Biomedical subjects

Robert D Powers

Publications and source records attributed to Robert D Powers.

5 recordsLinked to original sources

PubMed2006

Utility of thrombocytopenia as a marker for heparin allergy in adult ED patients.

INTRODUCTION: Up to 5% of patients who receive heparin develop heparin allergy (HA), manifested by the presence of heparin antibodies (HAb) and/or the clinical syndrome of heparin-induced thrombocytopenia. As many as 10% of patients with HA develop serious thrombotic complications when reexposed to heparin. Heparin is often given empirically to emergency department (ED) patients, some of whom have been recently hospitalized and are at risk for HA/heparin-induced thrombocytopenia. Emergency department physicians should have a rapid means of determining which patients are at risk for heparin sensitivity. The prevalence of HA among ED patients is unknown; most are asymptomatic and unaware, and there is no bedside test available. OBJECTIVES: This study was designed to assess the prevalence of HA or thrombocytopenia in ED patients and to determine whether thrombocytopenia could serve as a useful marker for HA. METHODS: This was a prospective, observational study, done during the spring of 2004 in an 80000 adult visit inner-city ED. A convenience sample of 115 adult patients undergoing venipuncture had a blood specimen analyzed for platelet count using standard laboratory methods. The same blood sample was tested for the presence of antiheparin antibodies using an enzyme-linked immunosorbent assay test. RESULTS: Of 115 patients, 12 (10.4%; 95% CI, 6.1%-17.4%) had thrombocytopenia (platelets <150000). Six (5.2%; 95% CI, 2.5%-10.9%) had antiheparin antibodies. There was no overlap between the 2 groups of patients. CONCLUSIONS: (1) Thrombocytopenia occurs in 10% of a sample of 115 adult ED patients undergoing venipuncture in an inner-city ED. (2) Heparin allergy was present in 5% of patients in the same cohort. (3) Thrombocytopenia is neither sensitive nor specific as a marker for HA in ED patients. Heparin-allergic patients are at risk if given heparin; a method of rapid detection of patients with HA should be identified.

Adult↗

PubMed2006

Acute thrombotic disorders.

The acquired hypercoagulable states are responsible for a broad range of thrombotic and thromboembolic disorders. Symptoms and signs of acute ischemia or organ dysfunction will lead many of these patients to seek care in EDs. Proper diagnosis and therapy must be based on an understanding of epidemiology and pathophysiology. Immediate anticoagulation with heparin may not always be the treatment of choice; careful analysis of clinical and laboratory parameters is necessary to arrive at the safest and most effective course of action. Newer anticoagulants, including low-molecular-weight heparins and nonheparin compounds, are changing the therapeutic approach to many of these disorders.

Acute Disease↗

PubMed2005

Association of body mass index, age, and cigarette smoking with serum testosterone levels in cycling women undergoing in vitro fertilization.

OBJECTIVE: [1] To examine the effects of body mass index (BMI), age, cigarette smoking, cause of infertility, and use of oral contraceptives on baseline serum testosterone (T), and [2] to examine associations between baseline serum T and IVF outcomes such as pre-hCG serum E(2), number of oocytes retrieved, oocyte fertilization rate, and pregnancy outcome in regularly cycling women. DESIGN: Prospective, cohort study. SETTING: Three IVF programs in eastern Massachusetts. PATIENT(S): Four hundred twenty-five regularly cycling women planning to undergo IVF. Women with polycystic ovary syndrome, ovulatory infertility, or irregular cycles were excluded from this study. INTERVENTION(S): Collection of epidemiological data and baseline serum in women undergoing IVF. MAIN OUTCOME MEASURE(S): Baseline serum total T, sex hormone binding globulin (SHBG), and calculation of free androgen index. RESULT(S): Body mass index >26 kg/m(2) was associated with a significant increase in serum T (P<.01) and free androgen index (P<.0001). Serum T decreased significantly throughout the fourth decade of life (P<.03). A history of cigarette smoking >10 pack years was associated with increased serum T (P<.01). A diagnosis of endometriosis was associated with decreased serum T. Serum T correlated positively with pre-hCG serum E(2) and number of oocytes retrieved. However, serum T did not significantly influence fertilization or pregnancy rates. CONCLUSION(S): In cycling infertile women, increasing BMI and cigarette smoking are associated with increased serum T. Advancing age and endometriosis are associated with decreased serum T.

Adult↗

PubMed2003

Pearls and pitfalls in the emergency department evaluation of abdominal pain.

Abdominal pain is a common complaint in the emergency department (ED), comprising approximately 5% of total visits. Although not typically serious, abdominal pain often presents many difficult situations for the clinician. Women of reproductive age and elderly individuals represent some of the most challenging patients to evaluate. Although there are general diagnostic and clinical principles that apply to the evaluation of all patients, these two groups deserve extra attention because of the broad differential diagnosis and potential for serious complications. This article outlines the epidemiology of abdominal pain in patients who present to the ED, and provides guidelines pertinent to the evaluation of all patients. In addition, the article discusses the approach to abdominal pain of pelvic origin in women of reproductive age and abdominal pain in elderly individuals.

Abdominal Pain↗

PubMed2002

Administrative barriers reduce emergency physician ordering of nasal and acromioclavicular joint radiographs.

The objective of this study was to determine whether administrative barriers to clinician ordering of nasal bone and acromioclavicular (AC) joint radiographs would result in a significant diminution in emergency department use of these films and in patient charges. This study involved a retrospective cohort or pre-post analysis of radiograph ordering by emergency care providers seeing adult patients with nasal area or shoulder injuries. Numbers of films ordered before and after enactment of a restrictive policy change were determined, as well as any charge reductions associated with diminished film use. For each radiograph type, there was a 1-year preintervention period, and 2 subsequent 12-month periods after the policy change. Nasal bone radiographs decreased from 166 in 1994 to 10 in 1995 and 4 in 1996 (P <.001, chi(2)). This resulted in potential annual charge savings of 33,176 dollars. AC joint radiographs decreased from 35 films in 1994 to 5 in 1995 and 8 in 1996 (P <.001, chi(2)), with potential annual charge savings of 6,578 dollars. Adoption of an interdepartmental policy that prohibits physicians from routinely ordering radiographs of limited clinical value can result in significant reduction of radiograph use. This drop in use can lead to considerable reductions in patient charges.

Acromioclavicular Joint↗