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Biomedical subjects

C S Federiuk

Publications and source records attributed to C S Federiuk.

13 recordsLinked to original sources
PubMed1999

The effect of abbreviations on MEDLINE searching.

OBJECTIVE: To determine the effect of the use of abbreviations and acronyms on citation retrieval in MEDLINE searches. METHODS: Twenty common medical abbreviations that retrieved a minimum of 400 citations each in MEDLINE text word searches were studied. Each abbreviation was entered in a MEDLINE subject search to determine whether it mapped to an appropriate medical subject heading (MeSH) term. The MeSH category and the number of citations retrieved were recorded. The abbreviation and its definition were each entered in separate text word searches, and the number of citations retrieved was recorded. Sets were combined to determine the number of identical and unique citations retrieved in the searches. RESULTS: MEDLINE recognized all 20 abbreviations and mapped them to appropriate MeSH headings. MeSH term assignment, however, may be case- and space-sensitive. MeSH term searches retrieved more citations than text word searches for 18 of 20 abbreviations. Comparison of the document sets yielded by each search method revealed a subset of citations common to each. Although all sets retrieved showed overlap, no two were identical. In addition, each citation set contained a proportion of unique documents. CONCLUSION: Retrieval of all unique citations required three searches; subject with abbreviation, text word with abbreviation, and text word with definition. These results have important implications for MEDLINE users.

Abbreviations as Topic↗
PubMed1999

Telemark skiing injuries: characteristics and risk factors.

OBJECTIVE: To determine the types of injuries associated with telemark skiing and the effects of ability level, equipment, and terrain. METHODS: A survey was mailed to a sample of North American telemark skiers. RESULTS: Completed surveys were returned by 548 telemarkers (response rate = 74.5%). The mean age was 42.7 (+/- 9.3) years, and 69% were male. A total of 439 injury events resulted in 494 body injuries, reported by 285 skiers (52%). Lower-extremity injuries (n = 231) were more frequent than upper-extremity injuries (n = 187). Knee injuries were most common with 128 cases, followed by 80 thumb, 66 shoulder, and 44 ankle injuries. Surgery was required in 39 cases. Skiers suffering thumb injuries with sequela lasting greater than 3 months were 10.1 times less likely to have sought medical attention than skiers with other long-term injuries (p < 0.001). Injuries occurred more often at lift-served ski areas (74.2%) than in the backcountry (25.8% [p < 0.001, OR = 2.09]). There was no association between boot type and overall knee or ankle injury, but risk of severe ankle injury was increased in leather boots compared to plastic (OR = 8.0, CI = 1.05, 60.59). Release bindings were used by 27.9% of all skiers but were in use in only 18.7% of injury events, suggesting that release plates have a protective effect against injury (OR = 0.59, p < 0.001). In 66 of 82 injuries (80.5%) sustained while using release bindings, the bindings did not release. CONCLUSIONS: The knee, thumb, shoulder, and ankle are most frequently injured telemark skiing. Injuries are more likely to occur at lift-served areas than in the backcountry. Thumb injuries are often ignored and may result in long-term sequela. Ankle injuries appear more severe in leather boots. Release bindings appear protective against injury, but they often do not release.

Adolescent↗
PubMed1998

Do patients refusing transport remember descriptions of risks after initial advanced life support assessment?

OBJECTIVE: To determine patient recall and understanding of instructions given to patients who refuse transport after initial paramedic assessment and medical treatment. METHODS: Following patient consent, a phone interview was completed for consecutive persons living in a large urban area for whom 9-1-1 was contacted but who subsequently refused transport after advanced life support (ALS) assessment. Subjects were asked about their recall of explained risks and benefits of transport, their understanding of those risks at the time of assessment, and subsequent use of medical care, including hospitalization. RESULTS: From October 1, 1996, to February 23, 1997, 324 people refused transport after ALS arrival. Sixty-eight people could not be contacted, providing a response rate of 79% (256/324). Six percent were subsequently admitted to the hospital for the same problem and an additional 59% sought care from a health care provider (66 ED visits, 63 personal physician, 16 urgent care, 5 other). There were no unexpected deaths. Ninety (35%) respondents were still experiencing symptoms at the time of phone contact. Despite the routine practice of providing a verbal explanation of risks and written instructions, only 141 (55%) recalled receiving written instructions and 56 (22%) recalled an explanation of risks. Twenty-six percent believed they did not fully understand their conditions or circumstances surrounding the 9-1-1 call when they refused transport and 18% would now take an ambulance if the same incident were to recur. CONCLUSION: A substantial proportion of patients refusing transport do not recall receiving verbal or written instructions and would reconsider their transport decision, raising doubts about people's ability to make informed decisions at a time of great vulnerability. The majority of patients accessed health care after refusing transport and 6% were hospitalized.

