = 0.98, P < 0.001).Conclusions:  An intuitive partition in the complexity distribution is identified at up to one procedure, one investigation and one consultation. Patient age is correlated with complexity and ED age distribution may be a useful proxy for complexity, particularly if used in conjunction with validated age versus complexity tables.
Chondrocyte Viability in Refrigerated Osteochondral Allografts Used for Transplantation within the Knee
Authors: Pearsall Albert W. , Tucker J. Allan , Hester Raymond B. , Heitman Robert J. 
Published: February 2004

Purpose To evaluate cell viability and matrix characteristics of refrigerated osteochondral allografts implanted up to 44 days after harvest. Methods Sixteen refrigerated allografts underwent histologic and ultrastructural examination and fluorescence excitation analysis prior to implantation. The average size of the graft implanted was 6.2 cm2 (± 3.4 cm2). Refrigerated allografts averaged 30 days (range, 17 to 44 days) from donor expiration to implantation. Nine specimens underwent cell viability testing. The percent viability of refrigerated allografts prior to implantation averaged 67%. Results No significant correlations were noted between histologic score, electron microscopy score, matrix staining percent (MSP) score, and viability. When time to implantation was assessed, an inverse correlation was noted with MSP score (r= .539) (P< 0.05), indicating less matrix staining in grafts refrigerated longer after harvest. Conclusion The current data indicate that refrigerated osteochondral allografts can be maintained for up to 44 days with average chondrocyte viability of 67%.
Ultrasonographic and Power Doppler Evaluation of the Patellar Tendon Ten Years after Harvesting Its Central Third for Reconstruction of the Anterior Cruciate Ligament
Authors: Järvelä Timo , Paakkala Timo , Kannus Pekka , Toivanen Jarmo , Järvinen Markku 
Published: February 2004

Background The long-term morphologic changes in the patellar tendon after harvesting its central third for the reconstruction of the anterior cruciate ligament have not been reported. Hypothesis Sonographic morphologic changes in the harvested patellar tendon are common 10 years after the harvesting procedure. Study Design Retrospective cohort study. Methods Thirty-one patients who had undergone an anterior cruciate ligament reconstruction using central-third bone-patellar tendon-bone autograft with a closure of the patellar tendon defect were included in this study. An ultrasonographic and Power Doppler examination was performed at a mean follow-up of 10 years. Results Ultrasonography of the harvested patellar tendon showed intratendinous calcification in 9 patients, hypoechoic lesion in 20 patients, hyperechoic lesion in 1 patient, and peritendinous changes in 1 patient. Only 3 (9.7%) of the 31 patients had no changes in the harvested patellar tendon. No abnormality was visible in the contralateral (normal) patellar tendons of the 31 patients. The harvested patellar tendon was significantly thicker than the contralateral patellar tendon (P < 0.05). Conclusions Sonographic morphologic changes of the patellar tendon were common 10 years after the harvesting procedure, although no evidence of inflammatory process, as could be seen in Power Doppler flow, was found inside of any patellar tendon.
Augmentation of Femoral Fixation in Hamstring Anterior Cruciate Ligament Reconstruction with a Bioabsorbable Bead
Authors: Arneja Shalinder , Froese Warren , MacDonald Peter 
Published: February 2004

