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Biomedical subjects

W R Mower

Publications and source records attributed to W R Mower.

32 records · Page 2Linked to original sources
PubMed1998

Misrepresentation of research citations among medical school faculty applicants.

PURPOSE: A descriptive study of bibliographic misrepresentations by applicants to medical school faculty positions. METHOD: The authors reviewed 250 1995 faculty applicant bibliographies from eight medical institutions, representing six medical specialities. Using computerized library database searches or direct retrieval, they evaluated the legitimacy of each journal, abstract, and book citation. The authors classified and tabulated the following discrepancies as misrepresentations: (1) citing a nonexistent article in an existent source, (2) claiming authorship on an article that did not list the applicant as an author, and (3) altering authorship order to enhance the applicant's position. RESULTS: The authors found 56 misrepresented citations among 2,149 verified articles (2.6%). These misrepresentations were distributed among 39 applicants (15.6%; 95% CI, 11.5% to 20.9%); 11 of whom (4.4%) had multiple discrepancies. Sixty-eight percent of all misrepresentations were due to discrepancies in authorship order, while journal citations constituted the most frequent source of misrepresentation (77%). CONCLUSIONS: Misrepresentation of bibliographic citations does exist among medical school faculty applicants. One possible solution to this problem would be to require applicants to document their bibliographic citations.

Authorship↗
PubMed1998

Pulse oximetry as a fifth vital sign in emergency geriatric assessment.

OBJECTIVE: To determine the utility of pulse oximetry as a routine fifth vital sign in emergency geriatric assessment. METHODS: Prospective study using pulse oximetry to measure O2 saturation in geriatric patients presenting to ED triage. Saturation values were disclosed to clinicians only after they had completed medical evaluations and were ready to release or admit each patient. The authors measured changes in medical management and diagnoses initiated after the disclosure of pulse oximetry values. The study included 1,963 consecutive adults aged > or = 65 years presenting to triage at a university ED. Measurements included changes in select diagnostic tests: chest radiography, complete blood count (CBC), spirometry, arterial blood gases (ABGs), pulse oximetry, and ventilation-perfusion scans; treatments: antibiotics, beta-agonists, and supplemental O2; and hospital admission and final diagnoses that occurred after complete ED evaluation when physicians were informed of triage pulse oximetry values. RESULTS: 397 (20.2%) geriatric patients had triage pulse oximetry values <95%. Physicians ordered repeat oximetry for 51 patients, additional chest radiography for 23, CBC for 16, ABGs for 15, spirometry for 5, and ventilation-perfusion scans for none. Physicians ordered 49 new therapies for 44 patients, including antibiotics for 14, supplemental O2 for 29, and beta-agonists for 6. Nine patients initially scheduled for ED release were subsequently admitted to the hospital. Physicians changed or added diagnoses for 27 patients. CONCLUSIONS: Using pulse oximetry as a routine fifth vital sign resulted in important changes in the diagnoses and treatments of a small proportion of emergency geriatric patients.

Aged↗
PubMed1997

Effect of intraluminal thrombus on abdominal aortic aneurysm wall stress.

PURPOSE: Abdominal aortic aneurysms (AAAs) rupture when the wall stress exceeds the strength of the vascular tissue. Intraluminal thrombus may absorb tension and reduce AAA wall stress. This study was performed to test the hypothesis that intraluminal thrombus can significantly reduce AAA wall stress. METHODS: AAA wall stresses were determined by axisymmetric finite element analysis. Model AAAs had external diameters ranging from 2.0 to 4.0 cm. Model parameters included: AAA length, 6 cm; wall thickness, 1.5 mm; Poisson's ratio, 0.49; Young's modulus, 1.0 MPa; and luminal pressure, 1.6 x 10(5) dyne/cm2. Stresses were calculated for each model without thrombus, and then were recalculated with thrombus filling 10% of the AAA cavity. Calculations were repeated as thrombus size was increased in 10% increments and as thrombus elastic modulus increased from 0.01 MPa to 1.0 MPa. Maximum wall stresses were compared between models that had intraluminal thrombus and the unmodified models. Stress reduction greater than 25% was considered significant. RESULTS: The maximum stress reduction of 51% occurred when thrombus with elastic modulus of 1.0 MPa filled the entire AAA cavity. Stresses were reduced by only 25% as modulus decreased to 0.2 MPa. Similarly, decreasing thrombus size by 70% resulted in stress reduction of only 28%. Large AAAs experienced greater stress reduction than small AAAs (48% vs 11%). CONCLUSION: Intraluminal thrombus can significantly reduce AAA wall stress.