Emergency Medical Services↗
PubMed1997

Telemark skiing injuries: a three-year study.

Telemark skiing is an increasingly popular wilderness activity. Little is known, however, about the injuries incurred during modern telemark skiing. To determine the incidence and types of these injuries we carried out a prospective analysis of injured telemarkers over three ski seasons from November 1994 through May 1997 at the Mount Hood Meadows ski area medical clinic in Oregon. Injured telemark skiers presenting to the clinic were asked to fill out a one-page survey, and a diagnosis was provided by the clinic physician or nurse. During the 1995-1996 and 1996-1997 ski seasons, skiers were counted at the ski lifts to determine the proportion of telemark skiers, alpine skiers, and snowboarders using the lifts. Using these proportions and the total ticket sales for the year, the number of downhill skiers, snowboarders, and telemarkers over the season were estimated, and injury rates were calculated. During the three ski seasons, 33 injuries were identified in 28 injured telemarkers. Of the study participants, 75% (21) were male. The average age was 33.1 years. Self-described intermediate and advanced telemarkers accounted for 74% of the injured. In 96% of the injuries, the skier was performing a telemark turn. Powder snow or heavy, wet snow conditions were reported most often. Lower-extremity injuries were most common, accounting for 42.5% (14) of the total. Seven of the lower-extremity injuries were ankle injuries, and four were knee injuries. Upper-extremity injuries comprised 24.2% (8) and head and facial injuries 21.2% (7) of the total. The least number of injuries occurred in the spine, 12.1% (4). Release plates were used by 8 of 28 skiers and only released in two instances. Telemark skiers comprised 0.9% of skiers counted at the lifts during the 1995-1996 season and 1.8% in 1996-1997. Injury rates/1000 skier days in 1995-1996 were 3.3 (95% CI: 3.27, 3.35) for downhill skiers, 4.1 (95% CI: 3.32, 5.22) for telemark skiers, and 6.8 (95% CI: 6.54, 7.00) for snowboarders. Injury rates/1000 skier days in 1996-1997 were 3.1 (95% CI: 3.05, 3.15) for downhill skiers, 1.7 (95% CI: 1.44, 2.11) for telemark skiers, and 5.6 (95% CI: 5.39, 5.78) for snowboarders. We conclude that telemark skiers comprise only a small proportion of skiers at a lift-served area. Lower-extremity injuries were most common, followed by upper-extremity and head and facial injuries. Injury rates for telemarkers are comparable to those for alpine skiers.

Adult↗
PubMed1996

Advanced life support in the wilderness: 5-year experience of the Reach and Treat team.

Increasing recreation in the wilderness raises questions about the value of providing advanced life support (ALS) care in the backcountry. Since 1989 the Reach and Treat (RAT) team has provided ALS care in the wilderness area that surrounds Mount Hood, Oregon. The purpose of our study was to describe patient demographics, terrain, injuries, and ALS treatment in the wilderness environment. We utilized a retrospective, observational analysis of RAT missions from 1989 to 1994 based on data sheets maintained by the RAT team, prehospital run sheets, and hospital charts. Of the 114 missions analyzed, the median time of missions was 3 h, 9 min (range, 44 min-76 h) and 20% required technical climbing skills. Of the 74 patients treated, 55 (90%) received ALS care: 8 were intubated, 52 had intravenous lines established, and 24 received morphine for pain. Twenty patients were entered into the local trauma system. The most common injuries were extremity injuries (58), head injuries (18), and hypothermia (15). Mean time from arrival to return to staging area was 95 min. No injuries to RAT team members occurred during these missions, although two minor injuries occurred during training and testing. We found that wilderness-trained paramedics safely provided ALS care in a backcountry environment. This care may improve patient comfort during long extrication and speeds the arrival of potentially life-saving interventions such as advanced airway management.