Background The EndoPearl is an adjunct to bioabsorbable interference screw fixation in the femoral tunnel in anterior cruciate ligament (ACL) reconstruction. The purpose of the study was to assess the clinical effectiveness of the EndoPearl using the KT-1000 Knee Arthrometer and the Mohtadi ACL Quality of Life (ACL-QOL) Questionnaire. Hypothesis The application of the EndoPearl in hamstring ACL reconstruction has no significant benefit when compared to conventional treatment in KT-1000 and ACL-QOL Questionnaire outcomes. Study Design Prospective single-blind randomized clinical trial. Methods ACL reconstruction with autogenous semitendinosus and gracilis tendons was performed on 35 patients. Preoperatively, 3 months, 6 months, and 18 months postoperatively, patients’ knees were evaluated using the KT-1000 Knee Arthrometer and the ACL-QOL Questionnaire. Results Statistically significant differences were achieved in terms of KT-1000 side-to-side differences between the study group and the control group at 6 months and 18 months postoperatively; the mean side-to-side differences are significantly less in the study group when compared to the control group. Statistically significant differences were not detected when comparing the ACL-QOL Questionnaire between the two groups at all time intervals. Conclusion The application of the EndoPearl in conjunction with a bioscrew in the femoral tunnel in autogenous ACL reconstruction using semitendinosus and gracilis tendon grafts provides a significantly decreased laxity up to 18 months postoperatively in terms of KT-1000 side-to-side differences.
Increased Injury Risk among First-Day Skiers, Snowboarders, and Skiboarders
Authors: Langran Mike , Selvaraj Sivasubramaniam 
Published: February 2004

Background Inexperience predisposes skiers, snowboarders, and skiboarders to a higher risk of injury. Hypothesis Individuals on their very 1st day's experience of skiing, snowboarding, or skiboarding are at greater risk of injury. Study Design Case control study. Methods All individuals injured at the three largest ski areas in Scotland during the three winter seasons 1999-2000 through 2001-2002 were included. First-day participants were identified. Individual demographic details and snow sports–related parameters were recorded. Control data were collected from uninjured individuals. Factors associated with injury were explored in univariate and multivariate analyses. Results First-day participants were overrepresented in the injured population by a factor of 2.2. Participant age younger than 17 years or older than 26 years, snowboarding, taking professional instruction, and the use of rented or borrowed gear were all independently associated with increased injury risk among 1st-day participants. Conclusions First-day participants are at increased risk of injury. Several independent risk factors for injury have been identified. Clinical Relevance First-day participants should be targeted in any future educational programs with emphasis on gear selection, use of protective gear, and the risks of exceeding the limits of their ability.
Chondrocyte Survival and Material Properties of Hypothermically Stored Cartilage
Authors: Williams Riley J. , Dreese James C. , Chen Chih-Tung 
Published: February 2004

Background There is little information available on the material properties of hypothermically stored allograft specimens used to repair osteochondral defects. Purpose To analyze the effect of hypothermic storage on the material properties of fresh knee specimens over a 60-day interval. Study Design Controlled laboratory study. Methods Twelve sheep knee condyles were isolated. The femoral and tibial condyles and the patella were stored in a nutritive medium containing Dulbecco's Modified Eagle's Medium for 1, 8, 15, 29, 45, or 60 days. Total chondrocyte density, chondrocyte viability, matrix proteoglycan content, matrix water content, and matrix dynamic modulus of elasticity were determined. Results Mean chondrocyte viability decreased significantly over the storage interval: 100% (day 1), 98.2% (day 8), ∗80.2% (day 15), ∗80.6% (day 29), ∗64.6% (day 45), and ∗51.6% (day 60) (∗ P< 0.05). Qualitative analysis demonstrated a preponderance of nonviable chondrocytes in the superficial cartilage layer. Significant decreases in matrix proteoglycan were observed in day 15 through day 60 specimens (P< 0.05). The matrix dynamic modulus significantly decreased from day 1 through day 60 (P< 0.05). Conclusion The material properties of hypothermically stored knee condyles progressively decline over 60 days. Clinical Relevance This observed decline may have significant ramifications on long-term graft survival following storedallograft implantation.
Medial Ankle Instability
Authors: Hintermann Beat , Valderrabano Victor , Boss Andreas , Trouillier Hans Heinrich , Dick Walter 
Published: February 2004