Aorta, Abdominal↗
PubMed1997

Psychosocial difficulties and emergency department use.

OBJECTIVE: To determine whether psychosocial difficulties are more prevalent among ambulatory patients using the ED for nonemergent complaints as compared with ambulatory patients having emergent complaints. METHODS: A survey of noncritical ED patients was performed using anonymous questionnaires addressing psychosocial difficulties: psychiatric illness, educational level, homelessness, alcohol and/or drug dependency (CAGE and DAST surveys), and depression (DSM-III criteria). Three independent physicians ranked each patient's chief complaint as either emergent or appropriate for primary care. The majority ranking was used to determine whether the complaint was emergent. Groups with and without specific psychosocial difficulties were compared for their proportion of emergent vs primary care complaints. RESULTS: Of 700 patients, 367 (52%) met criteria for > or = 1 psychosocial difficulty [acute psychosis-36 (5%), illiteracy-139 (20%), homelessness-45 (6%), alcohol dependency-111 (16%), drug dependency-66 (9%), and depression-130 (19%)]. There were 379 (54%) ED visits considered emergent. Patient groups with vs without > or = 1 psychosocial difficulty had similar rates of emergent visits (58% vs 50%, p = 0.04). Emergent visit rates also were similar for subgroups with vs without specific psychosocial difficulties: psychosis (56% vs 54%, p = 1.00) illiteracy (58% vs 53%, p = 0.89), homelessness (62% vs 54%, p = 0.33), alcohol dependency (62% vs 53%, p = 0.08), drug dependency (59% vs 54%, p = 0.47), or depression (58% vs 53%, p = 0.42). CONCLUSION: Psychosocial difficulties are common among ED patients; however, emergent complaints are just as common in these patients as they are in those without psychosocial difficulties.

Adult↗
PubMed1997

Pulse oximetry as a fifth pediatric vital sign.

PURPOSE: To determine the utility of pulse oximetry as a routine fifth vital sign in acute pediatric assessment. DESIGN: Prospective study using pulse oximetry to measure oxygen saturation in children presenting to emergency department triage. Saturation values were disclosed to clinicians only after they had completed medical evaluations and were ready to discharge or admit each child. We measured changes in medical treatment and diagnoses initiated after the disclosure of pulse oximetry values. SETTING AND PARTICIPANTS: The study included 2127 consecutive children presenting to triage at a university emergency department. MEASUREMENTS: Changes in select diagnostic tests: chest radiography, complete blood count, spirometry, arterial blood gases, pulse oximetry, and ventilation-perfusion scans; treatments: antibiotics, beta-agonists, supplemental oxygen; and hospital admission and final diagnoses that occurred after disclosure of triage pulse oximetry values. RESULTS: Of 305 children having triage pulse oximetry values less than 95%, physicians ordered second oximetry for 49, additional chest radiography for 16, complete blood counts for 7, arterial blood gas measurements for 4, spirometry for 2, and ventilation-perfusion scans for 2. Physicians ordered 39 new therapies for 33 patients, including antibiotics for 15, supplemental oxygen for 11, and beta-agonists for 8. Five patients initially scheduled for hospital discharge were subsequently admitted. Physicians changed or added diagnoses in 25 patients. CONCLUSIONS: Using pulse oximetry as a routine fifth vital sign resulted in important changes in the treatment of a small proportion of pediatric patients.

Adolescent↗
PubMed1996

Misrepresentation of research publications among emergency medicine residency applicants.

STUDY OBJECTIVE: To assess the prevalence of misrepresented citations among emergency medicine residency applicants and to determine whether misrepresentation increases as the number of citations increases. METHODS: We examined 350 consecutive emergency medicine residency applications and then reviewed all cited publications to determine whether they were genuine or misrepresented. Applicants with citations were divided into three groups: those who listed one citation, those with two to four citations, and those with five or more citations. The numbers of individuals and misrepresentations were then tabulated and compared among the groups. RESULTS: Publications were cited on 113 applications (32.3%). Twenty-three applicants (20.4% of those who cited publications and 6.6% of all applicants) misrepresented citations. Misrepresentations were found in 8 of 56 applications listing single citations (14.3%), 8 of 46 applications (17.4%) claiming two to four citations, and 7 of 11 (63.6%) applications claiming five or more citations (P=.00081, Pearson chi 2 test). CONCLUSION: Emergency medicine residency applications may contain misrepresented citations. The number of misrepresentations in this study increased as the number of citations increased.