Adolescent↗
PubMed1993

Job satisfaction of paramedics: the effects of gender and type of agency of employment.

STUDY OBJECTIVES: To document specific factors important in paramedic job satisfaction and job performance. DESIGN AND TYPE OF PARTICIPANTS: A cohort analysis sampled 63 male public-agency paramedics and 131 private-agency paramedics (90 male, 41 female). METHODS: Three scales from the Michigan Organizational Assessment Questionnaire measured total job satisfaction. A four-item scale assessed attitudes toward paramedic job performance. RESULTS: Fire paramedics reported highest levels of overall satisfaction, followed by male and female private-agency paramedics. Fire paramedics reported higher levels of intrinsic job satisfaction (eg, opportunity to learn new things) than private-agency paramedics. Differences in extrinsic job satisfaction (eg, pay, benefits) were even greater between fire paramedics and private-agency paramedics. Fire paramedics reported higher satisfaction than female private-agency paramedics with the social rewards of work (eg, the way they are treated by their coworkers). These findings were not explained by age, race, education level, and years on the job. Analysis of the attitudes toward paramedic job performance scale suggested that male paramedics are more likely to believe that female paramedics are not as capable of performing certain job functions. CONCLUSION: Type of agency and gender affect job satisfaction. Male public-agency paramedics are most satisfied, and female private-agency paramedics are least satisfied with their jobs.

Adult↗
PubMed1991

The effect of bicarbonate on resuscitation from cardiac arrest.

STUDY OBJECTIVES: This study attempted to determine the effect of bicarbonate administration on resuscitation in a porcine model of prolonged cardiac arrest. DESIGN: After instrumentation, 26 swine were subjected to ventricular fibrillation for 15 minutes (16 animals) or 20 minutes (ten animals) with no resuscitative efforts. INTERVENTIONS: Resuscitation attempts with open-chest cardiac massage and epinephrine were used in all animals after the arrest period. The experimental group was given sodium bicarbonate (3 mEq/kg), and the control group received 3% saline (5 mL/kg) at the initiation of cardiac massage. MEASUREMENTS: Resuscitation success, hemodynamics, and arterial and mixed venous gases were compared in the bicarbonate and hypertonic saline-treated groups. RESULTS: There was no difference in resuscitation rates between bicarbonate and nonbicarbonate-treated swine. After 15 minutes of ventricular fibrillation, six of eight bicarbonate-treated swine were resuscitated successfully compared with five of eight hypertonic saline-treated animals. None of the five bicarbonate-treated or five hypertonic saline-treated swine that underwent 20 minutes of ventricular fibrillation were resuscitated. The arterial and mixed venous pH values were significantly different in the bicarbonate-treated animals from values in the control group. There was no difference in systolic or diastolic blood pressures or myocardial perfusion pressure between the bicarbonate and hypertonic saline-treated animals. CONCLUSION: Despite correlation of arterial and venous acidemia, the use of sodium bicarbonate did not improve resuscitation from prolonged cardiac arrest.

Animals↗
PubMed1983

Characterization of the catalytic pathway for D-serine dehydratase. Evidence for variation of the rate-determining step with substrate structure.

Steady state kinetic parameters (kcat and Km) which were determined for the D-serine dehydratase-catalyzed decomposition of the isomers of serine and threonine at pH 5.7, 7.8, and 8.9 indicated that the enzyme exhibited considerable kinetic specificity. At pH 7.8 and 25 degrees C, the specificity constants (kcat/Km) were as follows: D-serine (3.4 X 10(5) M-1 s-1), D-threonine (2.9 X 10(4) M-1 s-1), D-allothreonine (7.5 X 10(3) M-1 s-1), and L-serine (38 M-1 s-1). Substrate C-2 deuterium atom isotope effects on the steady state kinetic parameters disclosed that the rate-determining step in the catalytic pathway varied with substrate structure and pH. Removal of the C-2 hydrogen atom of the substrate was shown to be fully rate-determining with L-serine and partially rate-determining with D-allothreonine as substrate at pH 7.8. Stopped flow measurements of absorbance and fluorescence were used to characterize intermediates in the catalytic pathway. These measurements indicated that D-serine, in addition to being the best substrate, was processed faster than the other substrates through steps in the catalytic pathway which were not rate-controlling. Kinetic evidence also was obtained which indicated that the base which accepts the proton from the C-2 carbon atom of the substrate must be aprotic. Thus, the catalytic site of D-serine dehydratase should contain a basic group in addition to the active site lysyl residue.