Background Very little objective data are available regarding medial ankle instability. Hypothesis Several structures contribute to the stabilization of the medial ankle, and, in the case of injury, they are not involved in a uniform way. Study Design Explorative, prospective case series. Methods Fifty-one patients (52 ankles; males 27, females 25; age 36.4 [16 to 60] years) were surgically treated because of medial ankle instability. All clinical findings and structural changes, as found by arthroscopy and surgical exploration, were compared with the clinical diagnosis and then addressed for surgical reconstruction. Results Pain in the medial gutter was noted in all ankles (100%). Arthroscopy verified a clinically expected additional lateral instability in 40 ankles (77%). At 4.43 years (2 to 6.5 years) after surgical reconstruction, the clinical result was considered to be good/excellent in 46 cases (90%), fair in 4 cases (8%), and poor in 1 case (2%). Conclusion The clinical characteristics of medial ankle instability are a feeling of giving way, pain on the medial gutter of the ankle, and a valgus and pronation deformity of the foot that can typically be actively corrected by the posterior tibial muscle. Arthroscopy was shown to be a very helpful diagnostic tool in verifying medial instability.
The Medial Collateral Ligament of the Elbow is not Isometric
Authors: Armstrong April D. , Ferreira Louis M. , Dunning Cynthia E. , Johnson James A. , King Graham J. W. 
Published: February 2004

Background The anterior bundle of the medial collateral ligament (AMCL) of the elbow has been shown to be the most important valgus stabilizer of the elbow. However, the isometry of this band has not been quantified. Hypothesis Isometric fibers exist within the AMCL, and these fibers are located within its central region. Study Design Controlled laboratory study. Methods Twelve cadaveric elbow specimens were mounted in a testing apparatus in a valgus gravity-loaded orientation. Passive supinated flexion was performed and the motion recorded using an electromagnetic tracking device. Hundreds of attachment points for the AMCL of the elbow were recorded on the medial epicondyle and ulna. The overall change in length between each point on the ulna to every humeral point, throughout the arc of motion, was quantified (. L = Lmax – Lmin). The locations of the smallest. L values were determined relative to the attachment site of the AMCL on the medial epicondyle. Results True isometry was not found throughout the arc of flexion. The smallest. L values averaged 2.8 ± 1.2 mm (range: 0.7 mm to 5.2 mm). Isometric fibers do not exist within the AMCL; however, “nearly” isometric areas are located on the lateral aspect of the attachment site of the AMCL on the medial epicondyle, near the anatomic axis of rotation. Conclusions We postulate that these nearly isometric areas would be the most ideal location for graft attachment during reconstruction of the AMCL.
Sensorimotor Control is Impaired in Dancers with Functional Ankle Instability
Authors: Hiller Claire E. , Refshauge Kathryn M. , Beard David J. 
Published: February 2004

Background Factors potentially causing chronic instability after ankle inversion sprains have rarely been examined during the injuring movement. Purpose To compare control of ankle movement during quiet stance and after inversion perturbation in chronically unstable ankles (n = 16) with healthy controls (n = 26). Methods Movement control was measured as magnitude of lateral ankle oscillation, using 3SPACE Fastrak during single leg stance (baseline oscillation) in two foot positions, flat and demi-pointe. In both positions, time to resume baseline oscillation after inversion perturbation (perturbation time) of 15 ° for the flat foot and 7.5 ° on demi-pointe was also determined. Results Baseline oscillation on demi-pointe was significantly smaller (P < 0.005) for the sprained group (2.5 ± 0.5 mm) than for controls (4.0 ± 2.3 mm). Perturbation time for the flat foot was significantly longer (P < 0.05) for the sprained group (2.2 ± 0.4 seconds) than for controls (1.8 ± 0.5 seconds). However, failure rate was higher (P < 0.05) among the sprained group than controls for perturbation with the foot flat and baseline oscillation on demi-pointe. Conclusions Findings demonstrated altered sensorimotor control in chronically unstable ankles. Those sprainers who successfully completed the tasks minimized oscillation. The impairments in the sprained group may reflect deficits in either movement detection, peroneal muscle response, or both.
MR Imaging of the Hip and Knee before and after Marathon Running
Authors: Hohmann Erik , Wörtler Klaus , Imhoff Andreas B. 
Published: February 2004

