Clinical and electrophysiological outcomes after eye muscle surgery in 81 adults with infantile nystagmus syndrome
METHODS:This was a prospective, single-center, interventional case series analysis of clinical and electro-phyisological data before and after surgery. Outcome measures included: clinical characteristics, surgical procedure, and preoperative and postoperative binocular best corrected visual acuity (BCVA) in the null position, anomalous head posture (AHP), contrast sensitivity, strabismic deviation, and nystagmus acuity function (NAFX). Postoperative data used were collected for a minimum of 12 months after surgery. Parametric and non-parametric statistical analysis of the outcome measures was performed.
PURPOSE:To characterize the effects of eye muscle surgery on patients older than 18 years with infantile nystagmus syndrome (INS) who have had only optical treatment.
Hertle RW; Curtis M; Boydstun I; Juric A; Evliyaoglu F; Ricker I
Journal Of Pediatric Ophthalmology & Strabismus
2021
2021-03-01
Journal Article
<table width="91" style="border-collapse:collapse;width:68pt;"><colgroup><col width="91" style="width:68pt;" /></colgroup><tbody><tr style="height:15pt;"><td width="91" height="20" class="xl18" style="width:68pt;height:15pt;"><a href="http://doi.org/10.3928/01913913-20210105-01">http://doi.org/10.3928/01913913-20210105-01</a></td>
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Most Patients With Gastroesophageal Reflux Disease Who Failed Proton Pump Inhibitor Therapy Also Have Functional Esophageal Disorders.
Aged; Humans; Male; Adult; Female; Prospective Studies; Middle Aged; Treatment Failure; Prognosis; Quality of Life; Follow-Up Studies; Proton Pump Inhibitors/therapeutic use; Esophagus; Esophageal pH Monitoring; Gastroesophageal Reflux; Heartburn; Impedance Test; Proton Pump Inhibitor; Regurgitation; Electric Impedance; Endoscopy Digestive System; Esophagus/diagnostic imaging/physiopathology; Gastroesophageal Reflux/diagnosis/drug therapy/physiopathology
BACKGROUND & AIMS: As many as 45% of patients with gastroesophageal reflux disease (GERD) still have symptoms after receiving once-daily proton pump inhibitor (PPI) therapy. We aimed to compare reflux characteristics and patterns between responders and non-responders to once-daily PPI therapy using combined impedance-pH monitoring. METHODS: Patients who reported heartburn and/or regurgitation at least twice per week for 3 months while receiving standard-dose PPI therapy were assigned to the PPI failure group (n = 16). Patients who reported a complete resolution of symptoms on once-daily PPIs for at least 4 weeks were assigned to the PPI success group (n = 13). We collected demographic data and subjects completed the short-form 36 and the GERD health-related quality of life questionnaires. Patients then underwent upper endoscopy and combined esophageal impedance-pH monitoring while on PPI therapy. RESULTS: Four patients in the PPI success group (31%) and 4 patients in the PPI failure group (25%) had abnormal results from the pH test (P = 1.00). Most of the patients in the PPI failure group (75%) were found to have either functional heartburn or reflux hypersensitivity with GERD. Impedance and pH parameters did not differ significantly between the PPI failure and success group. CONCLUSIONS: We found no difference in reflux characteristics between patients with GERD who had successful vs failed once-daily PPI therapy. Most patients in the PPI failure group (75%) had functional esophageal disorders.
Abdallah J; George N; Yamasaki T; Ganocy S; Fass R
Clinical Gastroenterology and Hepatology
2019
2019-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.cgh.2018.06.018" target="_blank" rel="noreferrer noopener">10.1016/j.cgh.2018.06.018</a>
ANTIGENIC-STIMULATION AND MULTIPLE-MYELOMA - A PROSPECTIVE-STUDY
inflammation; cancer; association; follow-up; leukemia; Oncology; rheumatoid-arthritis; risk; lymphoma; allergens; Allergy; antigens; autoimmune diseases; bacterial infections; multiple myeloma (etiology); plasma-cell; prospective studies
Background. A causal relationship between antigenic conditions and multiple myeloma was suggested by case reports. Although controlled studies identified associations with individual conditions, they failed to give overall support to the hypothesis. Using a prospective cohort representative of the U.S. population, the authors hypothesized that immune-stimulating conditions are a risk factor for multiple myeloma. Methods. The First National Health and Nutrition Examination Survey cohort of 14,407 persons were interviewed from 1971 to 1975 by the National Center for Health Statistics. Vital status with cause of death and hospitalizations were ascertained from 1982 to 1985 and in 1986. From the initial questionnaire, four risk factors were constructed: allergies (asthma, hives, hay fever, food allergies, and other allergies); autoimmune conditions (arthritis, thyroid disease and/or medication, rheumatic fever, diabetes, pernicious anemia); chronic bacterial conditions (chronic bronchitis or emphysema, chronic cough, tuberculosis, ulcers); and inflammatory conditions (gout, gallstones, recurrent or chronic enteritis, pleurisy). Results. Eighteen multiple myeloma (MM) cases were documented. The rate ratio (RR) of MM increased as the number of reported inflammatory conditions increased (one condition, RR = 2.0, 95% confidence interval [CI] = 1.2-3.3; 2 or more conditions, RR = 4.3, 95% CI = 1.5-12.4). The RR of myeloma also increased (P = 0.0002) with time since start of inflammatory conditions (RR = 1.6 for every 10 years of exposure). When cases were restricted to those with more than five years of follow-up, myeloma risk increased with the number of inflammatory conditions (two conditions, RR = 4.6, 95% CI = 1.5-13.8). Conclusions. Although the number of cases is small and exposure may be misclassified, the prospective nature of the study design strengthens the results of the study.
Bourguet C C; Logue E E
Cancer
1993
1993-10
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1002/1097-0142(19931001)72:7%3C2148::aid-cncr2820720714%3E3.0.co;2-q" target="_blank" rel="noreferrer noopener">10.1002/1097-0142(19931001)72:7%3C2148::aid-cncr2820720714%3E3.0.co;2-q</a>
Editorial Comment.
Humans; Male; Prospective Studies; *Elasticity Imaging Techniques; *Prostatic Neoplasms
Barr Richard G
The Journal of urology
2018
2018-09
<a href="http://doi.org/10.1016/j.juro.2018.03.165" target="_blank" rel="noreferrer noopener">10.1016/j.juro.2018.03.165</a>
Effectiveness of a group exercise program in a long-term care facility: a randomized pilot trial.
Female; Male; Aged; Sensitivity and Specificity; Prospective Studies; Age Factors; Sex Factors; Analysis of Variance; Patient Compliance; Pliability; Frail Elderly; Nursing Homes; Confidence Intervals; Inpatients; Human; Descriptive Statistics; P-Value; Repeated Measures; Data Analysis Software; Pilot Studies; Clinical Trials; Summated Rating Scaling; Clinical Assessment Tools; Analysis of Covariance; Outcomes (Health Care); Range of Motion; Random Assignment; Treatment Outcomes; Gerontologic Care; Long Term Care; Functional Status; Geriatric Functional Assessment; Crossover Design; Housing for the Elderly; Muscle Strengthening; Recreation; 80 and Over; Group Exercise – In Old Age
Objective:The purpose of this pilot was to determine whether a strength and flexibility program in frail long-term care facility (LTC) residents would result in improved function.Design:A prospective, randomized, controlled, semicrossover trial was designed with participants assigned either to group exercise (EX) or recreational therapy (C). In the EX group, the intervention continued for 1 year. In the C group, recreation continued for 6 months; these controls were then crossed over to the same exercise intervention as the EX group and followed for an additional 6 months. Functional outcomes were measured at baseline and 3, 6, 9, and 12 months for both groups.Setting:A LTC facility, which included both assisted living (AL) and nursing home (NH) residents.Participants:Twenty frail residents (5 from NH, 15 from AL) aged 75 to 99 years at one LTC facility.Intervention:After random group assignment, the EX group met 1 hour three times per week. An exercise physiologist and LTC staff conducted sessions which included seated range of motion (ROM) exercises and strength training using simple equipment such as elastic resistance bands (therabands) and soft weights. The C group met three times per week and participated in activities such as painting during the first 6 months, before crossing over to exercise.Measurements and Methods:Objective measures of physical and cognitive function were obtained at baseline and 3, 6, 9, and 12 months using the timed get-up-and-go test (TUG), Berg balance scale, physical performance test (PPT), and mini-mental status exam (MMSE). Because we were interested in the impact of exercise on multiple endpoints and to protect the type I error rate, a global hypothesis test was used.Results:There was a significant overall impact across the four measures of the exercise intervention (P = 0.013). Exercise benefit as indicated by the difference between exercise and control conditions showed exercise decreased TUG by 18 seconds, which represents an effect size (in standard deviation units) of 0.50, increased PPT scores by 1.3, with effect size = 0.40, increased Berg scores by 4.8, with effect size of 0.32, and increased MMSE by 3.1, with effect size = 0.54. Except for the Berg, 90% confidence intervals on these exercise effects excluded 0.Conclusion:Frail elderly in a LTC facility were able to participate and benefit from a strength training program. The program was delivered with low-cost equipment by an exercise physiologist and LTC staff. The advantage of such a program is that it provides recreational and therapeutic benefits.
