Catalogue Search | MBRL
Are you sure you want to remove the book from the shelf?
{{itemTitle}}
586
result(s) for
"Quinn, Eric"
Sort by:
Evaluating outcomes of patients with suspected pulmonary embolism using an age-adjusted cutoff with a D-dimer unit-based assay
Studies have suggested that an age-adjusted D-dimer (AADD) could improve specificity while maintaining sensitivity for the diagnosis of pulmonary embolism (PE). Most laboratories and published data report D-dimer in fibrinogen equivalent units, but some laboratory assays report using D-dimer units (DDU). However, only two small studies have examined AADD with a DDU-based assay. Our study aims to assess the sensitivity and specificity of AADD cutoffs, compared to the conventional cutoffs, in a large cohort of patients who underwent D-dimer testing using a DDU-based assay, for suspected PE.
We included 1831 patients who presented to the emergency department and underwent a diagnostic workup that included a D-dimer test followed by computed tomography pulmonary angiography (CTA). The laboratory utilized the HemosIL D-Dimer HS reagent, reporting D-dimer values in DDU (ng/mL). We retrospectively adjusted D-dimer levels for patients using the formula: age (years) x 5 ng/mL. This adjustment created a comparison group to evaluate the test characteristics of the AADD cutoff compared to the conventional cutoff.
The conventional D-dimer cutoff of 230 ng/mL had a sensitivity of 97.4 % (95 % Confidence Interval [CI]: 95.3–99.4 %), specificity of 7.3 % (CI: 6.0–8.6 %), positive predictive value (PPV) of 13 % (CI: 11.4–14.6 %), and negative predictive value (NPV) of 95.1 % (CI: 91.3–98.9 %). The AADD cutoff had a sensitivity of 96.1 % (CI: 93.5–98.6 %), specificity of 16.6 % (CI: 14.8–18.4 %), PPV of 14.1 % (CI: 12.3–15.8 %), and NPV of 96.7 % (CI: 94.6–98.8 %).
In this study using a DDU-based assay, the specificity of the AADD cutoff was greater while the sensitivity was similar to that of the unadjusted cutoff, with no statistically significant difference observed.
•Few studies have validated Age-adjusted D-Dimer (AADD) in D-Dimer unit based assays.•AADD sensitivity was 96.1 % (CI: 93.5-98.6 %) vs 97.4 % (CI: 95.3-99.4 %) for conventional.•AADD increased specificity to 16.6% (CI: 14.8-18.4 %) from 7.3% (CI: 6.0-8.6 %).•Applying AADD cutoffs could have reduced unnecessary imaging by 8.3%.
Journal Article
Off to save the day!
Supergirl wraps up all of the cosmic craziness that has developed since her arrival on Earth, including arch-frenemies, scheming faculty, an intergalactic orange kitty and a flying horse.
Book
Cold water immersion implementation for hyperthermia induced cardiac arrest
Cold water immersion (CWI) is the most effect, evidence-backed intervention for managing severe hyperthermia. The Wilderness Medical Society recommends prioritizing airway, breathing, and circulation before cooling, followed by treating heat stroke with CWI and intravenous hydration [ 5]. While CWI should not replace critical interventions such as high-quality chest compressions or airway management, we call upon the emergency and prehospital community to recognize the high mortality associated with hyperthermic cardiac arrest and the proven efficacy of CWI.
Journal Article
Secret entity!
A little orange cat with a big attitude shows up on the scene, and Lena makes a discovery that may change her friendship with Linda forever.
Book
Association of Heat Index and Patient Presentation Rate at a Stadium
Introduction: A mass gathering is defined as an event that has the potential to strain the resources of the local health system. An onsite physician for mass gatherings can mitigate the strain on the local health infrastructure. One factor affecting onsite medical usage and patient presentation rates is the heat index, which is a calculated value of perceived heat exposure that combines air temperature and relative humidity. In this study we asked whether there was a positive association between heat index and patient presentation rates for onsite medical care at a bounded (large event in an enclosed location) professional stadium sporting event. We hypothesized that a positive correlation exists between these two variables and assess whether it might surpass current onsite resources. Methods: We performed a prospective observational study with patients seeking medical care at a baseball stadium in a large northeastern city in the United States. The onsite physician collected information on patients who presented during games held at the stadium. Data on game attendance, temperature in degrees Fahrenheit (F), humidity, and heat index were collected using government and professional organization websites. We assessed the correlation between heat index and patient presentation rate with the Pearson product-moment correlation (PPMC) per 100,000 attendees at the game. Results: A total of 81 baseball games occurred at the studied stadium from April–September 2023, with eight games excluded due to incomplete data. The heat index ranged from 46°F to 91°F, with a mean (± SD) of 70.8°F (± 10.4°F). The number of patients varied from 0-5 per game, with a mean of 1.92 (± 1.13), and stadium attendance ranged from 25,007 to 47,295, with a mean of 40,824. The patient presentation rate per 100,000 in attendance was 5.04 (± 2.13). The PPMC was calculated to be 0.37 (P < .01), indicating a positive correlation between heat index and patient presentation rates. The most common reasons for seeking medical care were lightheadedness and musculoskeletal complaints. Conclusion: In this study we found that the heat index was moderately associated with higher patient presentation rates at bounded mass gathering baseball events. No additional resources were needed, but this correlation could aid future event medical planning efforts as the climate continues to evolve.
Journal Article
Evil in a skirt!
It is eighth grade graduation day, and between graduation, trying to keep her identity a secret, and a Supergirl copy showing up, Kara has a lot on her mind.
BOOK
Nebulized Ketamine Used for Managing Ankle Fracture in the Prehospital Emergency Setting: A Case Report
Introduction: Acute traumatic limb injury is a common complaint of patients presenting to the emergency department (ED). Ketamine is an effective analgesic administered via intravenous (IV), intranasal (IN), intramuscular (IM), and nebulized routes in the ED. It has also been used in the prehospital setting via IV, IM, and IN routes. Recent studies have proposed the prehospital use of nebulized ketamine via breath-actuated nebulizer (BAN) as a noninvasive and effective method of analgesic delivery, as well as an alternative to opioid analgesia. Case Report: We present a case of a patient with right ankle fracture after a 12-foot fall who subsequently received 0.75 milligrams per kilogram of nebulized ketamine via BAN in the prehospital setting. The patient reported improvement of pain from 8/10 to 3/10 on the pain scale without need for additional pain medication during prehospital transport. This report supports the use of nebulized ketamine via BAN in the prehospital setting for acute traumatic limb injuries. Conclusion: The use of nebulized ketamine via BAN in the prehospital setting may be an effective analgesic option for the management of patients with acute traumatic limb injuries, particularly in those with difficult IV access, where mucosal atomization devices are not accessible, or where opioid-sparing treatments are preferable.
Journal Article
Atlas of temporomandibular joint surgery
This second edition of the Atlas of Temporomandibular Joint Surgery is a major revision of Dr. Quinn's classic work, taking into account new procedures, equipment, and evidence-based findings from the latest research in TMJ treatment. Assuming that readers are familiar with non-surgical therapies to correct temporomandibular pain and disorders, Drs. Quinn and Granquist focus on the surgical remedies for disorders that are beyond conservative treatment. This concise, how-to surgical atlas guides both the novice and experienced surgeon through the intra-articular and extra-articular procedures that have proven efficacious in the treatment of advanced craniomandibular dysfunction. Chapters take readers through decision making for TMJ surgery, diagnostic imaging methods, surgical approaches, surgery for internal derangements, trauma, osseous surgical procedures, total joint replacement, and pathologies.
eBook