Background Despite its obvious benefits regarding aerobic fitness, the possible deleterious effects of long-distance running remain controversial. The repetitive loading associated with this activity could potentially predispose to the subsequent development of osteoarthritis. Lower extremity malalignment can also result in abnormal joint loading and is another possible contributing factor for premature articular cartilage degeneration. The purpose of this study is to investigate whether external impact loading in marathon runners creates internal stresses on bone and cartilage that are demonstrable on MR images. Participants were separately assessed for static lower extremity alignment, using standard radiographs. Methods Six recreational and two semi-professional runners underwent magnetic resonance (MR) imaging of the hip and knee before and after a marathon run using coronal T1-weighted and coronal STIR sequences. Results The pre-run and post-run scans failed to demonstrate marrow oedema, periosteal stress reactions, or joint effusions in seven runners. One patient who underwent a reconstruction of his anterior cruciate ligament 18 months ago demonstrated a small effusion in the reconstructed knee before and after the race. Conclusions Our results suggest that the high impact forces in long-distance running are well tolerated and subsequently do not demonstrate changes on MR images.
The Effect of Bracing on Patellofemoral Joint Stress during Free and Fast Walking
Authors: Powers Christopher M. , Ward Samuel R. , Chen Yu-jen , Chan Li-der , Terk Michael R. 
Published: February 2004

Background Although several studies have demonstrated decreases in patellofemoral pain (PFP) with the application of bracing, the mechanism by which bracing reduces symptoms has not been elucidated. Hypothesis Individuals who responded favorably to bracing will exhibit decreased patellofemoral stress during level walking. Study Design Repeated measures, cross-sectional. Methods Fifteen subjects with a diagnosis of PFP completed two phases of data collection: 1) MRI assessment of patellofemoral contact area and 2) gait analysis. Data were obtained under braced and nonbraced conditions. Variables obtained from both data collection sessions were used as input variables into a mathematical model to quantify patellofemoral stress. Results Subjects reported a 56% reduction in pain following bracing. Bracing significantly reduced peak stress during free and fast walking (17% and 27%, respectively). The decrease in stress was the result of increased contact area as patellofemoral joint reaction forces were increased following bracing. Conclusion Bracing resulted in a larger increase in patellofemoral contact area than the increase in joint reaction force, resulting in a decrease in joint stress. Clinical Relevance The results of this study suggest a possible mechanism by which bracing may be effective in reducing PFP and provides experimental support for the use of this treatment method.
Wakeboarding Injuries
Authors: Carson William G. 
Published: February 2004

Background Wakeboarding is a popular water sport that has the potential to produce serious injuries. To date, there has been only one article describing an injury caused by wakeboarding. Hypothesis Wakeboarding injuries are common. Study Design Analysis of data obtained from physician and patient questionnaires. Methods Analysis of questionnaire data obtained from 156 orthopaedic surgeons and 86 wakeboarders. Results Of 156 orthopaedic surgeons completing a wakeboarding injuries questionnaire, 49% reported no wakeboarding injuries, 36% (57) reported treating at least 1 wakeboarding injury, and 15% had never heard of wakeboarding. Fifty-seven orthopaedic surgeons reported 122 injuries, of which 47% were either anterior cruciate ligament (ACL) tears (31%) or shoulder dislocations (15%). In addition, 21% of all the injuries were some type of fracture. Of 86 wakeboarders completing the injuries survey, 77% reported sustaining an injury. There were 82 reported injuries in this group, of which 34% were either ACL tears (17%) or ankle sprains (17%). Conclusions This survey of wakeboarding injuries demonstrates that serious injuries can occur from participation in this sport. The most common injuries reported were ACL tears, shoulder dislocations, and ankle sprains. In addition, 21% of all the injuries were some type of fracture.