Medical Specialties Commons^™

Does A Dedicated Pediatric Team Within A Busy Mixed Emergency Department Make A Difference In Waiting Times, Satisfaction, And Care Transition?, Gerben Keijzers, Julia Crilly, Benjamin Walters, Rosalind Crawford, Christa Bell

Gerben Keijzers

Objectives: To evaluate the impact of a dedicated, free-floating, pediatric-targeted care delivery model on emergency department (ED) waiting times, parent satisfaction, and transition of care.

Methods: A prospective, observational study was conducted between July 16 and August 12, 2007. It incorporated a before-and-after design with a 2-week preintervention and a 2-week intervention group. In the intervention period, the pediatric ED initiative (PEDI) team was introduced, which consisted of a free-floating doctor and nurse equipped to see pediatric patients. Consenting patients/parents were followed up by telephone 7 to 14 days after discharge regarding satisfaction and waiting times.

Results: …

Systematic Review Of The Effect Of Aerobic And Resistance Exercise Training On Systemic Brain Natriuretic Peptide (Bnp) And N-Terminal Bnp Expression In Heart Failure Patients, N. Smart, M. Steele

Neil Smart

Background: BNP and the N-terminal portion (NT-pro-BNP) have emerged as powerful tools in the diagnosis and prognosis of heart failure on acute presentation. The aim of this work was to systematically review the effect of exercise training on BNP and NT-pro-BNP levels in patients with left ventricular dysfunction. Methods: A systematic search was conducted of Medline (Ovid) (1950–July 2008), Embase.com (1974–current), Cochrane Central Register of Controlled Trials, CINAHL (1981–current) and Web of Science (2000–current) to identify randomized controlled trials of aerobic and/or resistance exercise training in heart failure patients that measured BNP and/or pro-BNP. Primary outcome measures were changes in …

Clinical Diagnostic Criteria For Isolating Patients Admitted To Hospital With Suspected Pandemic Influenza, John Gerrard, Gerben Keijzers, Ping Zhang, Caleb Vossen, Deborough Macbeth

Gerben Keijzers

Extract: Australian hospitals have now experienced the first wave of pandemic H1N1 influenza during a southern hemisphere winter. Patients admitted to Australian hospitals with suspected pandemic influenza during this period were identified by use of approved national clinical diagnostic criteria. However, the imprecise nature of clinical diagnosis limited the ability of hospitals to isolate infectious patients effectively before the laboratory confirmation of infection (which typically takes a minimum of 48 h).

Single Drug Sedation With Fentanyl For Postintubation Sedation In Trauma Patients, Christopher Michetti, J Maguire, A Kaushik, T Boro, R Pullarkat, A Rizo, H Seoudi, M Meehan, L Robinson

Christopher P. Michetti, M.D., F.A.C.S.

No abstract provided.

Measuring Fall Risk And Predicting Who Will Fall: Clinimetric Properties Of Four Fall Risk Assessment Tools For Residential Aged Care, Anna Barker, Jennifer Nitz, Nancy Low Choy, Terry Haines

Nancy Low Choy

Background: The purpose of this prospective cohort study was to describe the clinimetric evaluation of four fall risk assessment tools (FRATs) recommended in best practice guidelines for use in residential aged care (RAC). Methods: Eighty-seven residents, mean age 81.59 years ( SD ± 10.69), participated. The Falls Assessment Risk and Management Tool (FARAM), Peninsula Health Fall Risk Assessment Tool (PHFRAT), Queensland Fall Risk Assessment Tool (QFRAT), and Melbourne Fall Risk Assessment Tool (MFRAT) were completed at baseline, and 2 and 4 months, and falls occurring in the 6 months after the baseline assessment were recorded. Interrater agreement (kappa), predictive accuracy …

Sex Differences In Symptom Presentation Associated With Acute Myocardial Infarction: A Population-Based Perspective, Robert Goldberg, Caitlin O'Donnell, Jorge Yarzebski, Carol Bigelow, Judith Savageau, Joel Gore

Jorge L. Yarzebski

OBJECTIVES: To describe sex differences in symptom presentation after acute myocardial infarction (AMI) while controlling for differences in age and other potentially confounding factors. BACKGROUND: Although several studies have examined sex differences in diagnosis, management, and survival after AMI, limited data exist about possible sex differences in symptom presentation in the setting of AMI. METHODS: Community-based study of patients hospitalized with confirmed AMI in all 16 metropolitan Worcester, Mass., hospitals (1990 census population = 437,000). Men (n = 810) and women (n = 550) hospitalized with validated AMI in 1986 and 1988 comprised the study sample. RESULTS: After simultaneously controlling …

