Thrombolysis for acute ischemic stroke has been studied for more than adecade, but its efficacy remains controversial. The first study to claim thattissue plasminogen activator (tPA) is effective in the treatment of acuteischemic stroke was a multicenter clinical trial coordinated by the NationalInstitute of Neurological Disorders and Stroke (NINDS) Study Group. The NINDSstudy's conclusions, published in1995,1 were that“treatment with intravenous tPA within 3 hours of the onset of ischemicstroke improved clinical outcome at 3 months... [A]s compared with patientsgiven placebo, patients treated with tPA were at least 30% more likely to haveminimal or no disability at 3months.”1(p1586)The NINDS study was widely perceived to be a well-executed and analyzedrandomized controlled trial, and its results were well received by manymedical professionals and thepublic.thepublic. Table 1 Percentage of patients (N = 320) in the 91 to 180-minute subgroups witha specific baseline National Institutes of Health Stroke Scale (NIHSS)score* Over the past 5 years, tPA therapy for acute ischemic stroke has enteredthe mainstream of emergency medical practice in the United States. When theAmerican Heart Association revised its advanced cardiac life support (ACLS)guidelines for the 2000 ACLS handbook, Guidelines 2000 for CardiopulmonaryResuscitation and Emergency Cardiovascular Care, it gave tPA a class Irecommendation for the therapy of acute ischemic stroke. The American HeartAssociation gives a drug a class I recommendation if the evidence in supportof its effectiveness is considered homogeneous, consistently positive, androbust. Are the NINDS study's results sufficiently robust to withstandrigorous analysis, and is tPA, therefore, fully deserving of a class Irecommendation for the treatment of acute ischemic stroke?
{"title":"Truths about the NINDS study: setting the record straight.","authors":"J. Mann","doi":"10.1136/ewjm.176.3.192","DOIUrl":"https://doi.org/10.1136/ewjm.176.3.192","url":null,"abstract":"Thrombolysis for acute ischemic stroke has been studied for more than adecade, but its efficacy remains controversial. The first study to claim thattissue plasminogen activator (tPA) is effective in the treatment of acuteischemic stroke was a multicenter clinical trial coordinated by the NationalInstitute of Neurological Disorders and Stroke (NINDS) Study Group. The NINDSstudy's conclusions, published in1995,1 were that“treatment with intravenous tPA within 3 hours of the onset of ischemicstroke improved clinical outcome at 3 months... [A]s compared with patientsgiven placebo, patients treated with tPA were at least 30% more likely to haveminimal or no disability at 3months.”1(p1586)The NINDS study was widely perceived to be a well-executed and analyzedrandomized controlled trial, and its results were well received by manymedical professionals and thepublic.thepublic. \u0000 \u0000 \u0000 \u0000Table 1 \u0000 \u0000Percentage of patients (N = 320) in the 91 to 180-minute subgroups witha specific baseline National Institutes of Health Stroke Scale (NIHSS)score* \u0000 \u0000 \u0000 \u0000Over the past 5 years, tPA therapy for acute ischemic stroke has enteredthe mainstream of emergency medical practice in the United States. When theAmerican Heart Association revised its advanced cardiac life support (ACLS)guidelines for the 2000 ACLS handbook, Guidelines 2000 for CardiopulmonaryResuscitation and Emergency Cardiovascular Care, it gave tPA a class Irecommendation for the therapy of acute ischemic stroke. The American HeartAssociation gives a drug a class I recommendation if the evidence in supportof its effectiveness is considered homogeneous, consistently positive, androbust. Are the NINDS study's results sufficiently robust to withstandrigorous analysis, and is tPA, therefore, fully deserving of a class Irecommendation for the treatment of acute ischemic stroke?","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"145 1","pages":"192-4"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90683981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Major General Mohammed Siad Barre, President of Somalia from 1969 to 1991,was a dismal tyrant who left a legacy of civil war, clan violence, and massstarvation. Ironically (and perhaps unintentionally), he also presided over asymbolic milestone in public health. Until 1972, Somali was not a written language. The literacy rate in Somaliawas 5%. Siad Barre introduced a Roman script and ordered the writing ofgovernment documents and educational material. Then, in August 1974, in a“Campaign Against Illiteracy,” he temporarily closed the schoolsand sent the teachers and students, more than 20,000, back to their homevillages and nomadic tribes to teach their brethren basic literacy. We think of clean water, good sewers, and immunization when we think ofimportant measures for public health. But education is the key event andeffective education begins with literacy. In numerous studies, literacy itselfhas been linked to reduced childhood mortality, reduced maternal mortality,effective family planning, and even a reduction in the prevalence of dentalcaries in children.