Baum EE; Jarjoura D; Polen AE; Faur D; Rutechi G
Journal of the American Medical Directors Association
2003
2003-04-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s1525-8610(04)70279-0" target="_blank" rel="noreferrer noopener">10.1016/s1525-8610(04)70279-0</a>
Dactylitis: implications for clinical practice.
Adult; Female; Male; Prospective Studies; Human; Chi Square Test; Descriptive Statistics; Middle Age; Fisher's Exact Test; Diagnosis; Differential; Fingers; Toes; Gout – Complications
OBJECTIVES: To assess the specificity of dactylitis for the diagnosis of spondyloarthropathy, sarcoidosis, and gout; and to characterize dactylitis specifically associated with gout. METHODS: Dactylitis was prospectively assessed among all individuals presenting to the Arthritis Center of Northeast Ohio from 1986 to 1996. RESULTS: Dactylitis was observed in 12% of individuals with spondyloarthropathy, 17% with sarcoidosis, and 5% with gout, but not in 96 patients with rheumatoid arthritis or in 2,434 patients with osteoarthritis, neck or back pain, or collagen vascular diseases. Among individuals with spondyloarthropathy, dactylitis was present in 22% with psoriatic, 28% with Reiter's syndrome, and only 7% with undifferentiated spondyloarthropathy. Gouty dactylitis was found only in individuals with polyarticular disease. CONCLUSIONS: Dactylitis is a valuable clue in the differential diagnosis of arthritis. Compared with the wider spectrum in children, sausage-shaped digits have only a few known causes in adults: Reiter's syndrome, psoriatic arthritis, sarcoidosis, flexor tendon sheath infections, and gout. In our series, the presence of dactylitis eliminated rheumatoid arthritis from the differential diagnosis. Copyright (c) 1998 by W.B. Saunders Company
Rothschild B M; Pingitore C; Eaton M
Seminars in Arthritis & Rheumatism
1998
1998-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0049-0172(98)80027-9" target="_blank" rel="noreferrer noopener">10.1016/s0049-0172(98)80027-9</a>
Correlation of noninvasive cerebral oximetry with cerebral perfusion in the severe head injured patient: a pilot study.
Adult; Female; Male; Prospective Studies; Confidence Intervals; Human; Convenience Sample; Chi Square Test; Data Analysis Software; Pilot Studies; Middle Age; Fisher's Exact Test; Pearson's Correlation Coefficient; T-Tests; Oximetry; Monitoring; Linear Regression; Tissue Perfusion; Intracranial Pressure; Head Injuries – Therapy
BACKGROUND: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in trauma patients. Cerebral perfusion pressure (CPP) directed ICU management is recommended for patients with severe TBI. It, however, requires an invasive device to measure intracranial pressure (ICP). Transcranial cerebral oximetry is a noninvasive method utilizing near-infrared technology to indirectly measure cerebral saturation (StCO2). METHODS: A prospective observational study was performed at a Level I trauma center. Data were collected hourly for the first 6 days on four patients with severe TBI. Each patient had ICP monitoring and StCO2 (INVOS, Somanetics) assessed from each frontal lobe. CPP directed care was used. RESULTS: Four patients with TBI, with admission GCS scores of 4, 4, 7, and 8, all had subdural hematomas and contusions; three had subarachnoid hemorrhage (SAH); one had an epidural hematoma (the only death; day 6); two had craniotomies. In the first 48 hours when CPP \textgreater or = 70, StCO2 was 71 +/- 9, while it was 61 +/- 9 when CPP \textless 70 (p \textless 0.0001). This relationship was constant for all study days, with p \textless 0.0001. Moreover, CPP \textless 70 correlated with StCO2 with r = 0.8l and r(2) = 0.66. StCO2 \textgreater or = 75 was associated with CPP \textgreater or = 70 96.4% of the time (95% CL, 94.3-98.5%). StCO2 \textless 55 was associated with CPP \textless 70 68.2% of the time (95% CL, 57-79.4%). Also, 13.4% of observations with CPP \textgreater or = 70 had StCO2 \textless 60, suggesting the potential of cerebral ischemia in the face of 'normal' CPP. The StCO2 patches were user-friendly and not technically finicky. CONCLUSION: In this pilot study, StCO2 correlated significantly with CPP. A StCO2 \textgreater or = 75 suggests that CPP is adequate, while \textless 55 suggests an inadequate CPP. Although these results should be confirmed in a larger study, StCO2 may serve as a noninvasive measurement of cerebral perfusion in the patient with a TBI or, at the very least, a sensitive indicator for the need to begin monitoring the ICP.
Dunham CM; Sosnowski C; Porter J M; Siegal J; Kohli C
Journal of Trauma
2002
2002-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/00005373-200201000-00009" target="_blank" rel="noreferrer noopener">10.1097/00005373-200201000-00009</a>
The effect of a 12-month longitudinal long-term care rotation on knowledge and attitudes of internal medicine residents about geriatrics.
Ohio; Aged; Curriculum; Prospective Studies; Attitude of Health Personnel; Educational Measurement; Clinical Competence; Education; Internship and Residency; Geriatric Assessment; Nursing Homes; Confidence Intervals; Internal Medicine; Human; Questionnaires; P-Value; Scales; Data Analysis Software; Pretest-Posttest Design; Professional Knowledge; Summated Rating Scaling; Interns and Residents; Internal Consistency; Attitude Measures; Wilcoxon Signed Rank Test; Paired T-Tests; Medical; Geriatrics – Education; Long Term Care – Education; Terminal Care – Education
OBJECTIVE: To determine if participation in a 12-month longitudinal long-term care (LTC) rotation resulted in improved knowledge and attitudes about geriatrics. DESIGN: Longitudinal study with paired measurements. SETTING: A community LTC facility and a university-affiliated, community-based internal medicine residency program. PARTICIPANTS: Sixty-seven internal medicine residents who participated in the rotation from 1997 through 2004. INTERVENTION: The internal medicine residents attended nursing home (NH) rounds one half day per month for 1 year, during which time they participated in a case-based interactive lecture on a core geriatric topic and rounded on their assigned patients. MEASUREMENTS: Knowledge was assessed using a 70-item test. Attitudes were evaluated with a 28-item, 5-point Likert scale (1 = least positive, 5 = most positive). RESULTS: The percent correct responses on geriatric knowledge pretest was 47% (95% CI = 45.2% to 48.8%) and on the posttest it was 57.5% (95% CI = 55.3% to 59.6%) (t = 8.180, df = 67, P \textless .001). The pretest total attitude score was 3.6 (95% CI = 3.6 to 3.7), with a posttest score of 3.7 (95% CI = 3.7 to 3.8) (P \textless .001). The difference in this total was accounted for mainly by the significant changes in the attitude subscales in educational preparation (pretest 3.6 [95% CI = 3.5 to 3.8]; posttest 3.8 [95% CI = 3.7 to 3.9] [P \textless .001]), general attitudes (pretest 4.0 [95% CI = 3.9 to 4.1]; posttest 4.2 [95% CI = 4.0 to 4.3] [P = .006]), and therapeutic potential (pretest 3.7 [95% CI = 3.5 to 3.8]; posttest 3.8 [95% CI = 3.7 to 3.9] [P = .048]). CONCLUSION: A longitudinal LTC rotation is an efficient and effective way to systematically provide internal medicine residents their core knowledge and experience in geriatrics.
Baum EE; Nelson KM
Journal of the American Medical Directors Association
2007
2007-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jamda.2006.05.009" target="_blank" rel="noreferrer noopener">10.1016/j.jamda.2006.05.009</a>
Reclining chairs reduce pain from gurneys in older emergency department patients: a randomized controlled trial.
Ohio; Aged; Sensitivity and Specificity; Prospective Studies; Pain Measurement; Patient Satisfaction; Outpatients; Hospitals; Self Report; Confidence Intervals; Human; Descriptive Statistics; Funding Source; Scales; Data Analysis Software; Surveys; Coefficient Alpha; Summated Rating Scaling; Emergency Service; Community; Treatment Outcomes; Emergency Patients; Beds and Mattresses; Interior Design and Furnishings; Patient Positioning; Single-Blind Studies; 80 and Over; Pain – Prevention and Control – In Old Age
OBJECTIVES: Pain related to the gurney is a frequent complaint of older emergency department (ED) patients. The authors hypothesized that these patients may have less pain and higher satisfaction if allowed to sit in a reclining hospital chair. METHODS: A single-blind, randomized controlled trial was performed. Patients 65 years old or older who were able to sit upright, transfer, and engage in normal conversation were eligible. Severely ill or cognitively impaired patients were excluded. Patients were randomized to either remain on the gurney or transfer to the chair after initial evaluation. Patients reported pain at arrival (t0), at one hour (t1), and at two hours (t2) using a 0-10 pain scale, and satisfaction at study completion on a 0-10 scale. The primary outcome was a decrease in pain between t0 and t1 or no pain at both t0 and t1. This outcome was analyzed using a 95% confidence interval for the difference between proportions; exclusion of zero was considered significant. RESULTS: Sixty-six patients in each group were enrolled. There was no difference in demographics between groups, but the chair patients were more likely to have pain at t0 than the gurney patients. More chair patients than gurney patients had a successful primary outcome (97% vs. 76%, 21% difference, 95% CI=10% to 32%). The mean satisfaction score was higher in the chair group than in the gurney group (8.1 vs. 6.0, 2.1 difference, 95% CI=1.4% to 2.8%). CONCLUSIONS: The simple modification of allowing older ED patients to sit in reclining chairs resulted in less pain and higher satisfaction.
