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Medical Sciences	100%

Selected Abstracts

Competence of New Emergency Medicine Residents in the Performance of Lumbar Punctures

ACADEMIC EMERGENCY MEDICINE, Issue 7 2005
Richard L. Lammers MD
Abstract Background: Medical students are taught some procedural skills during medical school, but there is no uniform set of procedures that all students learn before residency. Objective: To determine the level of competence in the performance of a lumbar puncture (LP) by new postgraduate year 1 (PGY1) emergency medicine (EM) residents. Methods: An observational study was conducted at three EM residencies with 42 PGY1 residents who recently graduated from 26 various medical schools. The LP procedure was divided into 26 major and 44 minor steps to create a scoring protocol. The model, procedure, and scoring protocol were validated by experienced emergency physicians. Subjects performed the procedure without interruption or feedback on an LP training model using a standard LP kit. A step was scored as "performed correctly" if two of the three evaluators concurred. Pre- and poststudy questionnaires assessed subjects' prior instruction and clinical experience with LP, self-confidence, sense of relevance, motivation, and fatigue. Results: Subjects completed an average of 14.8 (57%; 95% confidence interval [95% CI] = 53% to 61%) of the major steps (range: 4,26) and 19.1 (43%; 95% CI = 42% to 45%) of the minor steps (range: 7,28) in 14.3 minutes (range: 3,22). Sixty-nine percent failed to obtain cerebrospinal fluid from the model. Subjects' levels of confidence changed slightly on a five-point scale from 2.8 ("little-to-some") before the test to 2.5 after the test. Eighty-three percent of the subjects previously performed LPs on patients during medical school (average attempts = 2.2; range: 0,10), but only 40% of those who did so were supervised by an attending during their first attempt. Conclusions: In the cohort studied, new PGY1 EM residents had not attained competence in performing LPs from training in medical school. Most new PGY1 residents probably require training, practice, and close, direct supervision of this procedure by attending physicians until the residents demonstrate competent performance. [source]

Cardiovascular and Metabolic Effects of High-dose Insulin in a Porcine Septic Shock Model

ACADEMIC EMERGENCY MEDICINE, Issue 4 2010
Joel S. Holger MD
Abstract Objectives:, High-dose insulin (HDI) has inotropic and vasodilatory properties in various clinical conditions associated with myocardial depression. The authors hypothesized that HDI will improve the myocardial depression produced by severe septic shock and have beneficial effects on metabolic parameters. In an animal model of severe septic shock, this study compared the effects of HDI treatment to normal saline (NS) resuscitation alone. Methods:, Ten pigs were randomized to an insulin (HDI) or NS group. All were anesthetized and instrumented to monitor cardiovascular function. In both arms, Escherichia coli endotoxin lipopolysaccharide (LPS) and NS infusions were begun. LPS was titrated to 20 ,g/kg/hour over 30 minutes and continued for 5 hours, and saline was infused at 20 mL/kg/hour throughout the protocol. Dextrose (50%) was infused to maintain glucose in the 60,150 mg/dL range, and potassium was infused to maintain a level greater than 2.8 mmol/L. At 60 minutes, the HDI group received an insulin infusion titrated from 2 to 10 units/kg/hour over 40 minutes and continued at that rate throughout the protocol. Survival, heart rate (HR), mean arterial pressure (MAP), pulmonary artery and central venous pressure, cardiac output, central venous oxygen saturation (SVO2), and lactate were monitored for 5 hours (three pigs each arm) or 7 hours (two pigs each arm) or until death. Cardiac index, systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), O2 delivery, and O2 consumption were derived from measured data. Outcomes from the repeated-measures analysis were modeled using a mixed-effects linear model that assumed normally distributed errors and a random effect at the subject level. Results:, No significant baseline differences existed between arms at time 0 or 60 minutes. Survival was 100% in the HDI arm and 60% in the NS arm. Cardiovascular variables were significantly better in the HDI arm: cardiac index (p < 0.001), SVR (p < 0.003), and PVR (p < 0.01). The metabolic parameters were also significantly better in the HDI arm: SVO2 (p < 0.01), O2 delivery (p < 0.001), and O2 consumption (p < 0.001). No differences in MAP, HR, or lactate were found. Conclusions:, In this animal model of endotoxemic-induced septic shock that results in severe myocardial depression, HDI is associated with improved cardiac function compared to NS resuscitation alone. HDI also demonstrated favorable metabolic, pulmonary, and peripheral vascular effects. Further studies may define a potential role for the use of HDI in the resuscitation of septic shock. ACADEMIC EMERGENCY MEDICINE 2010; 17:429,435 © 2010 by the Society for Academic Emergency Medicine [source]