{"title":"Literacy and public health","authors":"D. Heiden","doi":"10.1136/ewjm.176.3.216","DOIUrl":"https://doi.org/10.1136/ewjm.176.3.216","url":null,"abstract":"Major General Mohammed Siad Barre, President of Somalia from 1969 to 1991,was a dismal tyrant who left a legacy of civil war, clan violence, and massstarvation. Ironically (and perhaps unintentionally), he also presided over asymbolic milestone in public health. \u0000 \u0000Until 1972, Somali was not a written language. The literacy rate in Somaliawas 5%. Siad Barre introduced a Roman script and ordered the writing ofgovernment documents and educational material. Then, in August 1974, in a“Campaign Against Illiteracy,” he temporarily closed the schoolsand sent the teachers and students, more than 20,000, back to their homevillages and nomadic tribes to teach their brethren basic literacy. \u0000 \u0000We think of clean water, good sewers, and immunization when we think ofimportant measures for public health. But education is the key event andeffective education begins with literacy. In numerous studies, literacy itselfhas been linked to reduced childhood mortality, reduced maternal mortality,effective family planning, and even a reduction in the prevalence of dentalcaries in children.","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"12 1","pages":"216-216"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86470010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Childhood anxiety disorders are the most common type of psychiatric problemin children.1 Thesedisorders cause severe impairment and excessive distress. Although effectivepsychosocial and drug therapy exists, these anxious youngsters are virtuallyignored compared with children with other psychiatric problems. Few clinicallyanxious children come to the attention of physicians or other mental healthproviders.2 In 11 of 15 studies worldwide of impairing childhood anxiety disorders, theprevalence was greater than10%.3 In four offive large US surveys, prevalence was between 12% and20%.3 Otherpsychiatric problems are common in anxious children, particularly depression,behavior disorders, and substance misuse. Childhood anxiety disorderstypically onset in early childhood and follow a chronic and fluctuating courseinto adulthood.4 Although historically thought to be benign, these disorders can interferewith academic, social, and familyfunctioning.5 Theyare associated with an increased risk of failure in school and, in adulthood,low-paying jobs and financial dependence on welfare or other governmentsubsidies. Childhood anxiety is predictive of adult anxiety disorder, majordepression, suicide attempts, and psychiatrichospitalization.4,6 Children born to anxious parents are themselves more likely to be anxious.The mechanism for this association is unclear—both environmental(parenting style, parentchild interactions) and genetic factors have beenimplicated. Anxious parents may exacerbate their children's anxiety through aparticular style of interaction, including overprotection and excessivecontrol.7,8 Unfortunately, most children with anxiety disorders do not receive adequateassessment andtreatment.2 Thisfact is particularly disturbing because these disorders can be treatedeffectively with cognitive behaviortherapy9 and the useof selective serotonin reuptakeinhibitors.10 Why do practitioners neglect childhood anxiety? The reason may be a common,yet inaccurate, belief that anxiety in children and adolescents isdevelopmentally normal, typically transient, and innocuous. Terms such asfear, phobia, and anxiety are often used interchangeably among mental healthprofessionals and physicians, leading to diagnostic confusion andmisperceptions of the actual significance of anxiety disorders inchildhood.11 Fears are developmentally appropriate reactions to threats, which may beobjective (blood tests, tooth extractions) or subjective (strangers,lightning). During the first year of life, children typically fear intensestimuli, such as loud noises; potentially harmful stimuli, such as fallingover or strangers, and novel stimuli. Fears of tangible items (dogs, bodilyinjury) and vague objects (monsters, dark, separation) are most prevalentduring the preschool years (ages 1 to 4). During the school years, appropriatefears of evaluation, school-related events (tests, oral presentations), andaspects of peer relationships are most common. Phobias are different
