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Biomedical subjects

R B Abu-Laban

Publications and source records attributed to R B Abu-Laban.

9 recordsLinked to original sources
PubMed2006

Community-dwelling seniors who present to the emergency department with a fall do not receive Guideline care and their fall risk profile worsens significantly: a 6-month prospective study.

INTRODUCTION: Fall risk is a major contributor to fracture risk; implementing fall reduction programmes remains a challenge for health professionals and policy-makers. MATERIALS AND METHODS: We aimed to (1) ascertain whether the care received by 54 older adults after an emergency department (ED) fall presentation met internationally recommended 'Guideline Care', and (2) prospectively evaluate this cohort's 6-month change in fall risk profile. Participants were men and women aged 70 years or older who were discharged back into the community after presenting to an urban university tertiary-care hospital emergency department with a fall-related complaint. American Geriatric Society (AGS) guideline care was documented by post-presentation emergency department chart examination, daily patient diary of falls submitted monthly, patient interview and physician reconciliation where needed. Both at study entry and at a 6-month followup, we measured participants physiological characteristics by Lord's Physiological Profile Assessment (PPA), functional status, balance confidence, depression, physical activity and other factors. RESULTS: We found that only 2 of 54 (3.7%) of the fallers who presented to the ED received care consistent with AGS Guidelines. Baseline physiological fall risk scores classified the study population at a 1.7 SD higher risk than a 65-year-old comparison group, and during the 6-month followup period the mean fall-risk score increased significantly (i.e. greater risk of falls) (1.7+/-1.6 versus 2.2+/-1.6, p=0.000; 29.5% greater risk of falls). Also, functional ability [100 (15) versus 95 (25), p=0.002], balance confidence [82.5 (44.4) versus 71.3 (58.7), p=0.000] and depression [0 (2) versus 0 (3), p=0.000] all worsened over 6 months. Within 6 months of the index ED visit, five participants had suffered six fall-related fractures. DISCUSSION: We conclude that this group of community-dwelling fallers, who presented for ED care with a clinical profile suggesting a high risk of further falls and fracture, did not receive Guideline care and worsened in their fall risk profile by 29.5%. This gap in care, at least in one centre, suggests further investigation into alternative approaches to delivering Guideline standard health service.

Accidental Falls↗
PubMed2001

Derivation and validation of a formula to calculate the contribution of ethanol to the osmolal gap.

STUDY OBJECTIVES: We sought to evaluate the relationship between osmolal gap and serum ethanol level and derive a formula that can be used clinically to calculate the expected osmolal gap in the presence of ethanol. Some investigators have noted that the residual osmolal gap appears to increase as the ethanol level increases, and thus it is important to determine the exact relationship between these 2 values. METHODS: In part 1, a convenience sample of emergency department patients undergoing serum ethanol determination had sodium, urea, and glucose levels and osmolality determined on the same blood sample, and values were prospectively recorded. Predicted osmolality excluding ethanol was calculated with the following formula: 2 Na (mEq/L) + (Urea [mg/dL])/2.8 + (Glucose [mg/dL])/18. The osmolal gap was determined by subtracting the calculated serum osmolality excluding ethanol from the measured serum osmolality. Linear regression analysis was then used to derive a formula for the relationship between ethanol and the osmolal gap. This formula was then prospectively validated on a second convenience sample of patients. In part 2, we repeated this experiment in vitro by adding known amounts of ethanol to serum. RESULTS: We derived the formula to calculate the contribution of ethanol to the osmolal gap by using 98 observations. The mean ethanol level was 197.8 mg/dL (SD 138.5), with a range of 0 to 538.2 mg/dL. The relationship between ethanol and osmolal gap was linear, with a Pearson coefficient of correlation of 0.99. Linear regression analysis generated a model with the following formula: Osmolal gap=(Ethanol [mg/dL])/3.7 - 0.35 or, in SI units: Osmolal gap (mOsm/kg)=1.25 (Ethanol [mmol/L]) - 0.35 The 95% confidence interval (CI) for the multiplicative factor was 1/3.58 to 1/3.80 (or, in SI units, 1.21 to 1.28). The 95% CI for the additive constant was -2.19 to 1.50. We prospectively validated our formula on 128 patients. The mean residual osmolal gap for this group of patients was 0.84 mOsm/L (SD 5.65; range, -18.40 to 17.85 mOsm/L). The results of the in vitro experiments were similar. CONCLUSION: Our data suggest that the best formula for the calculation of the contribution of ethanol to osmolality is as follows: Ethanol (mg/dL)/3.7 or, in SI units: 1.25 (Ethanol [mmol/L])

Adult↗
PubMed1999

Prereduction radiographs in clinically evident anterior shoulder dislocation.