Wilber S T; Burger B; Gerson L W; Blanda M
Academic Emergency Medicine
2005
2005-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2005.tb00846.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2005.tb00846.x</a>
Outcomes in pharyngoplasty: a 10-year experience.
Adult; Female; Male; Ohio; Child; Infant; Risk Factors; Prospective Studies; Age Factors; Sex Factors; Hospitals; Sample Size; Reoperation; Speech; Confidence Intervals; Human; Descriptive Statistics; Middle Age; Adolescence; Retrospective Design; T-Tests; Surgical Flaps; Preschool; Treatment Outcomes; Record Review; Cleft Lip; Cleft Palate; Pediatric – Ohio; Mouth Abnormalities – Surgery; Pharyngeal Diseases – Surgery; Pharynx – Surgery
Objective: The outcomes of 61 patients who underwent a pharyngoplasty for velopharyngeal insufficiency were reviewed to determine potential risk factors for reoperation.Design: This was a retrospective chart review of 61 consecutive patients over approximately 10 years (1993 to 2003). Variables analyzed included gender, cleft type, age at the time of pharyngoplasty, length of time between palate repair and pharyngoplasty, and associated syndromes.Participants: Of the 61 patients, 20 (34%) had a unilateral cleft lip and palate, 5 (8%) had a bilateral cleft lip and palate, 13 (21%) had an isolated cleft palate, 7 (11%) had a submucous cleft palate, and 16 (26%) were diagnosed with noncleft velopharyngeal insufficiency.Results: Of the 61 patients, 10 (16%) required surgical revision. No statistically significant difference was found among gender, cleft type, age at the time of pharyngoplasty, the length of time between palate repair and pharyngoplasty, and associated congenital syndromes, with respect to the need for surgical revision (p \textgreater .05). Of the surgical revisions, 50% (5) were performed for a pharyngoplasty that was placed too low.Conclusions: Because 50% of the pharyngoplasty revisions had evidence of poor velopharyngeal closure and associated hypernasality resulting from low placement of the sphincter, the pharyngoplasty needs to be placed at a high level to reduce the risk for revisional surgery. The pharyngoplasty is a good operation for velopharyngeal insufficiency with an overall success rate of 84% (51 of 61) after one operation and greater than 98% (60 of 61) after two operations.
Pryor LS; Lehman J; Parker M G; Schmidt A; Fox L; Murthy AS
Cleft Palate-Craniofacial Journal
2006
2006-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1597/04-115" target="_blank" rel="noreferrer noopener">10.1597/04-115</a>
Home modification to prevent falls by older ED patients.
Female; Male; Aged; Prospective Studies; Confidence Intervals; Human; Chi Square Test; Funding Source; Data Analysis Software; Logistic Regression; T-Tests; Emergency Service; Accidents; Consumer Health Information; Home Environment; Home Safety; Pamphlets; 80 and Over; Accidental Falls – Prevention and Control; Home – Prevention and Control
This trial was conducted at 11 EDs to test the effectiveness of distributing fall prevention information to patients 65 years or older. Intervention patients were given 2 brochures and received a reminder call 2 weeks later. All patients were called at 1 month and asked if they made home safety modifications. Three hundred ninety-seven patients were enrolled (118 control, 279 intervention). Seventy-six percent had complete follow up interviews. Nine percent of control and 8% of intervention patients reported a home modification (95% confidence interval on difference, -8.1% to 5.5%). Patients who fell in the prior year had a 2.0 increased odds (95% confidence interval, 0.8-4.6) of making a home modification. The similar home modification rates in the 2 study groups suggest that even minimum discussion (eg, the informed consent procedure) may increase patients' fall prevention activities. The stronger association in patients who fell suggests that a targeted program may have added benefit. Copyright © 2005 by Elsevier Science (USA).
Gerson L W; Camargo CA Jr; Wilber S T
American Journal of Emergency Medicine
2005
2005-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.ajem.2005.02.035" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2005.02.035</a>
Does functional decline prompt emergency department visits and admission in older patients?
Female; Male; Ohio; Aged; Prospective Studies; Hospitals; Activities of Daily Living; Confidence Intervals; Human; Convenience Sample; Questionnaires; Cross Sectional Studies; Descriptive Statistics; Funding Source; Data Analysis Software; Surveys; Coefficient Alpha; Clinical Assessment Tools; Emergency Service; Community; Geriatric Functional Assessment; 80 and Over; Emergency Care – In Old Age; Functional Status – In Old Age; Health Resource Utilization – In Old Age; Patient Admission – In Old Age
BACKGROUND: Older patients may visit the emergency department (ED) when their illness affects their function. OBJECTIVES: To quantify the function of older ED patients, to assess whether functional decline (FD) had occurred, and to determine whether function contributes to the ED visit and hospital admission. METHODS: The authors performed an institutional review board-approved, prospective, cross-sectional study in a community teaching hospital ED. Eligible patients were older than 74 years of age, with an illness at least 48 hours old. Patients from a nursing facility and those without a proxy who were unable or unwilling to complete the questions were excluded. The Older Americans Resources and Services Questionnaire, which tests seven instrumental activities of daily living (IADL) and seven physical ADLs (PADL), was used. Data are presented as means or proportions with 95% confidence intervals (95% CI), and comparisons as 95% CI for the difference between proportions. RESULTS: The authors enrolled 90 patients (mean age, 81.6 yr [SD +/- 4.9], 40% male). Dependence in at least one IADL was reported by 68% (95% CI = 57% to 77%), and in at least one PADL by 61% (95% CI = 50% to 71%). Functional decline was reported by 74% (95% CI = 64% to 83%). Two thirds of those with IADL decline and three quarters of those with PADL decline said that this contributed to their ED visit. Seventy-seven percent with, and 63% without, IADL decline were admitted (14% difference, 95% CI = -6.1% to 33%). Seventy-nine percent with and 61% without PADL decline were admitted (18% difference, 95% CI = -1.4% to 38%). CONCLUSIONS: Functional decline is common in older ED patients and contributes to ED visits in older patients; its role in admission is unclear.
Wilber S T; Blanda M; Gerson L W
Academic Emergency Medicine
2006
2006-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1197/j.aem.2006.01.006" target="_blank" rel="noreferrer noopener">10.1197/j.aem.2006.01.006</a>
The Six-item Screener to Detect Cognitive Impairment in Older Emergency Department Patients.
Female; Male; Aged; Sensitivity and Specificity; Prospective Studies; ROC Curve; Geriatric Assessment; Academic Medical Centers; Confidence Intervals; Psychological Tests; Human; Cross Sectional Studies; Emergency Service; Cognition Disorders – Diagnosis; Emergency Medicine – Equipment and Supplies
BACKGROUND: Cognitive impairment due to delirium or dementia is common in older emergency department (ED) patients. To prevent errors, emergency physicians (EPs) should use brief, sensitive tests to evaluate older patient's mental status. Prior studies have shown that the Six-Item Screener (SIS) meets these criteria. OBJECTIVES: The goal was to verify the performance of the SIS in a large, multicenter sample of older ED patients. METHODS: A prospective, cross-sectional study was conducted in three urban academic medical center EDs. English-speaking ED patients \textgreater or = 65 years old were enrolled. Patients who received medications that could affect cognition, were too ill, were unable to cooperate, were previously enrolled, or refused to participate were excluded. Patients were administered either the SIS or the Mini-Mental State Examination (MMSE), followed by the other test 30 minutes later. An MMSE of 23 or less was the criterion standard for cognitive impairment; the SIS cutoff was 4 or less for cognitive impairment. Standard operator characteristics of diagnostic tests were calculated with 95% confidence intervals (CIs), and a receiver operating characteristic curve was plotted. RESULTS: The authors enrolled 352 subjects; 111 were cognitively impaired by MMSE (32%, 95% CI = 27% to 37%). The SIS was 63% sensitive (95% CI = 53% to 72%) and 81% specific (95% CI = 75% to 85%). The area under the receiver operating characteristic curve was 0.77 (95% CI = 0.72 to 0.83). CONCLUSIONS: The sensitivity of the SIS was lower than in prior studies. The reasons for this lower sensitivity are unclear. Further study is needed to clarify the ideal brief mental status test for ED use.