Adult↗
PubMed1996

A comparison of pulse oximetry and respiratory rate in patient screening.

OBJECTIVE: To examine how well respiratory rate correlates with arterial oxygen saturation status as measured by pulse oximetry, and determine whether respiratory rate measurements detect oxygen desaturation reliably. METHODS: Respiratory rate (RR) and oxygen saturation (SaO2) were measured prospectively on 12,096 consecutive adult emergency department triage patients at a university medical center. Respiratory rate was measured by counting ausculated breath sounds for 1 min. Pulse oximetry was used to measure SaO2. Measurements were analysed by age (with one group for 18-19 year olds, groups for every 10 yr from age 20 to age 60, and groups for every 5 yr for subsequent ages). Pearson correlation coefficients were calculated for each age group as well as the weighted average coefficient. Cases having oxygen saturation below 90% were examined to determine how frequently they exhibited increased RR (increased RRs were defined as any rate in the upper five percentile by age. RESULTS: Correlation coefficients ranged from 0.379 to -0.465 with a weighted mean of -0.160. Coefficients for ages 18 through 70 years (representing 10,740 patients) all had magnitude < 0.252. Overall, only 33% of subjects with oxygen saturation below 90% exhibited increased RR. CONCLUSIONS: Respiratory rate measurements correlate poorly with oxygen saturation measurements and do not screen reliably for desaturation. Patients with low SaO2 do not usually exhibit increased RR. Similarly, increased RR is unlikely to reflect desaturation.

Adolescent↗
PubMed1995

Effect of routine emergency department triage pulse oximetry screening on medical management.

PURPOSE: To determine the utility of routine triage pulse oximetry screening in emergency department (ED) patients. DESIGN: Prospective study using pulse oximetry to measure oxygen saturation of ED patients at triage. Saturation values were disclosed to physicians only after they completed medical evaluations and were ready to discharge or admit each patient. We measured changes in medical management initiated after disclosure of pulse oximetry values. SETTING AND PARTICIPANTS: The study included 14,059 consecutive patients presenting to triage at a university ED. MEASUREMENTS: Changes in select diagnostic tests: chest radiography, CBC count, spirometry, arterial blood gases, pulse oximetry, and ventilation-perfusion scans; treatments: antibiotics, beta-agonists, supplemental oxygen; and hospital admission and final diagnoses that occurred after disclosure of triage pulse oximetry values. RESULTS: Of 1,175 patients having triage pulse oximetry values less than 95%, physicians ordered repeat pulse oximetry on 159 (13.5%), additional chest radiography on 5.4%, CBC count on 3.1%, arterial blood gases on 2.9%, spirometry on 0.9%, and ventilation-perfusion scans on 0.3%. Physicians ordered 178 new therapies on 134 patients (11.4%), including supplemental oxygen for 6.5%, antibiotics for 3.9%, and beta-agonists for 1.8%. Thirty-five patients (3.0%) initially scheduled for hospital discharge were subsequently admitted. Physicians changed or added diagnoses in 77 patients (6.6%). CONCLUSIONS: Providing physicians with routine triage pulse oximetry measurements resulted in significant changes in medical treatment of these patients.

Adolescent↗
PubMed1993

Advance directives. Effect of type of directive on physicians' therapeutic decisions.

