The efficacy and value of emergency medicine: a supportive literature review

Study objectives

The goal of this study was to identify publications in the medical literature that support the efficacy or value of Emergency Medicine (EM) as a medical specialty and of clinical care delivered by trained emergency physicians. In this study we use the term "value" to refer both to the "efficacy of clinical care" in terms of achieving desired patient outcomes, as well as "efficiency" in terms of effective and/or cost-effective utilization of healthcare resources in delivering emergency care. A comprehensive listing of publications describing the efficacy or value of EM has not been previously published. It is anticipated that the accumulated reference list generated by this study will serve to help promote awareness of the value of EM as a medical specialty, and acceptance and development of the specialty of EM in countries where EM is new or not yet fully established.

Methods

The January 1995 to October 2010 issues of selected journals, including the EM journals with the highest article impact factors, were reviewed to identify articles of studies or commentaries that evaluated efficacy, effectiveness, and/or value related to EM as a specialty or to clinical care delivered by EM practitioners. Articles were included if they found a positive or beneficial effect of EM or of EM physician-provided medical care. Additional articles that had been published prior to 1995 or in other non-EM journals already known to the authors were also included.

Results

A total of 282 articles were identified, and each was categorized into one of the following topics: efficacy of EM for critical care and procedures (31 articles), efficacy of EM for efficiency or cost of care (30 articles), efficacy of EM for public health or preventive medicine (34 articles), efficacy of EM for radiology (11 articles), efficacy of EM for trauma or airway management (27 articles), efficacy of EM for using ultrasound (56 articles), efficacy of EM faculty (34 articles), efficacy of EM residencies (24 articles), and overviews and editorials of EM efficacy and value (35 articles).

Conclusion

There is extensive medical literature that supports the efficacy and value for both EM as a medical specialty and for emergency patient care delivered by trained EM physicians.     

椎体形术与保守疗法治疗骨质疏松性椎体压缩骨折的对照研究

目的 探讨椎体成形术（PVP）治疗骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fractures,OVCF）的临床疗效,并与保守治疗方法进行比较.方法 回顾性分析2006年5月～2009年11月我院60例OVCF患者,其中PVP治疗30例,保守治疗30例,对术后2周及3月后疗效进行统计学分析.结果 对于OVCF患者,2周内行PVP术疗效较优,3月以后二者之间的差异没有统计学意义.结论 PVP及保守疗法均是治疗椎体骨质疏松性压缩骨折的有效方法,而在2周以内,PVP较保守治疗能更有效地减轻疼痛.     

酸性氧化电位水空气消毒效果及影响因素研究

目的：探讨酸性氧化电位水空气消毒效果及其影响因素。方法：在两个1m^3的气雾室内,单因素试验方法研究酸性氧化电位水剂量、温度和有机物对其空气消毒效果的影响。在现场试验中评价其对空气中的自然菌的杀灭效果。结果：酸性氧化电位水的空气消毒效果受到酸性氧化电位水的剂量、温度和有机物的影响。剂量为20ml／m^3实验室试验中对白色葡萄球菌气溶胶杀灭率〉99．90％,现场试验中其对自然菌的杀灭率〉90．00％。结论：剂量为20ml／m^3酸性氧化电位水杀菌效果可靠。酸性氧化电位水的杀菌效果受其剂量、温度和有机物浓度等因素的影响。     

Benzylidene analogs of anabaseine display partial agonist and antagonist properties at the mouse 5-hydroxytryptamine(3A) receptor.