Wilber S T; Carpenter CR; Hustey FM
Academic Emergency Medicine
2008
2008-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2008.00158.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2008.00158.x</a>
Sinus CT Scan Findings in 'Sinus Headache' Migraineurs.
Prospective Studies; Tomography; Human; Evaluation Research; Severity of Illness Indices; X-Ray Computed – Methods; Migraine – Complications; Migraine – Radiotherapy; Paranasal Sinus Diseases – Complications; Paranasal Sinus Diseases – Radiography; Paranasal Sinuses – Abnormalities; Paranasal Sinuses – Radiography
Objective.- To evaluate the sinus CT scan findings in 'sinus headache' migraineurs, and to compare the findings to nonmigraine 'sinus headache' patients. Background.- The majority of patients presenting with 'sinus headache' satisfy the International Headache Society (IHS) criteria for migraine headache. Few studies have correlated the rhinologic complaints and computed tomography (CT) findings in these patients. Methods.- Thirty-five patients with 'sinus headache' were evaluated prospectively and referred for CT of the paranasal sinuses. The CT scans were assessed for sinus abnormality (recorded as a Lund-Mackay [L-M] score) and were analyzed for concha bullosa and septal deviation. The findings in the migraine cohort were compared with the nonmigraine 'sinus headache' patients. Findings.- Twenty-six patients (74.3%) satisfied the IHS criteria for migraine. The mean CT scan L-M score did not differ significantly between the migraine (2.07) and nonmigraine cohort (2.66). Five of the migraine group had substantial sinus disease radiographically (with L-M scores of 5 or above). Concha bullosa of at least 1 middle turbinate was more common in the nonmigraine cohort. An analysis of the sidedness of the headaches, sinus disease, concha bullosa, and/or septal deviation is presented. Conclusions.- The majority of 'sinus headache' patients satisfy the IHS criteria for migraine. Surprisingly, these patients often have radiographic sinus disease. This raises the possibility of selection bias in otolaryngology patients, inaccurate diagnosis, or radiographic sinus disease and migraine as comorbid conditions. Positive migraine histories apparently do not obviate the need for a thorough ENT workup, possibly including CT scanning.
Mehle ME; Kremer PS
Headache: The Journal of Head & Face Pain
2008
2008-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1526-4610.2007.00811.x" target="_blank" rel="noreferrer noopener">10.1111/j.1526-4610.2007.00811.x</a>
Hemipelvic amputations for recalcitrant pelvic osteomyelitis.
Adult; Female; Male; Aged; Prospective Studies; Human; Middle Age; Retrospective Design; Treatment Outcomes; 80 and Over; Antibiotics – Therapeutic Use; Recurrence – Prevention and Control; Palliative Care – Methods; Hemipelvectomy – Methods; Hemipelvectomy – Psychosocial Factors; Osteomyelitis – Drug Therapy; Osteomyelitis – Microbiology; Osteomyelitis – Surgery; Paraplegia – Psychosocial Factors; Pelvic Bones – Surgery; Wound Infection – Drug Therapy; Wound Infection – Microbiology
Ziran BH; Smith WR; Rao N
Injury
2008
2008-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.injury.2007.12.002" target="_blank" rel="noreferrer noopener">10.1016/j.injury.2007.12.002</a>
Risk ratios and odds ratios for common events in cross-sectional and cohort studies.
Female; Pregnancy; Odds Ratio; Prospective Studies; Cross Sectional Studies; Descriptive Statistics; Logistic Regression; Models; Statistical; Pregnancy Trimester; Third; Relative Risk; Fibrin Fibrinogen Degradation Products – Analysis
Wilber S T; Fu R
Academic Emergency Medicine
2010
2010-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2010.00773.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2010.00773.x</a>
The influence of family environment on dissociation in pediatric injury patients.
Female; Male; Ohio; Socioeconomic Factors; Child; Prospective Studies; Income; Self Report; Confidence Intervals; Family; Social Environment; Human; Semi-Structured Interview; Questionnaires; Chi Square Test; Descriptive Research; Descriptive Statistics; Funding Source; Scales; Correlational Studies; Data Analysis Software; Pretest-Posttest Design; Checklists; Adolescence; Pearson's Correlation Coefficient; Retrospective Design; Analysis of Covariance; Child Development; Bivariate Statistics; Severity of Illness Indices; Family Relations; Family Coping; Interview Guides; Parametric Statistics; Parenting Education; Patient-Family Relations; Dissociative Disorders – Risk Factors; Accidents – Adverse Effects; Wounds and Injuries – Complications
Nugent Nicole R; Sledjeski Eve M; Christopher Norman C; Delahanty Douglas L
Clinical Child Psychology & Psychiatry
2011
2011-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/1359104511406487" target="_blank" rel="noreferrer noopener">10.1177/1359104511406487</a>
Perfusion Pressures and Distal Oxygenation in Individuals With Diabetes Undergoing Chronic Hemodialysis.
Female; Male; Aged; Prospective Studies; Microcirculation; Wound Healing; Human; Descriptive Statistics; Data Analysis Software; Comparative Studies; Pilot Studies; Middle Age; Diabetic Patients; Dialysis Patients; Oxygenation; Peripheral Circulation; Tissue Perfusion; Diabetes Mellitus – Complications; Hemodialysis – Adverse Effects; Lower Extremity – Blood Supply
Kay David B; Ray Susan; Haller Nairmeen Awad; Hewit Michael
Foot & Ankle International
2011
2011-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3113/FAI.2011.0700" target="_blank" rel="noreferrer noopener">10.3113/FAI.2011.0700</a>
Comparison of short-acting intramuscular antipsychotic medication: impact on length of stay and cost.
Adult; Female; Male; Prospective Studies; Health Care Costs; Injections; Middle Age; Retrospective Design; Intramuscular; Antiinfective Agents; Length of Stay – Statistics and Numerical Data; Schizophrenia – Drug Therapy; Heterocyclic Compounds – Therapeutic Use; Antianxiety Agents; Antipsychotic Agents – Administration and Dosage; Antipsychotic Agents – Economics; Antipsychotic Agents – Therapeutic Use; Benzodiazepine – Economics; Benzodiazepine – Therapeutic Use; Haloperidol – Economics; Haloperidol – Therapeutic Use; Heterocyclic Compounds – Economics; Length of Stay – Economics; Psychomotor Agitation – Drug Therapy; Quinolone – Economics; Quinolone – Therapeutic Use; Thiazoles – Economics; Thiazoles – Therapeutic Use
A retrospective cohort study was conducted to determine if there is an association between short-acting intramuscular (SAIM) antipsychotics used for acute agitation and length of stay (LOS). Patients with a diagnosis of schizophrenia or schizoaffective disorder who were dispensed at least one dose of a SAIM antipsychotic were divided into groups based on the initial SAIM antipsychotic received once admitted to a psychiatric unit. Electronic records were used to gather demographic information, LOS, and number of injections received during an admission. Cost was calculated from the number of injections received. One-hundred and thirty-six patients were enrolled. When comparing the haloperidol group to the second generation antipsychotic group, there was no statistically significant difference, in LOS 16.98 ± 9.56 days versus 17.59 ± 11.52 days (P = 0.75), respectively. There was a statistically significant difference in both cost and number of injections between groups, favoring the haloperidol group. Ziprasidone was associated with a shorter LOS compared with olanzapine, 13.57 and 19.10 days, respectively (P = 0.026). Patient characteristics should be evaluated when determining an agent for acute agitation. However, because literature indicates second generation SAIM antipsychotics are only noninferior to haloperidol; other factors should also be evaluated; including impact on LOS and impact on hospital resources. This study indicates use of a second generation SAIM antipsychotic for acute agitation is more costly, requires more injections, and was not associated with a shorter length of stay when compared with SAIM haloperidol.
Leung JG; Benedetti AM; Frazee L A; Myers N; Leung Jonathan G; Benedetti Amanda M; Frazee Lawrence A; Myers Nancy
American Journal of Therapeutics
2011
2011-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/MJT.0b013e3181d48320" target="_blank" rel="noreferrer noopener">10.1097/MJT.0b013e3181d48320</a>
Associations Between Disordered Eating, Menstrual Dysfunction, and Musculoskeletal Injury Among High School Athletes.