BACKGROUND: Despite growing support for advance directives, there are few data validating their utility. We conducted this study to determine if the type of advance directive influences physicians' willingness to withhold specific therapies and if physicians are equally willing to withhold these therapies. METHODS: The 444 full-time faculty of the department of medicine of a university medical center were presented with patient scenarios and accompanying advance directives in three separate surveys that were mailed. They were asked if they would withhold each of 12 specific therapies based on their interpretation of the advance directive. Three types of advance directives were studied: general statement, therapy specific, and therapy specific combined with designation of a proxy and prior patient-physician discussion. RESULTS: The mean proportion of all 12 therapies that were withheld varied by type of advance directive: general-statement advance directive, 55%; therapy-specific advance directive, 71%; and therapy-specific advance directive with proxy and prior patient-physician discussion, 83%. Respondents were more likely to withhold cardiopulmonary resuscitation when given a therapy-specific advance directive vs general-statement advance directive, 84% vs 73%, respectively. With a therapy-specific advance directive that was supported by a proxy and prior patient-physician discussion, 100% of physicians were willing to withhold cardiopulmonary resuscitation. With the therapy-specific advance directive that was supported by proxy and prior patient-physician discussion, physicians were not equally willing to withhold all therapies, ie, mechanically assisted ventilation, 98%; intravenous fluids, 82%; antibiotics, 80%; simple tests, 70%; and pain medications, 13%. CONCLUSIONS: Detailed advance directives with a supportive proxy, coupled with physician-patient discussion, furnish the most reliable medical directives. Even with such directives, physicians are more likely to withhold life-saving therapies than simple tests, treatments, and pain medications.

Advance Directive Adherence↗
PubMed1993

Stress distributions in vascular aneurysms: factors affecting risk of aneurysm rupture.

Aneurysm rupture occurs when local wall stresses exceed the tensile strength of vascular tissues. Knowledge of vascular wall stresses, and insight into the factors that change wall stresses, will lead to a better understanding of how aneurysms grow and rupture. In this study, stress distributions in the walls of small aneurysms were calculated using finite element analysis (FEA), a numerical technique able to predict stress distributions with greater accuracy than the Law of Laplace. Stresses were calculated for an initial small aneurysm and compared to stresses produced by increasing the aneurysm diameter, decreasing the wall thickness, and changing the material properties of the aneurysm wall. FEA calculations indicate that wall stresses are generally greatest on the inner surface of an aneurysm, and decrease nonlinearly as the outer wall is approached. Maximum wall stresses occur along the region of greatest diameter, and circumferential stresses tend to be significantly greater than longitudinal stresses. Doubling the diameter of an aneurysm produced a twofold increase in the maximum wall stress. Decreasing the wall thickness by half also produced a doubling of the maximum wall stress. Changing material properties produced no appreciable change in wall stresses. However, weaker materials fail at lower stresses, thus halving material strength would be equivalent to doubling wall stresses. We conclude that the Law of Laplace is inaccurate in predicting the complicated stress distributions that exist in aneurysm walls, and that more sophisticated tools, such as FEA, will be needed to understand this complex phenomenon. We also conclude that proportional changes in the diameter, wall thickness, or aneurysm tissue strength have roughly equivalent effects on aneurysm growth and rupture.

Aneurysm↗
PubMed1986

Postsplenectomy infection in patients with chronic leukemia.

The added risk of infectious complications due to splenectomy in patients already immunocompromised because of chronic leukemia was studied over a 22 year period. When compared to patients with chronic leukemia who did not undergo splenectomy, survival was not influenced. Splenectomy did significantly increase the total number of serious infections (65 percent versus 35 percent, p less than 0.001), the number of infections per patient (p less than 0.05), and the interval between infections (p less than 0.01) in this patient population. Fatal septic episodes were not due to Streptococcus pneumoniae, but did occur significantly more often in the splenectomy group (22 percent versus 7 percent, p less than 0.05). Although the location of infection was similar, there was a significant difference in the number of Pseudomonas aeruginosa infections in the patients who had undergone splenectomy (p less than 0.05). Consideration must be given to the significantly increased risk of postoperative infectious morbidity in patients with chronic leukemia when evaluating the usefulness of splenectomy.

Adult↗
PubMed1985

Acute abdominal conditions in patients with leukemia.

Acute abdominal abnormalities are relatively uncommon during the treatment of leukemia. Over a 22 1/2 year period, acute abdominal abnormalities were diagnosed in 22 of 412 patients (5.3 percent) with acute leukemia and in 9 of 343 patients (2.6 percent) with chronic leukemia. Five patients with acute leukemia and two patients with chronic leukemia were treated medically, and all died within 1 week of diagnosis. Operative mortality decreased from 50 percent during the first half of the study period to 12.5 percent during the last half and was not related to the preoperative white blood cell count, platelet count, age of the patient, type of leukemia, or state of relapse or remission. Postoperative survival averaged 23 months in the patients with chronic leukemia and 5 months in those with acute leukemia, approximating the length of survival of patients with uncomplicated acute or chronic leukemia. Indications for operation in patients with leukemia are the same as for other patients and should be based on careful physical examination.

Abdomen, Acute↗