{"title":"Recognizing and treating childhood anxiety disorders.","authors":"J. Piacentini, Tami L. Roblek","doi":"10.1136/EWJM.176.3.149","DOIUrl":"https://doi.org/10.1136/EWJM.176.3.149","url":null,"abstract":"Childhood anxiety disorders are the most common type of psychiatric problemin children.1 Thesedisorders cause severe impairment and excessive distress. Although effectivepsychosocial and drug therapy exists, these anxious youngsters are virtuallyignored compared with children with other psychiatric problems. Few clinicallyanxious children come to the attention of physicians or other mental healthproviders.2 \u0000 \u0000In 11 of 15 studies worldwide of impairing childhood anxiety disorders, theprevalence was greater than10%.3 In four offive large US surveys, prevalence was between 12% and20%.3 Otherpsychiatric problems are common in anxious children, particularly depression,behavior disorders, and substance misuse. Childhood anxiety disorderstypically onset in early childhood and follow a chronic and fluctuating courseinto adulthood.4 \u0000 \u0000Although historically thought to be benign, these disorders can interferewith academic, social, and familyfunctioning.5 Theyare associated with an increased risk of failure in school and, in adulthood,low-paying jobs and financial dependence on welfare or other governmentsubsidies. Childhood anxiety is predictive of adult anxiety disorder, majordepression, suicide attempts, and psychiatrichospitalization.4,6 \u0000 \u0000Children born to anxious parents are themselves more likely to be anxious.The mechanism for this association is unclear—both environmental(parenting style, parentchild interactions) and genetic factors have beenimplicated. Anxious parents may exacerbate their children's anxiety through aparticular style of interaction, including overprotection and excessivecontrol.7,8 \u0000 \u0000Unfortunately, most children with anxiety disorders do not receive adequateassessment andtreatment.2 Thisfact is particularly disturbing because these disorders can be treatedeffectively with cognitive behaviortherapy9 and the useof selective serotonin reuptakeinhibitors.10 \u0000 \u0000Why do practitioners neglect childhood anxiety? The reason may be a common,yet inaccurate, belief that anxiety in children and adolescents isdevelopmentally normal, typically transient, and innocuous. Terms such asfear, phobia, and anxiety are often used interchangeably among mental healthprofessionals and physicians, leading to diagnostic confusion andmisperceptions of the actual significance of anxiety disorders inchildhood.11 \u0000 \u0000Fears are developmentally appropriate reactions to threats, which may beobjective (blood tests, tooth extractions) or subjective (strangers,lightning). During the first year of life, children typically fear intensestimuli, such as loud noises; potentially harmful stimuli, such as fallingover or strangers, and novel stimuli. Fears of tangible items (dogs, bodilyinjury) and vague objects (monsters, dark, separation) are most prevalentduring the preschool years (ages 1 to 4). During the school years, appropriatefears of evaluation, school-related events (tests, oral presentations), andaspects of peer relationships are most common. Phobias are different","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"50 1","pages":"149-51"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79527059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Martel and Biller reported that the socially ideal height for western menis 188 cm (6 ft 2 in) andrising.1 Withadvances in genetic engineering, parents will be able to control the heightsof their children, and these heights are likely to increase with each newgeneration. Indeed, greater height and associated lean body mass are viewedpositively by the medical profession and society. This bias is based on a fewstudies and our cultural values but ignores extensive data that indicate thatshorter stature is healthier. We summarize our findings of more than 25 yearsof personal and literatureresearch.literatureresearch. Table 1 Age-standardized death rates from all causes, coronary heart disease(CHD), and stroke per 100,000 population (males) for 6 ethnic groups inCalifornia