Female; Multivariate Analysis; Odds Ratio; Prospective Studies; Self Report; Confidence Intervals; Women's Health; Psychological Tests; Human; Questionnaires; Chi Square Test; Descriptive Statistics; Funding Source; Data Analysis Software; Post Hoc Analysis; Adolescence; One-Way Analysis of Variance; Logistic Regression; Retrospective Design; Wisconsin; Record Review; Body Weights and Measures; Adolescent Health; Adolescent Nutrition; Female Athlete Triad; Athletes; High School; Athletic Injuries – Epidemiology – In Adolescence; Body Mass Index – Evaluation; Eating Behavior – Evaluation; Eating Disorders – Epidemiology – In Adolescence; Health Status – Evaluation; Menstruation Disorders – Epidemiology – In Adolescence; Musculoskeletal System – Injuries – In Adolescence; Sports – Classification
Thein-Nissenbaum Jill M; Rauh Mitchell J; Carr Kathleen E; Loud Keith J; McGuine Timothy A
Journal of Orthopaedic & Sports Physical Therapy
2011
2011-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2519/jospt.2011.3312" target="_blank" rel="noreferrer noopener">10.2519/jospt.2011.3312</a>
Utilization of a reminder mailing to improve blood glucose log reporting in an outpatient diabetes clinic.
Adult; Female; Male; Aged; Prospective Studies; Patient Compliance; Human; Middle Age; Retrospective Design; Mail; Reminder Systems; Ambulatory Care – Methods; Hypoglycemic Agents – Therapeutic Use; Blood Glucose Self-Monitoring – Methods; Diabetes Mellitus – Drug Therapy
Self-monitored blood glucose (SMBG) offers a strategy used to achieve glycemic control in diabetic patients. However, if SMBG readings are unavailable to clinicians, this strategy will have a limited effect. This study assessed the impact of a reminder mailing on response rates to requests for SMBG logs. Patients were asked to mail completed SMBG logs to the clinic in 2 weeks. For the intervention, a reminder mailing was sent to each patient 1 week before SMBG logs were to be returned. Compliance rates pre and postinterventions were compared. The primary outcome was the percentage of all SMBG logs returned on time. Secondary outcomes included the percentage of SMBG logs returned, percentage fulfilled, percentage of clinic appointments kept, percentage of SMBG logs brought to follow-up appointments, and number of interventions made to antidiabetic therapy. Twenty SMBG requests were made in the preintervention cohort versus 19 in postintervention cohort. A trend toward more on time and fulfilled SMBG requests was observed post vs. preintervention. Overall return rates were similar between groups. A nonsignificant increase in clinic appointments kept and a nonsignificant decrease in interventions made were observed postintervention. Receipt of a reminder mail was not a significant predictor of patients bringing an SMBG log to follow-up appointments. In conclusion, the use of a reminder mail was not associated with an increase in the return rate of SMBG logs, although there were nonsignificant trends toward more on time and fulfilled SMBG logs received during the postintervention period.
Moorman JM; Frazee L A; Dillon ML; Chomo DL; Myers NA
American Journal of Therapeutics
2012
2012-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/MJT.0b013e3181f94c16" target="_blank" rel="noreferrer noopener">10.1097/MJT.0b013e3181f94c16</a>
Patient Preferences in Choosing a Primary Care Physician.
Adult; Female; Male; Aged; Multivariate Analysis; Odds Ratio; Prospective Studies; Decision Making; Physicians; Self Report; Family; Human; Questionnaires; Chi Square Test; Descriptive Statistics; Data Analysis Software; Middle Age; Adolescence; Logistic Regression; T-Tests; Patient Attitudes; Nonexperimental Studies; Maximum Likelihood; Patient
Mercado Francis; Mercado Margaret; Myers Nancy; Hewit Michael; Haller Nairmeen Awad
Journal of Primary Care & Community Health
2012
2012-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/2150131911421802" target="_blank" rel="noreferrer noopener">10.1177/2150131911421802</a>
Efficacy of intravenous lidocaine to reduce pain and distress associated with propofol infusion in pediatric patients during procedural sedation.
Female; Male; Child; Infant; Prospective Studies; Pain Measurement; Analysis of Variance; Placebos; Injections; Human; Chi Square Test; Preschool; Intravenous; Anesthetics; Treatment Outcomes; Double-Blind Studies; Hypnotics and Sedatives – Administration and Dosage; Lidocaine – Administration and Dosage; Local – Administration and Dosage; Propofol – Administration and Dosage
BACKGROUND: Research suggests that young children experience an increased incidence and severity of discomfort during propofol infusion. Evaluations of varied interventions to reduce or eliminate this discomfort with adult subjects suggest that premedication with intravenously administered lidocaine (0.5 mg/kg) offers the best overall effectiveness. OBJECTIVE: Because this regimen's efficacy in a pediatric population is undocumented, we conducted a randomized, double-blind, placebo-controlled study to determine the effectiveness of intravenous lidocaine pretreatment to alleviate pain in pediatric subjects before propofol infusion. METHODS: Subjects (aged 2-7 years) scheduled for painless diagnostic procedures received either a saline placebo or 1 of 2 lidocaine doses before administering propofol. To capture the patient's baseline behavioral state, a trained observer administered the validated Face, Legs, Activity, Cry, Consolability Pain Assessment Scale before propofol infusion. During deep sedation induction, the sedating physician, a trained research assistant, and the patient's parent documented maximum distress using a 100-mm visual analog scale (VAS). RESULTS: Ninety-one subjects participated. We found no difference in VAS pain scores between groups pretreated with lidocaine 0.25 mg/kg, lidocaine 0.5 mg/kg, and placebo. Statistical analysis also found no interrater differences between parents, physician, or observer VAS scores. CONCLUSIONS: Our data do not support using lidocaine pretreatment to alleviate pain/discomfort in pediatric patients during propofol infusion.
Depue K; Christopher NC; Raed M; Forbes ML; Besunder J; Reed MD
Pediatric emergency care
2013
2013-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/PEC.0b013e31827b227e" target="_blank" rel="noreferrer noopener">10.1097/PEC.0b013e31827b227e</a>
Delayed Primary Epstein-Barr Virus Infection: Clinical and Immunologic Manifestations.
Female; Male; Young Adult; Prospective Studies; Epidemiology; Minnesota; Hypersensitivity; Severity of Illness; Hematologic Tests; Immune System; Delayed; Epstein-Barr Virus Infections – Risk Factors; Epstein-Barr Virus Infections – Symptoms; T Lymphocytes – Physiology
Watkins Richard R
Internal Medicine Alert
2013
2013-03-29
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Continuous Infusion of Beta-lactams for Sepsis Improves Outcomes.
Prospective Studies; Human; Multicenter Studies; Infusions; Microbial Culture and Sensitivity Tests; Randomized Controlled Trials; Double-Blind Studies; Antibiotics – Administration and Dosage; Intravenous – Utilization; Sepsis – Drug Therapy
Despite notable advances in critical care medicine, mortality from severe sepsis remains unacceptably high. With current therapeutic strategies, nothing has proven more crucial than early and effective antibiotics. Among the most commonly utilized antibiotics in intensive care units (ICUs) are beta-lactams, such as piperacillin-tazobactam and meropenem. These agents are usually administered by intermittent bolus dosing. However, pharmocodynamic data have shown that continuous infusion administration results in greater blood and fluid exposure with more time above the minimum inhibitory concentration (MIC) compared to intermittent dosing. Dulhunty and colleagues sought to determine the clinical and pharmacokinetic differences between continuous and intermittent bolus dosing of beta-lactam antibiotics in patients with severe sepsis. The study was a prospective, double-blind, randomized controlled trial conducted at several hospitals in Australia and Hong Kong between April 2010 and November 2011. Patient inclusion criteria included \textgreater 18 years of age, severe sepsis in the preceding 24 hours, treatment within the previous 24 hours with ticarcillin-clavulanate, piperacillin-tazobactam or meropenem, and expected or actual ICU stay greater than 24 hours. Patients were excluded if they were on continuous renal replacement therapy, lacked a central access catheter with at least 3 lumens, or received the study drug for \textgreater 24 hours. They were randomized to receive active infusion and placebo boluses (intervention group), or placebo infusion and active boluses (control group). On days 3 and 4 blood samples were taken to ascertain plasma trough levels. The primary endpoint was the time that antibiotic concentration was above the MIC. Secondary endpoints were clinical response at days 7 to 14 after study drug cessation, time to clinical resolution, status at ICU and hospital discharge, and number of days alive and free of ICU admission in the first 28 days post-randomization. Sixty patients were enrolled, 30 in the continuous infusion group and 30 in the intermittent bolus group. The most common source of infection in both groups was lung, followed by blood, intra-abdominal, skin or skin structure, urinary tract, and central nervous system. The patients who received continuous infusion compared to intermittent bolus administration achieved higher times above the MIC (82% vs. 29%, P = .001) and higher clinical cure (76.7% vs. 50%, P = .032). Moreover, there was less time to clinical resolution (11 days vs. 16.5 days, P = .14), lower ICU length of stay (7.5 days vs. 9 days, P = .50), better hospital survival (90% vs 80% P = .47), and higher ICU survival (93.3% vs. 86.7%, P = .67) in the continuous infusion group, but these did not reach statistical significance. Plasma antibiotic concentration of meropenem was greater than the MIC in 100% of patients who received continuous infusion compared to 22% in the intermittent bolus group. Piperacillin-tazobactam and ticarcillin-clavulanate continuous infusions resulted in concentrations above the MIC 75% and 50% of the time, respectively. The corresponding- intermittent bolus administration achieved concentrations above the MIC 36% and 0% of the time with piperacillin-tazobactam and ticarcillin-clavulanate.