The main study objective was to determine if experienced emergency physicians can accurately identify a subgroup of patients with anterior shoulder dislocation for whom prereduction radiographs do not alter patient management. Our prospective study evaluated 97 patients who presented to 2 ski-hill clinics and to our rural emergency department with possible shoulder dislocation between November 1996 and May 1997. Emergency physicians were certain of shoulder dislocation by clinical examination alone in 40 of 59 cases (67.8%) of possible dislocation. All 40 cases were found to have a dislocation (100%; 95% Cl, 91.19% to 100%), and the prereduction radiograph did not affect management of the injury. Prereduction radiographs added 29.6 +/- 12.68 minutes to treatment. We conclude that shoulder dislocation is often readily apparent from history and physical examination. When the experienced emergency physician is certain of the diagnosis of anterior shoulder dislocation, prereduction radiography delays treatment and does not alter management.

Adolescent↗
PubMed1991

Snowboarding injuries: an analysis and comparison with alpine skiing injuries.

OBJECTIVE: To analyse the types and causes of injuries associated with recreational snowboarding and to compare these with the injuries seen in alpine skiing. DESIGN: Prospective case series. SETTING: Rural hospital near three large ski resorts. PATIENTS: All people presenting to the Emergency Department with an injury caused by snowboarding during two ski seasons (1988-90). Of the 115 injured snowboarders identified, 73 (63%) completed the questionnaire. Information on the other patients was obtained from the hospital emergency records. Information was also obtained on seven alpine skiers who collided with snowboarders. RESULTS: Of the snowboarders 87 (76%) were male, and the mean age was 20.3 years. A total of 132 injuries were documented. Of the respondents to the questionnaire 83% reported that their fitness level was excellent or above average, 36% had never been on a snowboard previously, 25% were in their first year of snowboarding, 39% reported excellent snow conditions, 59% reported light traffic on the hill, and 7% had consumed alcohol before their accident. Injuries were equally divided between the upper body and the legs, 75% of the lower-limb injuries involving the left (lead) leg. Significant differences were noted between the patterns of injuries in snowboarding and alpine skiing: snowboarders were less likely to have lacerations (0% v. 8% respectively), boot-top contusions (0% v. 4%), thumb injuries (1% v. 10%) and knee sprains (14% v. 27%) and more likely to have spinal injuries (12% v. 4%), foot or ankle injuries (28% v. 5%) and distal radius fractures (10% v. 1%). CONCLUSIONS: Snowboarding is associated with a unique pattern of injuries, the knowledge of which could influence snowboarder education, accident prevention and equipment design. Additional research is needed to understand better the types, causes and rates of injury associated with snowboarding.

Adolescent↗
PubMedDate not supplied

Acute mesenteric ischemia in a middle-aged patient: case report and discussion.

Mesenteric ischemia usually occurs in elderly patients, especially those with predisposing factors. It has also been described in young patients using oral contraceptive pills or illicit drugs. We present a case of a middle-aged woman who developed acute focal ischemia of the small intestine without predisposing factors. The unusual presentation of this patient, combined with her relative youth, obscured the diagnosis, which was ultimately made at laparotomy. The diagnosis of mesenteric ischemia should be considered in patients of any age presenting with recurrent or severe abdominal pain, particularly when no alternative cause is apparent. The definitive study to diagnose mesenteric ischemia is angiography. Unless identified early in its course, the condition may progress to frank infarction with a significant increase in morbidity and mortality. Because of this, an aggressive approach to the diagnosis and therapy of mesenteric ischemia is essential.

Abdominal Pain↗
PubMedDate not supplied

Amylase and lipase in the emergency department evaluation of acute pancreatitis.

Serum amylase and lipase levels are commonly obtained in the emergency department for the diagnosis of acute pancreatitis. The role of these enzymes has frequently been the subject of confusion and controversy. This article comprehensively reviews the history, biochemistry, clinical, and laboratory literature on both enzymes as used in the evaluation of pancreatitis. Specific guidelines are presented to assist the Emergency Physician in the appropriate use and interpretation of these clinical laboratory tests.

Acute Disease↗