{"title":"Height, body size, and longevity: is smaller better for the human body?","authors":"T. Samaras, H. Elrick","doi":"10.1136/EWJM.176.3.206","DOIUrl":"https://doi.org/10.1136/EWJM.176.3.206","url":null,"abstract":"Martel and Biller reported that the socially ideal height for western menis 188 cm (6 ft 2 in) andrising.1 Withadvances in genetic engineering, parents will be able to control the heightsof their children, and these heights are likely to increase with each newgeneration. Indeed, greater height and associated lean body mass are viewedpositively by the medical profession and society. This bias is based on a fewstudies and our cultural values but ignores extensive data that indicate thatshorter stature is healthier. We summarize our findings of more than 25 yearsof personal and literatureresearch.literatureresearch. \u0000 \u0000 \u0000 \u0000Table 1 \u0000 \u0000Age-standardized death rates from all causes, coronary heart disease(CHD), and stroke per 100,000 population (males) for 6 ethnic groups inCalifornia","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"33 1","pages":"206-8"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85420053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Solid archaeologic evidence shows that North and South America werecompletely occupied by about 10,000 years ago, and new findings suggest thatboth continents were inhabited much earlier. At European contact in the late15th century, American Indian populations were diverse in their cultural andecologic adaptations and in their languages. The conditions accompanying thepeopling of the New World and the subsequent cultural and linguisticdiversification also favored genetic diversification. To the extent that theAmerican Indian populations have remained intact, the patterns of moderngenetic polymorphisms provide clues about the roles of genetic, environmental,and sociocultural factors in disease causation and the mechanisms by whichthese diverse causes interact. Even with the distortions of the pre-Columbiangenetic pool associated with disease, warfare, and dislocation after Europeancontact, it is likely that studies of genetic polymorphisms will yieldimportant health benefits. The study of genetic markers is clearly not a new phenomenon—datahave been accumulating in various ways for decades—but the exquisiteprecision of current molecular analysis has introduced a new paradigm. ManyIndian people are concerned that such research has unknown consequences, someof which may be adverse. Indian people themselves should judge the ultimateusefulness of such studies.
{"title":"Genetic polymorphism and American Indian health.","authors":"J. Long, J. Lorenz","doi":"10.1136/EWJM.176.3.203","DOIUrl":"https://doi.org/10.1136/EWJM.176.3.203","url":null,"abstract":"Solid archaeologic evidence shows that North and South America werecompletely occupied by about 10,000 years ago, and new findings suggest thatboth continents were inhabited much earlier. At European contact in the late15th century, American Indian populations were diverse in their cultural andecologic adaptations and in their languages. The conditions accompanying thepeopling of the New World and the subsequent cultural and linguisticdiversification also favored genetic diversification. To the extent that theAmerican Indian populations have remained intact, the patterns of moderngenetic polymorphisms provide clues about the roles of genetic, environmental,and sociocultural factors in disease causation and the mechanisms by whichthese diverse causes interact. Even with the distortions of the pre-Columbiangenetic pool associated with disease, warfare, and dislocation after Europeancontact, it is likely that studies of genetic polymorphisms will yieldimportant health benefits. \u0000 \u0000The study of genetic markers is clearly not a new phenomenon—datahave been accumulating in various ways for decades—but the exquisiteprecision of current molecular analysis has introduced a new paradigm. ManyIndian people are concerned that such research has unknown consequences, someof which may be adverse. Indian people themselves should judge the ultimateusefulness of such studies.","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"17 1","pages":"203-5"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81756238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ms Roberts, a 54-year-old African American woman with cirrhosis due to hepatitis B, presented with a new right upper quadrant abdominal pain. A computed tomographic scan showed a poorly defined mass with indistinct borders located near the portal vein. The likely diagnosis was hepatocellular carcinoma, probably unresectable due to proximity to the portal vein. A gastroenterologist tells her that the mass may represent cancer but that a liver biopsy is needed to establish the diagnosis. She agrees to the biopsy. Her physician reads the biopsy report while Ms Roberts is sitting in a clinic examining room.