Watkins Richard R
Infectious Disease Alert
2013
2013-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Clinical impact of temporary therapy interruptions on anticoagulation control in patients treated with warfarin.
Female; Male; Aged; Prospective Studies; International Normalized Ratio; Drug Administration Schedule; Preoperative Care; Postoperative Care; Human; Middle Age; Retrospective Design; Dose-Response Relationship; Drug; Treatment Outcomes; Drug Monitoring; Anticoagulants – Therapeutic Use; Anticoagulants – Administration and Dosage; Atrial Fibrillation – Drug Therapy; Blood Coagulation Disorders – Drug Therapy; Coronary Thrombosis – Drug Therapy; Euthanasia; Passive; Venous Thromboembolism – Drug Therapy; Warfarin – Administration and Dosage; Warfarin – Therapeutic Use
This retrospective cohort study was completed to describe the impact of short-term therapy interruptions on anticoagulation control in patients receiving warfarin. Patients seen in a pharmacist-managed anticoagulation clinic were included if they were on a stable warfarin dose and then underwent a planned interruption in therapy. Patients were excluded if phytonadione was administered before the interruption or if medications known to interact with warfarin were altered during the interruption. Data were analyzed for 2 groups: (1) patients with a single interruption in therapy (group 1) and (2) patients with a single interruption in therapy plus patients with an extended interruption in therapy (group 2). The primary endpoint was the change in weekly maintenance warfarin dose from preinterruption to postinterruption. Evaluation of 199 patients resulted in 31 interruptions in group 1 and 34 interruptions in group 2. A change in dose was required in 58% of patients in group 1 and 56% of patients in group 2. The mean absolute change in dose was 2.03 ± 2.79 mg (P \textless 0.003) in group 1 and 1.96 ± 2.72 mg (P \textless 0.002) in group 2. For the majority of patients, the dose change represented \textless10% of their preinterruption weekly dose. Of patients requiring a dose change, 50% required an increase in dose. In conclusion, close follow-up is warranted after a warfarin therapy interruption as dose adjustments will likely be needed to regain anticoagulation control and the direction of this dose change cannot be predicted.
Boros Melanie L; Rybarczyk Amy M; Gallegos Patrick J; Zimmerman Jacob P
American Journal of Therapeutics
2013
2013-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/MJT.0b013e31824ea644" target="_blank" rel="noreferrer noopener">10.1097/MJT.0b013e31824ea644</a>
Characteristics of Prehospital ST-segment Elevation Myocardial Infarctions.
Female; Male; Prospective Studies; Emergency Medical Services; Demography; Data Collection; Patient Care; Academic Medical Centers; Confidence Intervals; Human; Data Analysis; Middle Age; Outcomes (Health Care); Emergency Service; Databases; Angioplasty; Race Factors; Prehospital Care; Percutaneous Coronary; Transluminal; Myocardial Infarction – Diagnosis; Myocardial Infarction – Therapy; Cardiac Patients – Evaluation; Chest Pain – Diagnosis; Myocardial Infarction – Symptoms; ST Segment – Evaluation
Introduction. Despite attention directed at treatment times of ST-segment elevation myocardial infarctions (STEMIs), little is known about the types of STEMIs presenting to the emergency department (ED). Objective. The purpose of this study was to determine the relative frequencies and characteristics of emergency medical services (EMS) STEMIs compared with those in patients who present to the ED by walk-in. This information may be applied in EMS training, system planning, and public education. Methods. This was a query of a prospectively gathered database of all STEMIs in patients presenting to Summa Akron City Hospital ED in 2009 and 2010. We collected demographic information, chief complaint, mode and time of arrival, and STEMI pattern (anterior, lateral, inferior, or posterior). We excluded transfers and in-hospital STEMIs. We calculated means, percentages, significance, and 95% confidence intervals (CIs) ± 10%. Results. We analyzed data from 308 patients. Most patients (241/308, 78%, CI 73%-83%) arrived by EMS, were male (203/308, 66%, CI 60%-71%), and were white (286/308, 93%, CI 89%-96%). Patients arriving by EMS were older (average 63 years, range 35-95) than walk-in patients (average 57 years, range 24-92). Two percent (5/241, 2%, CI 1%-5%) of EMS STEMI patients were under 40 years of age, compared with 10% (7/67, 10%, CI 4%-20%) of walk-in patients (p = 0.0017). The most common chief complaint was chest pain (278/308, 90%, CI 86%-93%). Inferior STEMIs were most common (167/308, 54%, CI 49%-60%), followed by anterior (127/308, 41%, CI 48%-60%), lateral (8/308, 3%, CI 1%-5%), and posterior (6/308, 2%, CI 1%-4%). A day-of-the-week analysis showed that no specific day was most common for STEMI presentation. Forty percent (122/308, 40%, CI 34%-45%) of patients presented during open catheterization laboratory hours (Monday through Friday, 0730-1700 hours). There was no significant statistical difference between EMS and walk-in patients with regard to STEMI pattern or patient demographics. Conclusions. In this study, 95% (294/308) of all STEMIs were inferior or anterior infarctions, and these types of presentations should be stressed in EMS education. Most STEMI patients at this institution arrived by ambulance and during off-hours. Younger patients were more likely to walk in. We need further study, but we may have identified a target population for future interventions. Key words: emergency medical services; allied health personnel; electrocardiography; myocardial infarction; heart catheterization; STEMI
Celik Daniel H; Mencl Francis R; DeAngelis Anthony; Wilde Joshua; Steer Sheila H; Wilber Scott T; Frey Jennifer A; Bhalla Mary Colleen
Prehospital Emergency Care
2013
2013-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.3109/10903127.2013.785619" target="_blank" rel="noreferrer noopener">10.3109/10903127.2013.785619</a>
Efficacy of Higher-dose Oseltamivir in Adults with Influenza A and B.
Prospective Studies; Multicenter Studies; Dose-Response Relationship; Treatment Outcomes; Influenza A Virus; Influenza B Virus; Influenza – Drug Therapy; Oseltamivir – Adverse Effects; Oseltamivir – Therapeutic Use
Watkins Richard R
Infectious Disease Alert
2014
2014-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Hospital Wards with Higher Rates of Antibiotic Prescribing Are Associated with Increased Risk for C. difficile Infection.
Adult; Multivariate Analysis; Prospective Studies; Inpatients; Human; Retrospective Design; Physiologic; Monitoring; Record Review; Clostridium Difficile; Antibiotics – Therapeutic Use; Clostridium Infections – Epidemiology; Clostridium Infections – Risk Factors
Watkins Richard R
Infectious Disease Alert
2015
2015-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Oral Fluconazole During Pregnancy Increases Risk for Spontaneous Abortion.
Female; Pregnancy; Prospective Studies; Registries; Human; Denmark; Abortion; Perinatal Death; Disease; Fluconazole – Adverse Effects; Fluconazole – In Pregnancy; Spontaneous – Risk Factors
A nationwide cohort study from Denmark found a significantly increased risk of spontaneous abortion associated with oral fluconazole usage. Caution with this medication during pregnancy is advised.
Watkins Richard R
Infectious Disease Alert
2016
2016-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Early Uncomplicated Appendicitis-Who Can We Treat Nonoperatively?
Adult; Female; Male; Aged; Young Adult; Prospective Studies; Patient Selection; Drug Administration Schedule; Appendectomy; Injections; Human; Middle Age; Adolescence; Retrospective Design; Intravenous; Administration; Oral; Treatment Outcomes; Severity of Illness Indices; Antibiotics – Therapeutic Use; Ampicillin – Therapeutic Use; Appendicitis – Diagnosis; Appendicitis – Drug Therapy; Appendicitis – Surgery; Enzyme Inhibitors – Therapeutic Use; Penicillins – Therapeutic Use
This study evaluated nonoperative treatment for mild appendicitis and reviewed selection criteria to be used in introducing this option into clinical practice. A retrospective review of 73 consecutive cases of appendicitis treated by a single surgeon from 2011 to 2013 was completed. Patients who were diagnosed with mild appendicitis meeting the criteria of an APPENDICITIS scoring algorithm proposed in this manuscript were considered for nonoperative management. An additional 17 patients with mild appendicitis were offered and successfully treated nonoperatively between 2014 and 2016 and reviewed. Of these original 73 patients, 37 had moderate to severe appendicitis and directly underwent appendectomy. The remaining patients were diagnosed with mild appendicitis and considered eligible for nonoperative management. Of these, 14 patients were offered nonoperative therapy. Thirteen responded successfully; one patient responded partially, but later opted for surgery. In 2014, this scoring system and preliminary results were shared with the other surgeons in our department. Nonoperative management was then selectively adopted by a few of the surgeons from 2014 to 2016 with another 17 patients (APPENDICITIS score of 0 or 1) being offered and successfully managed nonoperatively. Patients with mild or early appendicitis can be successfully managed nonoperatively. A proposed APPENDICITIS scoring system may provide a helpful mnemonic for successfully selecting patients for this option.