Treatment of class III multiple gingival recessions: a randomized-clinical trial

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 1 2010
Sofia Aroca
Abstract Background: The aim of this controlled randomized split-mouth study was to evaluate whether a modified tunnel/connective tissue graft (CTG) technique , enamel matrix derivative (EMD) combination will improve the treatment of multiple class III recession when compared with the same technique alone. Materials and Methods: Twenty healthy subjects with a mean age of 31.7 years, were enrolled for the trial in a university periodontal clinic. Patients with at least three adjacent gingival recessions on both sides of the mouth were treated with a modified tunnel/CTG technique. On the test side, an EMD was used in addition. Clinical parameters were measured at baseline, 28 days, 3, 6 and 12 months after the surgery. Results are presented at the subject level. Results: The mean root coverage from baseline to 1 year post-surgery was 82% for the test group and 83% for the control group. Complete root coverage was achieved at 1 year in eight (38%) of the 20 surgeries (experimental and control group). Conclusions: One-year results indicate that the modified tunnel/CTG technique is predictable for the treatment of multiple class III recession-type defects. The addition of EMD does not enhance the mean clinical outcomes. [source]

A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 2008
Part I: Lateral approach
Abstract Objectives: The objectives of this systematic review were to assess the survival rate of grafts and implants placed with sinus floor elevation. Material and Methods: An electronic search was conducted to identify studies on sinus floor elevation, with a mean follow-up time of at least 1 year after functional loading. Results: The search provided 839 titles. Full-text analysis was performed for 175 articles resulting in 48 studies that met the inclusion criteria, reporting on 12,020 implants. Meta-analysis indicated an estimated annual failure rate of 3.48% [95% confidence interval (CI): 2.48%,4.88%] translating into a 3-year implant survival of 90.1% (95% CI: 86.4%,92.8%). However, when failure rates was analyzed on the subject level, the estimated annual failure was 6.04% (95% CI: 3.87%,9.43%) translating into 16.6% (95% CI: 10.9%,24.6%) of the subjects experiencing implant loss over 3 years. Conclusion: The insertion of dental implants in combination with maxillary sinus floor elevation is a predictable treatment method showing high implant survival rates and low incidences of surgical complications. The best results (98.3% implant survival after 3 years) were obtained using rough surface implants with membrane coverage of the lateral window. [source]

Compromised GCF total antioxidant capacity in periodontitis: cause or effect?

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 2 2007
I. L. C. Chapple
Abstract Background: Oxidative stress is implicated in the pathogenesis of periodontitis. The total antioxidant capacity (TAOC) of gingival crevicular fluid volume (GCF) and plasma appears compromised in periodontitis, but it is unclear whether this predisposes to, or results from the inflammatory process. Aim: To investigate longitudinal changes in GCF and plasma TAOC following reductions in periodontal inflammation with successful non-surgical therapy. Materials and Methods: Two longitudinal studies were run in series on non-smokers with chronic periodontitis (CP). Study-1 (n=17) assessed index sites with mild disease; Study-2 (n=18) investigated deep sites. GCF sampling and clinical measures were performed at baseline and 3 months post-therapy. Plasma and GCF TAOC was determined by enhanced chemiluminescence and 32 age/sex-matched periodontally healthy controls were used. Results: Therapy improved clinical outcomes consistent with the literature. There were no differences in plasma TAOC between periodontitis patients (507±92 ,MTeq) and controls (520±100 ,MTeq; p=0.57) at baseline, but GCF TAOC was lower (p<0.0001) in CP patients (680±371 ,MTeq) than controls (1129±722 ,MTeq). Successful periodontal therapy did not alter plasma TAOC (p=0.56), but GCF TAOC increased (by 449±722 ,MTeq, p<0.001) to control subject levels (p=0.47) Conclusions: Local total antioxidant capacity in CP appears to reflect increased oxygen radical activity during periodontal inflammation and can be restored to control subject levels by successful non-surgical therapy. [source]