{"title":"Communicating bad news.","authors":"A. Back, J. Curtis","doi":"10.1136/EWJM.176.3.177","DOIUrl":"https://doi.org/10.1136/EWJM.176.3.177","url":null,"abstract":"Ms Roberts, a 54-year-old African American woman with cirrhosis due to hepatitis B, presented with a new right upper quadrant abdominal pain. A computed tomographic scan showed a poorly defined mass with indistinct borders located near the portal vein. The likely diagnosis was hepatocellular carcinoma, probably unresectable due to proximity to the portal vein. A gastroenterologist tells her that the mass may represent cancer but that a liver biopsy is needed to establish the diagnosis. She agrees to the biopsy. Her physician reads the biopsy report while Ms Roberts is sitting in a clinic examining room.","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"17 1","pages":"177-80"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82683116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 12-year-old girl is brought in by her mother, who is concerned because her daughter is short even compared with other family members. She estimates that her daughter has grown less than 3 cm ( 1 in) in the past year andasks if she should receive growth hormone-a treatment that was recently mentioned in a newspaper article. The girl has no significant past medical illness or family history of disease that might be associated with short stature and is free of symptoms. She is a good student and has not been subjected to physical or verbal bullying at school. Her father is 170 cm (5 ft 10 in) tall (10th percentile for a man), and her mother is 160 cm (5 ft 3 in) tall (25th percentile for a woman). Neither was a "late bloomer." On physical examination, the prepubertal girl has no signs of disease. Her height is 133 cm (4 ft 4 in) (. 5th percentile for age), and her weight is 35 kg (77 lb) (25th percentile).
{"title":"Management of short stature.","authors":"S. Taback, H. Dean, E. Elliott","doi":"10.1136/EWJM.176.3.169","DOIUrl":"https://doi.org/10.1136/EWJM.176.3.169","url":null,"abstract":"A 12-year-old girl is brought in by her mother, who is concerned because her daughter is short even compared with other family members. She estimates that her daughter has grown less than 3 cm ( 1 in) in the past year andasks if she should receive growth hormone-a treatment that was recently mentioned in a newspaper article. The girl has no significant past medical illness or family history of disease that might be associated with short stature and is free of symptoms. She is a good student and has not been subjected to physical or verbal bullying at school. Her father is 170 cm (5 ft 10 in) tall (10th percentile for a man), and her mother is 160 cm (5 ft 3 in) tall (25th percentile for a woman). Neither was a \"late bloomer.\" On physical examination, the prepubertal girl has no signs of disease. Her height is 133 cm (4 ft 4 in) (. 5th percentile for age), and her weight is 35 kg (77 lb) (25th percentile).","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"66 1","pages":"169-72"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78729079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The wind wheeled with deliberate menace, chopping the water white withfroth. The sheet of black rain riding in on it promised to arrive in less than5 minutes. Pauker muttered to himself, stomped off the dock, and headed up thetrail back to the cabin. After the briefest thought of braving the weather, Ifollowed him through the swaying pines toward the amber light above. I reachedthe porch door just as the shatter of rain began to pound the cabin roof. Thewind behind it gusted to gale force. I was glad to be inside.