Horattas Mark C; HORATTAS ILEANA K; VASILIOU ELYA M
American Surgeon
2018
2018-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Effect of digital rectal examination (and ejaculation) on serum prostate-specific antigen after twenty-four hours. A randomized, prospective study.
Adult; Humans; Male; Middle Aged; Time Factors; Aged; Prospective Studies; Rectum; *Palpation; Ejaculation; Prostate-Specific Antigen/*blood; 80 and over
The purpose of this randomized, controlled, clinical trial was to determine the effect of the digital rectal examination (DRE) on the prostate-specific antigen (PSA) serum levels in view of conflicting literature reports and screening methods and misconceptions by physicians. We showed that the DRE had no clinically important effect on PSA values twenty-four hours later. The mean PSA rose from 1.57 to 1.62 ng/mL, similar to the controls. Ejaculation had no meaningful effect on the serum PSA values.
McAleer J K; Gerson L W; McMahon D; Geller L
Urology
1993
1993-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Gallstone pancreatitis: a prospective randomized trial of the timing of surgery.
Adult; Female; Humans; Male; Middle Aged; Time Factors; Aged; Random Allocation; Risk Factors; Prospective Studies; Necrosis; Cholecystectomy; Cholelithiasis/complications/*surgery; Edema; Hemorrhage; Pancreatitis/*etiology/pathology
The correct timing of surgery in cases of gallstone pancreatitis is debatable. To delineate more clearly the influence of the timing of surgery in the treatment of the disease, a prospective randomized clinical study of early surgery (less than 48 hours after admission) and delayed surgery (more than 48 hours after admission) was conducted in 165 patients. Ranson's prognostic signs of severity of disease were used to classify the patients into two risk groups: mild pancreatitis (three or fewer positive signs) and severe pancreatitis (more than three positive signs). In patients with three or fewer positive Ranson's signs, the time of surgery appeared to have little effect on the outcome, whereas in patients with more than three positive signs, early surgery resulted in a significant increase in rates of morbidity and mortality. Controlled randomization showed that in patients with gallstone pancreatitis, edematous or hemorrhagic necrotizing pancreatitis can develop, with or without impacted stones, early or late in the progression of the disease, during early or delayed surgery. These findings suggest that (1) although a gallstone initiates a bout of pancreatitis, it does not cause the progression of the disease; (2) the fate of the progression of pancreatitis is decided early by the amount of digestive enzymes being activated; (3) early removal of an impacted stone does not ameliorate the progression of pancreatitis; and (4) surgery should be performed during the initial hospital admission after the pancreatitis has subsided.
Kelly T R; Wagner D S
Surgery
1988
1988-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Randomized comparison of gastric pH control with intermittent and continuous intravenous infusion of famotidine in ICU patients.
Female; Humans; Male; Middle Aged; Aged; Treatment Outcome; Prospective Studies; Analysis of Variance; Double-Blind Method; Hydrogen-Ion Concentration; Intensive Care Units; Drug Administration Schedule; Famotidine/administration & dosage/*therapeutic use; Stomach Ulcer/blood/etiology/*prevention & control; Stomach/*drug effects/physiopathology; Infusions; Intravenous
OBJECTIVE: To compare gastric pH control using intravenous famotidine as a primed, continuous infusion versus intermittent infusion. METHODS: In a prospective, double-blind study, 40 ICU patients at risk for stress ulceration were randomly assigned to receive either famotidine 20 mg intravenous bolus followed by 1.67 mg/h infusion or famotidine 20 mg intravenously every 12 h. Intraluminal gastric pH was recorded at baseline and every 4 h using a glass electrode. Clinical outcome indicators were also monitored. Subjects were studied for a minimum of 24 h and a maximum of 6 days. Continuous variables were analyzed by ANOVA and nominal variables by Fisher's exact test (alpha = 0.05). RESULTS: Nineteen patients were randomized to the continuous infusion group, and 21 were randomized to the intermittent group. Using gastric pH greater than 4.0 as an endpoint, the continuous group exhibited better pH control, both in terms of percentage of total measurements (83% versus 63%, p \textless 0.001) and time spent above pH 4.0 (91% versus 76%, p \textless 0.01). Similar results were found at pH greater than 5.0 (78% versus 56% for all measurements for the continuous and bolus groups, respectively (p \textless 0.001), and 88% versus 72% for the time spent above pH 5.0 (p \textless 0.01). Clinical outcomes, including evidence for gastrointestinal bleeding and hospital mortality, did not differ significantly between groups. CONCLUSION: Famotidine infusion at 1.67 mg/h, when preceded by a bolus dose of 20 mg, provides a greater and more sustained increase in gastric pH than intermittent administration of famotidine 20 mg every 12 h.
Heiselman D E; Hulisz D T; Fricker R; Bredle D L; Black L D
The American journal of gastroenterology
1995
1995-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Stages of change analysis of smokers attending clinics for the medically underserved.
Adult; Humans; Male; Socioeconomic Factors; Surveys and Questionnaires; Prospective Studies; *Health Behavior; *Smoking Cessation/psychology/statistics & numerical data; Counseling; Medically Underserved Area; Models; Theoretical
OBJECTIVE: To determine whether smokers at clinics providing care for the medically underserved can be characterized according to the transtheoretical stages of change model. STUDY DESIGN: Prospective, descriptive study. POPULATION: Smokers in the waiting rooms of clinics providing care for the medically underserved. OUTCOMES MEASURED: Standardized questionnaires that assessed stages of change, processes of change, decisional balance, and self-efficacy and temptation. RESULTS: The smoking rate of subjects interviewed at 4 clinics was 44%. Two hundred current smokers completed the questionnaires. Smokers claiming that they planned to quit within 6 months scored higher on experiential process statements that are consistent with quitting smoking than did smokers who claimed they were not planning to quit within 6 months. They also scored higher on behavioral statements related to quitting. Concerns about the negative aspects of smoking were more important to smokers planning to quit than to smokers not planning to quit, whereas the statements assessing positive aspects of smoking were rated the same. Fifty-five percent of the smokers were smoking a pack or more each day and reported smoking more during negative situations and from habit than did smokers who smoked less than a pack a day. CONCLUSIONS: Smokers planning to quit who still smoke at least a pack a day may benefit from counseling to decrease smoking for specific reasons or from pharmacologic aids. Smokers at the clinics who planned to quit smoking reported experiences and behaviors that were consistent with their stated desire to quit and should be counseled in the same fashion as smokers from more traditional practices.
Gil Karen M; Schrop Susan Labuda; Kline Sarah C; Kimble Emily A; McCord Gary; McCormick Kenelm F; Gilchrist Valerie J
The Journal of Family Practice
2002
2002-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Findings from a 10-year follow-up of bone mineral density in competitive perimenopausal runners.
Adult; Female; Humans; Middle Aged; Surveys and Questionnaires; Follow-Up Studies; Prospective Studies; Case-Control Studies; Bone Density/*physiology; Running/*physiology; Hip Joint/diagnostic imaging/*physiology; Lumbar Vertebrae/diagnostic imaging/*physiology; Perimenopause; Osteoporosis; Human; Questionnaires; Clinical Trials; Middle Age; Case Control Studies; Absorptiometry; Photon; Postmenopausal/*diagnostic imaging; Menopause; Bone Density – Physiology; Hip Joint – Physiology; Hip Joint – Radiography; Lumbar Vertebrae – Physiology; Lumbar Vertebrae – Radiography; Osteoporosis – Radiography; Running – Physiology
OBJECTIVE: To evaluate bone mineral density (BMD) in perimenopausal competitive runners with long-term follow-up. STUDY DESIGN: Fifteen master female runners between 40 and 50 years old who ran at least 20 miles per week were evaluated. BMD was measured by dual-energy x-ray absorptiometry (DEXA) at baseline and at the 10-year follow-up. RESULTS: The median age was 46 and median miles run per week, 25. At baseline, after a median of 11 years of competitive running, hip BMD was above peak bone mass (T-score = 0.8) and that of age-matched controls (Z-score = 1.6), while lumbar spine BMD was below peak bone mass (T-score = -0.8) and equal to that of age-matched controls (Z-score = -0.1). At the 10-year follow-up, hip BMD fell below peak bone mass (T-score = -0.2, p = 0.0004) but was still above that of age-matched controls (Z-score = 0.5, p = 0.002), while there was little change in lumbar spine BMD. CONCLUSION: Competitive running prior to the perimenopausal period seems to be associated with improved hip BMD. However, continued competitive running during the perimenopausal period is not associated with prevention of a perimenopausal hip BMD decline. In contrast, competitive running had little effect on peri-menopausal lumbar spine BMD.
Fanning James; Larrick Lori; Weinstein Louis; Horrigan Terrence J; Marcotte Michael P; Flora Robert F
The Journal of reproductive medicine
2007
2007-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
The consultation and referral process. A report from NEON. Northeastern Ohio Network Research Group.