Effect Of Elevated Leukocyte Count On In-Hospital Mortality Following Acute Myocardial Infarction, Mark Furman, Richard Becker, Jorge Yarzebski, Judith Savageau, Joel Gore, Robert Goldberg

Jorge L. Yarzebski

The peripheral white blood cell count on presentation with acute myocardial infarction directly correlates with short-term in-hospital mortality. This association is independent of other prognostic factors, including extent and size of the acute myocardial infarction.

Differences In Discharge Medication After Acute Myocardial Infarction In Patients With Hmo And Fee-For-Service Medical Insurance, Danny Mccormick, Jerry Gurwitz, Judith Savageau, Jorge Yarzebski, Joel Gore, Robert Goldberg

Jorge L. Yarzebski

OBJECTIVE: To assess the impact of fee-for-service (FFS) versus HMO medical insurance coverage on receipt of aspirin, beta-blockers, and calcium channel blockers at the time of hospital discharge following an acute myocardial infarction. DESIGN: Prospective, population-based study. SETTING: All 16 community and tertiary care hospitals in the metropolitan area of Worcester, Massachusetts. PATIENTS: The study population consisted of patients under 65 years of age hospitalized with a validated acute myocardial infarction in all hospitals in the Worcester (Massachusetts) Standard Metropolitan Statistical Area (1990 census estimate, 437,000) during 1986, 1988, 1990, 1991, and 1993. MEASUREMENTS AND MAIN RESULTS: After adjustment for …

Age-Related Trends (1986-1993) In The Use Of Thrombolytic Agents In Patients With Acute Myocardial Infarction. The Worcester Heart Attack Study, Harish Chandra, Jorge Yarzebski, Robert Goldberg, Judith Savageau, Colleen Singleton, Jerry Gurwitz, Joel Gore

Jorge L. Yarzebski

OBJECTIVE: To examine age-related differences and temporal trends in the use of thrombolytic therapy in a community-wide study of patients hospitalized with acute myocardial infarction (AMI) between 1986 and 1993. METHODS: All hospitals in the Worcester, Mass, metropolitan area (1990 census population, 4370000) were included. A total of 3824 patients with validated AMI categorized according to age comprised the study sample: younger than 55 years (n = 577), 55 to 64 years (n = 758), 65 to 74 years (n = 1143), and 75 years or older (n = 1346). RESULTS: Use of thrombolytic therapy increased during the period under …

Health Insurance Coverage And Outcome Following Acute Myocardial Infarction. A Community-Wide Perspective, Silvia Kreindel, Ronald Rosetti, Robert Goldberg, Judith Savageau, Jorge Yarzebski, Joel Gore, Arthur Russo, Carol Bigelow

Jorge L. Yarzebski

BACKGROUND: Several studies have suggested that type of medical insurance coverage is associated with hospital utilization rates and receipt of selected diagnostic or treatment approaches. To our knowledge no studies, however, have examined the relation between medical insurance coverage and short-term outcomes following acute myocardial infarction (AMI) from a multihospital, community-wide perspective. OBJECTIVE: To examine the association between medical insurance coverage and in-hospital case-fatality rates as well as length of hospital stay following AMI. METHODS: The study sample consisted of 3735 residents of the Worcester, Mass, metropolitan area hospitalized with validated AMI during 1986, 1988, 1990, 1991, and 1993 at …

Qualidade De Vida No Trabalho: Indicadores E Instrumentos De Medidas / Quality Of Work Life: Indicators And Instruments Of Measure, Everton Fernando Alves

Everton Fernando Alves

The measurement of Quality of Life at Work (QLW) has been emerging in the scientific community as an important tool for investigating and evaluating the occupational health of individuals in a holistic manner. The measurement instruments are developed for many different purposes and directions, being held by generic scales of health status and specific scales to a given situation. The objective of this study is to discuss important aspects related to QLW and present in a systematic concept, indicators and measurement instruments used and validated in Brazil. Was conducted a study of narrative review of available knowledge in the literature, …

Inhibitory Effect Of Monocyte Reactive Antibodies On Monocyte Chemotaxis In Systemic Lupus Erythematosus, Gyula Szegedi, Katalin Lukacs, E. Bodolay, L. Gulacsi, Ildiko Sonkoly, Gyongyi Szabo, J. Szollosi