{"title":"The neglected discipline.","authors":"M. Lacombe","doi":"10.1136/EWJM.176.3.210","DOIUrl":"https://doi.org/10.1136/EWJM.176.3.210","url":null,"abstract":"The wind wheeled with deliberate menace, chopping the water white withfroth. The sheet of black rain riding in on it promised to arrive in less than5 minutes. Pauker muttered to himself, stomped off the dock, and headed up thetrail back to the cabin. After the briefest thought of braving the weather, Ifollowed him through the swaying pines toward the amber light above. I reachedthe porch door just as the shatter of rain began to pound the cabin roof. Thewind behind it gusted to gale force. I was glad to be inside.","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"126 1","pages":"210-2"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87637183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Altered mental state or encephalopathy may range from mild confusion tototalunresponsiveness.1At one end of the spectrum, stupor and coma refer to a state of near or totalunresponsiveness and can be caused by either a focal or diffuse process. Inthis review, we discuss the general approach to patients with stupor and coma.Timely diagnosis and appropriate treatment are important because stupor andcoma often reflect life-threatening, systemic or intracranialprocesses.intracranialprocesses. Table 1
{"title":"An approach to critically ill patients in coma.","authors":"Y. Liao, Y. So","doi":"10.1136/EWJM.176.3.184","DOIUrl":"https://doi.org/10.1136/EWJM.176.3.184","url":null,"abstract":"Altered mental state or encephalopathy may range from mild confusion tototalunresponsiveness.1At one end of the spectrum, stupor and coma refer to a state of near or totalunresponsiveness and can be caused by either a focal or diffuse process. Inthis review, we discuss the general approach to patients with stupor and coma.Timely diagnosis and appropriate treatment are important because stupor andcoma often reflect life-threatening, systemic or intracranialprocesses.intracranialprocesses. \u0000 \u0000 \u0000 \u0000Table 1","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"22 1","pages":"184-7"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86821621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVE To describe the injury pattern of skateboarding injuries today. METHODS The pattern of injuries, circumstances, and severity were investigated in a study of 139 people injured in skateboarding accidents during 1995 through 1998 inclusive and admitted to the University Hospital of Umeå, Umeå, Sweden. This is the only hospital in the area, serving a population of 135,000. RESULTS Of the 139 injured, 3 were pedestrians hit by a skateboard rider; the rest were riders. The age range was 7 to 47 years (mean, 16.0). The severity of the injuries was minor (Abbreviated Injury Scale 1) to moderate (Abbreviated Injury Scale 2); fractures were classified as moderate. The annual number of injuries increased during the study period. Fractures were found in 29% of the casualties, and four children had concussion. The most common fractures were of the ankle and wrist. Older patients had less severe injuries, mainly sprains and soft tissue injuries. Most children were injured while skateboarding on ramps and at arenas; only 12 (9%) were injured while skateboarding on roads. Some 37% of the injuries occurred because of a loss of balance and 26% because of a failed trick attempt. Falls caused by surface irregularities resulted in the highest proportion of the moderate injuries. CONCLUSIONS Skateboarding should be restricted to supervised skateboard parks, and skateboarders should be required to wear protective gear. These measures would reduce the number of skateboarders injured in motor vehicle collisions, the personal injuries among skateboarders, and the number of pedestrians injured in collisions with skateboarders.
{"title":"Developing a culture of safety in a reluctant audience.","authors":"R. Schieber, S. Olson","doi":"10.1136/EWJM.176.3.E1","DOIUrl":"https://doi.org/10.1136/EWJM.176.3.E1","url":null,"abstract":"OBJECTIVE\u0000To describe the injury pattern of skateboarding injuries today.\u0000\u0000\u0000METHODS\u0000The pattern of injuries, circumstances, and severity were investigated in a study of 139 people injured in skateboarding accidents during 1995 through 1998 inclusive and admitted to the University Hospital of Umeå, Umeå, Sweden. This is the only hospital in the area, serving a population of 135,000.\u0000\u0000\u0000RESULTS\u0000Of the 139 injured, 3 were pedestrians hit by a skateboard rider; the rest were riders. The age range was 7 to 47 years (mean, 16.0). The severity of the injuries was minor (Abbreviated Injury Scale 1) to moderate (Abbreviated Injury Scale 2); fractures were classified as moderate. The annual number of injuries increased during the study period. Fractures were found in 29% of the casualties, and four children had concussion. The most common fractures were of the ankle and wrist. Older patients had less severe injuries, mainly sprains and soft tissue injuries. Most children were injured while skateboarding on ramps and at arenas; only 12 (9%) were injured while skateboarding on roads. Some 37% of the injuries occurred because of a loss of balance and 26% because of a failed trick attempt. Falls caused by surface irregularities resulted in the highest proportion of the moderate injuries.\u0000\u0000\u0000CONCLUSIONS\u0000Skateboarding should be restricted to supervised skateboard parks, and skateboarders should be required to wear protective gear. These measures would reduce the number of skateboarders injured in motor vehicle collisions, the personal injuries among skateboarders, and the number of pedestrians injured in collisions with skateboarders.","PeriodicalId":22925,"journal":{"name":"The Western journal of medicine","volume":"436 1","pages":"E1-2"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79611473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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