Adult; Female; Humans; Male; Middle Aged; Ohio; Adolescent; Aged; Child; Cross-Sectional Studies; United States; Prospective Studies; *Medicine; Physicians; *Communication; Interprofessional Relations; *Specialization; Family; *Family Practice/statistics & numerical data; *Referral and Consultation/statistics & numerical data; Ambulatory Care; Preschool
BACKGROUND: Consultation and referral are essential components of the practice of primary care. Despite this, little is known about the factors that contribute to the success of a referral. We examined the short-term outcomes of communication between family physicians and consultants during the referral process. METHODS: The study setting was six family practice centers in northeastern Ohio. All eligible physicians at each center participated in data collection by means of a card study. Data was recorded on any patient who received a referral to a physician or nonphysician provider during the month of July 1994. One year later, referrals were followed up by physician questionnaire. RESULTS: Three hundred nine of 5172 total patients were referred (5.97 referrals per 100 office visits). At follow-up, the family physicians reported that 63% of patients had visited the consultant, 14% had not, and the physician had no knowledge of the actions taken by the other 23%. The referring physician received feedback from the consultant regarding 55% of the patients referred. Receipt of feedback was strongly related to communication by the family physician to the consultant at the time of referral. Physicians who received feedback were the most satisfied with communication from the consultant and the care their patient had received. CONCLUSIONS: Primary care physicians can influence the likelihood of receiving feedback from a consultant by initiating communication with the consultant. A referral wherein the physicians involved do not communicate with one another results in physician dissatisfaction. Primary care physicians must practice strategies to improve the referral process.
Bourguet C C; Gilchrist V; McCord G
The Journal of Family Practice
1998
1998-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Correlation of the NBME advanced clinical examination in EM and the national EM M4 exams.
Humans; United States; Prospective Studies; Linear Models; Emergency Medicine/*education; Clinical Competence; Educational Measurement/*methods; *Clinical Clerkship; Human; Descriptive Statistics; Multicenter Studies; Data Analysis Software; Academic Performance; Undergraduate; Medical; *Education; Linear Regression; Emergency Care – Education
INTRODUCTION: Since 2011 two online, validated exams for fourth-year emergency medicine (EM) students have been available (National EM M4 Exams). In 2013 the National Board of Medical Examiners offered the Advanced Clinical Examination in Emergency Medicine (EM-ACE). All of these exams are now in widespread use; however, there are no data on how they correlate. This study evaluated the correlation between the EM-ACE exam and the National EM M4 Exams. METHODS: From May 2013 to April 2014 the EM-ACE and one version of the EM M4 exam were administered sequentially to fourth-year EM students at five U.S. medical schools. Data collected included institution, gross and scaled scores and version of the EM M4 exam. We performed Pearson's correlation and random effects linear regression. RESULTS: 305 students took the EM-ACE and versions 1 (V1) or 2 (V2) of the EM M4 exams (281 and 24, respectively) [corrected].The mean percent correct for the exams were as follows: EM-ACE 74.9 (SD-9.82), V1 83.0 (SD-6.39), V2 78.5 (SD-7.70) [corrected]. Pearson's correlation coefficient for the V1/EM-ACE was 0.53 (0.43 scaled) and for the V2/EM-ACE was 0.58 (0.41 scaled) [corrected]. The coefficient of determination for V1/ EM-ACE was 0.73 and for V2/EM-ACE 0.71 (0.65 and .49 for scaled scores) [ERRATUM]. The R-squared values were 0.28 and 0.30 (0.18 and 0.13 scaled), respectively [corrected]. There was significant cluster effect by institution. CONCLUSION: There was moderate positive correlation of student scores on the EM-ACE exam and the National EM M4 Exams.
Hiller Katherine; Miller Emily S; Lawson Luan; Wald David; Beeson Michael; Heitz Corey; Morrissey Thomas; House Joseph; Poznanski Stacey
The western journal of emergency medicine
2015
2015-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.5811/westjem.2014.11.24189" target="_blank" rel="noreferrer noopener">10.5811/westjem.2014.11.24189</a>
Two-trocar cholecystectomy by strategic laparoscopy for improved cosmesis (SLIC).
Adult; Female; Humans; Middle Aged; Young Adult; Feasibility Studies; Prospective Studies; Body Mass Index; Operative Time; Surgical Instruments; Cholecystectomy; Laparoscopic/*instrumentation/*methods
BACKGROUND AND OBJECTIVES: Until the advent of singleincision laparoscopic surgery, few advances were aimed at improving cosmesis with laparoscopic cholecystectomy. Criticisms of the single-incision laparoscopic surgery technique include a larger incision and increased incidence of wound-related complications. We present our initial experience with a novel technique aimed at performing strategic laparoscopy for improved cosmesis (SLIC) for cholecystectomy. METHODS: Twenty-five patients with biliary symptoms were selected for SLIC cholecystectomy. Access to the abdomen was obtained with a 5-mm optical trocar in the left upper quadrant and a 5-mm trocar in the umbilicus. Retraction was performed by a transabdominal suture in the dome of the gallbladder and a needlescopic grasper. Age, American Society of Anesthesiologists score, body mass index, operative time, length of stay, pathology results, and short-term complications at follow-up were prospectively recorded. RESULTS: The 25 female patients had a mean age of 34.3 years and mean body mass index of 24 kg/m(2). American Society of Anesthesiologists scores ranged from 1 to 3. The mean operative time was 51.3 minutes. Pathology revealed chronic cholecystitis in all patients. All procedures were performed on an outpatient basis. The only complication was one ultrasonography-documented deep vein thrombosis. All 25 planned SLIC cholecystectomies were successfully completed. CONCLUSIONS: SLIC cholecystectomy is feasible and safe. This technique decreases the cumulative incision length, as well as the number of incisions, leading to very desirable cosmetic results in patients with a favorable body habitus and surgical history.
Dan Adrian G; Mirhaidari Shayda; Pozsgay Mark; Standerwick Andrew; Bohon Ashley; Zografakis John G
JSLS : Journal of the Society of Laparoendoscopic Surgeons
2013
2013-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.4293/108680813X13693422520242" target="_blank" rel="noreferrer noopener">10.4293/108680813X13693422520242</a>
Mechanical Ventilation Antioxidant Trial.
Adult; Female; Humans; Male; Middle Aged; Time Factors; Aged; Length of Stay; Treatment Outcome; Prospective Studies; Oxidative Stress; Double-Blind Method; Intensive Care Units; Antioxidants/*therapeutic use; Antioxidants; Oxidative Stress/*drug effects; Critical Care/*methods; Human; Chi Square Test; Funding Source; Data Analysis Software; Middle Age; T-Tests; Ascorbic Acid/therapeutic use; Critical Illness; Cystine/analogs & derivatives/therapeutic use; Inflammation/*drug therapy/*etiology; Vitamin E/therapeutic use; Vitamins/therapeutic use; 80 and over; Artificial; Respiration; Artificial/*adverse effects; Randomized Controlled Trials; Double-Blind Studies; Acetylcysteine; Critically Ill Patients; Dietary Supplementation; Log-Rank Test; Mantel-Haenszel Test; Ventilator Weaning; Vitamin E; 80 and Over; Ascorbic Acid – Administration and Dosage
BACKGROUND: Many patients each year require prolonged mechanical ventilation. Inflammatory processes may prevent successful weaning, and evidence indicates that mechanical ventilation induces oxidative stress in the diaphragm, resulting in atrophy and contractile dysfunction of diaphragmatic myofibers. Antioxidant supplementation might mitigate the harmful effects of the oxidative stress induced by mechanical ventilation. OBJECTIVE: To test the clinical effectiveness of antioxidant supplementation in reducing the duration of mechanical ventilation. METHODS: A randomized, prospective, placebo-controlled double-blind design was used to test whether enterally administered antioxidant supplementation would decrease the duration of mechanical ventilation, all-cause mortality, and length of stay in the intensive care unit and hospital. Patients received vitamin C 1000 mg plus vitamin E 1000 IU, vitamin C 1000 mg plus vitamin E 1000 IU plus N-acetylcysteine 400 mg, or placebo solution as a bolus injection via their enteral feeding tube every 8 hours. RESULTS: Clinical and statistically significant differences in duration of mechanical ventilation were seen among the 3 groups (Mantel-Cox log rank statistic = 5.69, df = 1, P = .017). The 3 groups did not differ significantly in all-cause mortality during hospitalization or in the length of stay in the intensive care unit or hospital. CONCLUSIONS: Enteral administration of antioxidants is a simple, safe, inexpensive, and effective intervention that decreases the duration of mechanical ventilation in critically ill adults.
Howe Kimberly P; Clochesy John M; Goldstein Lawrence S; Owen Hugh
American journal of critical care : an official publication, American Association of Critical-Care Nurses
2015
2015-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.4037/ajcc2015335" target="_blank" rel="noreferrer noopener">10.4037/ajcc2015335</a>