Gyongyi Szabo

Presence of different types of autoantibodies is a basic feature of systemic lupus erythematosus (SLE). Though monocytes, macrophages play an important role in cellular immunity, autoantibodies against monocytes have not been sufficiently studied. The authors used automatic fluorochromatic assay to detect monocyte reactive autoantibodies in the sera of SLE patients. Of SLE 35.5% sera showed complement-mediated monocytotoxic activity against healthy monocytes. Monocyte reactive SLE sera as well as monoclonal antibodies against human monocytes inhibited chemotaxis of control monocytes. The results suggest that monocyte reactive autoantibodies may play a role in the decreased monocyte number and defective monocyte functions observed in …

Polymorphonuclear Functions In Patients With Mixed Connective Tissue Disease, E. Bodolay, Katalin Lukacs, G. Frendl, Gyongyi Szabo, G. Arato, Gyula Szegedi

Gyongyi Szabo

Polymorphonuclear leukocytes (PMNs) from 29 patients with mixed connective tissue disease (MCTD) were studied "in vitro" for their phagocytic and chemotactic function as well as for granulocyte alkaline phosphatase (GAP) activity. Fc-receptor expression detected by EA-rosette formation was comparable to the control. Yeast-phagocytosis, C3b-receptor mediated phagocytosis and chemotaxis of PMNs, however, significantly decreased in MCTD. At the same time, photometric measure of alkaline phosphatase activity indicated a nearly two fold increase in PMNs from patients with MCTD. Although no correlation was found between PMN functions and the activity of the disease, PMN disorders may play a role in pathogenesis of …

Monocyte Functions In Patients With Mixed Connective Tissue Disease, E. Bodolay, Katalin Lukacs, Gyongyi Szabo, G. Frendl, T. Ben, Gyula Szegedi

Gyongyi Szabo

The authors investigated the number and functions of peripheral blood monocytes in patients with mixed connective tissue disease. Moderate monocytopenia was detected in the active stage of the disease. There was a close correlation between the sensitized sheep red blood cell binding capacity of monocytes and the elevated levels of circulating immune complexes. The yeast phagocytosis of monocytes and the chemotactic activity were normal in patients with mixed connective tissue disease. C3b receptor mediated phagocytosis of monocytes decreased in the active and inactive stages of the disease. This study suggests that the decreased function of C3b receptors of monocytes is …

Selective Induction Of Mononuclear Phagocytes To Produce Neopterin By Interferons, Gabriele Bitterlich, Gyongyi Szabo, Ernst Werner, C. Larcher, Dietmar Fuchs, Arno Hausen, Gilbert Reibnegger, T.F. Schulz, J. Troppmair, Helmut Wachter

Gyongyi Szabo

Interferon-gamma (IFN-gamma) has been shown to be a potent inducer of neopterin secretion by human peripheral blood monocytes/macrophages (1). In this paper, it is shown that other known stimuli of monocytes (e.g., to secrete proteases or to migrate) such as zymosan-activated human serum, lipopolysaccharide, human C3/iC3 and zymosan coated with complement were unable to trigger monocytes/macrophages to release neopterin. Monocytes/macrophages could be stimulated solely by IFN-gamma (25 U/ml) and IFN-alpha at very high concentrations (10,000 U/ml). In the case of human peripheral blood mononuclear cells (PBMNC), basically the same pattern was observed. If however, in the buffer controls PBMNC showed …

Spontaneous Contractions Of The Pig Urinary Bladder: The Effect Of Atp-Sensitive Potassium Channels And The Role Of The Mucosa, Hironobu Akino, Christopher Chapple, Neil Mckay, Rebecca Cross, Shigetaka Murakami, Osamu Yokoyama, Russ Chess-Williams, Donna Sellers

Donna Sellers

To investigate the influence of the mucosa on the inhibitory effects of the ATP-sensitive potassium channel (KATP channel) opener, cromakalim, on the spontaneous contractions of pig bladder strips from the bladder dome and trigone. Little is known about the influence of the mucosa on spontaneous contractions and whether the nature of these contractions differs between the bladder dome and trigone.