Escherichia coli↗
PubMed1983

A reaction pathway for transimination of the pyridoxal 5'-phosphate in D-serine dehydratase by amino acids.

Transimination of the enzyme-linked cofactor by an amino acid is the first chemical transformation in the reactions catalyzed by pyridoxal 5'-phosphate-requiring enzymes. In this work, stopped flow fluorimetry was used to characterize the kinetics of transimination of the cofactor in D-serine dehydratase by several amino acids. The results of these studies indicate that transimination is a multistep process, the first step of which is probably formation of a noncovalent complex between the enzyme and the amino acid. D-Serine dehydratase was found to exhibit considerable specificity in the transimination reaction. Furthermore, the enzyme was shown to facilitate the transimination reaction with amino acids and inhibit transimination of the bound cofactor by amines lacking a carboxylate group. A reaction pathway was proposed for the transimination process which accounts for the specificity of the enzyme and indicates the changes in the conformation of the bound cofactor as dictated by the stereoelectronic requirements of the transimination reaction.

Amino Acids↗
PubMed1981

Inactivation of D-serine dehydratase by alkylamines via a transimination of enzyme-linked cofactor.

The time-dependent inactivation of D-serine dehydratase by alkylamines was characterized. Evidence is presented indicating that inactivation proceeds via a transimination reaction analogous to the first step in the catalytic pathway. The product of alkylamine attack, an alkylamine pyridoxal 5'-phosphate Schiff base, readily dissociated from D-serine dehydratase to produce inactive apoenzyme. Reaction with alkylamines was shown to be a convenient way of producing apoenzyme which can be reconstituted with pyridoxal 5'-phosphate to fully active holoenzyme. Amino acids such as glycine and alanine, unlike alkylamines, did not resolve D-serine dehydratase but were competitive inhibitors of the enzyme. The inability of amino acids to resolve D-serine dehydratase from its cofactor was attributed to a failure of the amino acid-cofactor Schiff base to dissociate from the enzyme. Transimination of D-serine dehydratase with its substrate D-serine was at least 3.5 X 10(5) times faster than a nonenzymic model transimination reaction and more than 70 million times faster than the reaction of the enzyme with 2-hydroxyethylamine, indicating that the carboxyl group of the substrate is an important structural determinant for catalysis of the transimination step in the catalytic pathway. An analysis of the inhibitory effect of potassium ion on the rate and extent of inactivation of D-serine dehydratase by alkylamines indicated that K+ binding increased the affinity of the enzyme for its cofactor by at least 13-fold.

Amines↗
PubMedDate not supplied

Sources of disagreement among public and private agency paramedics.

INTRODUCTION: The purpose of the study was to document the occurrence and causes of disagreements between paramedics in a tiered-response emergency medical services (EMS) system. METHODS. This cohort analysis of disagreements between paramedics sampled 63 male public agency, 90 male private agency, and 41 female private agency paramedics. Paramedics responded to Likert-type items and one open-ended item concerning the occurrence of conflict between paramedics. RESULTS: On-scene conflict between EMS personnel from public and private agencies was reported by 70% of the respondents. Conflicts that interfered with patient care were reported to occur more frequently between paramedics from different types of agencies. The most commonly mentioned subject of disagreement was patient treatment, followed by patient transport, interpersonal and interagency conflicts, and patient assessment. CONCLUSION: A majority of paramedics have experienced on-scene disagreements with other paramedics. Disagreements occur more frequently between paramedics from different agencies and encompass a wide range of issues concerning patient care and interpersonal relationships.

Adult↗