MATERIALS AND METHODS
Paired longitudinal strips of female pig bladders were isolated from the dome and trigone. The mucosa was removed from one strip per pair and tissues were set up in organ baths. Spontaneous activity was allowed to develop …

Spontaneous Contractions Of The Pig Urinary Bladder: The Effect Of Atp-Sensitive Potassium Channels And The Role Of The Mucosa, Hironobu Akino, Christopher Chapple, Neil Mckay, Rebecca Cross, Shigetaka Murakami, Osamu Yokoyama, Russ Chess-Williams, Donna Sellers

Russ Chess-Williams

To investigate the influence of the mucosa on the inhibitory effects of the ATP-sensitive potassium channel (KATP channel) opener, cromakalim, on the spontaneous contractions of pig bladder strips from the bladder dome and trigone. Little is known about the influence of the mucosa on spontaneous contractions and whether the nature of these contractions differs between the bladder dome and trigone.

MATERIALS AND METHODS
Paired longitudinal strips of female pig bladders were isolated from the dome and trigone. The mucosa was removed from one strip per pair and tissues were set up in organ baths. Spontaneous activity was allowed to develop …

A Prospective Study Of Physician-Observed Concussion During Junior Ice Hockey: Implications For Incidence Rates, Paul Echlin, Charles Tator, Michael Cusimano, Robert Cantu, Jack Taunton, Ross Upshur, Craig Hall, Andrew Johnson, Lorie Forwell, Elaine Skopelja

Andrew M. Johnson

No abstract provided.

The Beta3-Adrenoceptor Mediates The Inhibitory Effects Of Beta-Adrenoceptor Agonists Via The Urothelium In Pig Bladder Dome, Koichi Masunaga, Christopher Chapple, Neil Mckay, Masaki Yoshida, Donna Sellers

Donna Sellers

Aims: Relaxation of detrusor muscle via b-adrenoceptors may contribute to urine storage during bladder filling. Thus there is increasing interest in b-adrenoceptor agonists as a potential treatment for detrusor overactivity. The role of the urothelium in bladder responses to b-adrenoceptor agonists is not yet clear, although we have shown that these agonists have a greater inhibitory effect on detrusor contraction when the urothelium is intact. The aim was to determine which b-adrenoceptor subtype is involved in this effect.

Methods: Paired strips of pig bladder dome mucosa-intact and mucosa-denuded, were mounted in tissue baths. Relaxation responses were obtained to b-adrenoceptor agonists …

Return To Play After An Initial Or Recurrent Concussion In A Prospective Study Of Physician-Observed Junior Ice Hockey Concussions: Implications For Return To Play After A Concussion, Paul Echlin, Charles Tator, Michael Cusimano, Robert Cantu, Jack Taunton, Ross Upshur, Michael Czarnota, Craig Hall, Andrew Johnson, Lorie Forwell, Molly Driediger, Elaine Skopelja

Andrew M. Johnson

Object. The authors investigated return-to-play duration for initial and recurrent concussion in the same season in 2 teams of junior (16–21-year-old) ice hockey players during a regular season. Methods. The authors conducted a prospective cohort study during 1 junior regular season (2009–2010) of 67 male fourth- tier ice hockey players (mean age

Finding Information By "Design": Search Strategies For Cardiothoracic And Vascular Anesthesia Literature, Denise Hersey, Viji Kurup

Denise Hersey

A Prospective Study Of Concussion Education In 2 Junior Ice Hockey Teams: Implications For Sports Concussion Education, Paul Echlin, Andrew Johnson, Suzanne Riverin, Charles Tator, Robert Cantu, Michael Cusimano, Jack Taunton, Ross Upshur, Craig Hall, Lorie Forwell, Elaine Skopelja

Andrew M. Johnson

No abstract provided.

Developing Constructs For Psychopathology Research: Research Domain Criteria, Charles A. Sanislow, Daniel S. Pine, Kevin J. Quinn, Michael J. Kozak, Marjorie A. Garvey, Robert K. Heinssen, Philip S. Wang, Bruce N. Cuthbert

Charles A. Sanislow, Ph.D.

There exists a divide between findings from integrative neuroscience and clinical research focused on mechanisms of psychopathology. Specifically, a clear correspondence does not emerge between clusters of complex clinical symptoms and dysregulated neurobiological systems, with many apparent redundancies. For instance, many mental disorders involve multiple disruptions in putative mechanistic factors (e.g., excessive fear, deficient impulse control), and different disrupted mechanisms appear to play major roles in many disorders. The Research Domain Criteria (RDoC) framework is a heuristic to facilitate the incorporation of behavioral neuroscience in the study of psychopathology. Such integration might be achieved by shifting the central research focus …