The nicotinic receptor drug candidate, 3-(2,4-dimethoxybenzylidene)-anabaseine (also known as GTS-21; DMXBA), its hydroxy metabolites, and some related analogs were evaluated with the two-electrode voltage-clamp technique in mouse 5-hydroxytryptamine (5-HT)(3A) receptors expressed in Xenopus oocytes. Although DMXBA lacked partial agonist activity, its hydroxy-benzylidene metabolites and related analogs were partial agonists, displaying the following rank order of potency (EC(50)) and apparent efficacy: 5-HT, 0.9 +/- 0.06 microM (100% efficacy) > 3-(2-hydroxy,4-methoxybenzylidene)-anabaseine (2-OH-MBA), 2.0 +/- 0.3 microM (63% efficacy) > 3-(2,4-dihydroxybenzylidene)-anabaseine, 2.6 +/- 0.3 microM (63% efficacy) > 3-(2-methoxy,4-hydroxybenzylidene)-anabaseine, 17.2 +/- 1.0 microM (30% efficacy). To examine the influence of a benzylidene ring hydroxy substituent, the agonist actions of the three possible monohydroxy isomers were examined. The rank order of potency, based on EC(50) determinations, and apparent efficacy was: 3-(2-hydroxybenzylidene)-anabaseine, 20.3 +/- 2.6 microM (63% efficacy) > 3-(4-hydroxybenzylidene)-anabaseine, 32.3 +/- 5.9 microM (14% efficacy) > 3-(3-hydroxybenzylidene)-anabaseine (3-OH-BA) (no agonist activity). Both DMXBA and 3-OH-BA antagonized 5-HT-mediated currents, with IC(50) values of 15.7 +/- 0.9 and 27.5 +/- 4.7 microM, respectively. DMXBA demonstrated both competitive and noncompetitive forms of antagonism over the range of concentrations tested. These results suggest that a hydroxy substituent at the 2' position of the benzene ring is necessary and sufficient for partial agonist activity; substitution at the 4' position with a hydroxy or methoxy group further enhances agonist potency. Because 2-OH-MBA is a primary metabolite of DMXBA, it may contribute to the physiological, biochemical, and behavioral effects of the parent compound when administered in vivo.     

Efficacy of Monoclonal Antibodies against Defined Antigens for Passive Immunotherapy of Chronic Gastrointestinal Cryptosporidiosis

Cryptosporidium parvum is an important cause of diarrhea in humans and calves and can persistently infect immunocompromised hosts. Presently, there are no consistently effective parasite-specific drugs for cryptosporidiosis. We hypothesized that neutralizing monoclonal antibodies (MAbs) targeting the apical complex and surface antigens CSL, GP25-200, and P23 could passively immunize against cryptosporidiosis. We recently reported that a formulation of MAbs 3E2 (anti-CSL), 3H2 (anti-GP25-200), and 1E10 (anti-P23) provided significant additive prophylactic efficacy over that of the individual MAbs in neonatal ICR mice. In the present study, these MAbs were evaluated for therapeutic efficacy against persistent infection in adult gamma interferon-depleted SCID mice. 3E2 demonstrated the most significant and consistent therapeutic effect, reducing intestinal infection in two experiments. In one experiment, 3E2 plus 3H2 and 3E2 plus 3H2 plus 1E10 also significantly reduced infection; however, no significant increase in efficacy over 3E2 alone was apparent. The results indicate that anti-CSL MAb 3E2 has highly significant efficacy in reducing, but not eliminating, persistent C. parvum infection.     

关节镜下关节清理治疗膝关节骨性关节炎的疗效观察

【目的】探讨关节镜下关节清理治疗膝关节骨性关节炎的疗效。【方法】收集98例诊断为膝关节骨性关节炎的住院患者共126膝,根据治疗方法分为两组,保守治疗62膝,其中早中期组40膝、晚期组22膝;手术治疗64膝,其中早中期组46膝、晚期组18膝。比较关节清理和保守治疗早中晚期膝关节骨性关节炎的疗效。【结果】本组中135膝,其中126膝者获得随访,随访率93．3％,随访时间为6～12个月。随访98例患者均采用Lysholm膝关节功能评分表进行随访,其中保守治疗早中期组患者与手术治疗均能取得较好疗效,但两组评分无统计学意义;晚期组患者保守治疗效果不佳,尤其在随访12个月时效果显著下降,与手术治疗患者评分有统计学差异;早中期组、晚期组手术治疗患者疗效均满意,但评分前者高于后者。【结论】关节镜下关节清理治疗不同分期膝关节骨性关节炎能达到满意效果,早中期组患者疗效更优。     

Effects of pyridine ring substitutions on affinity,efficacy, and subtype selectivity of neuronal nicotinic receptor agonist epibatidine

2'-Pyridine ring substituted analogs of epibatidine were assessed for equilibrium binding affinity, functional potency, and efficacy at rat neuronal nicotinic receptors expressed in Xenopus oocytes. Binding affinities were determined in membrane homogenates from oocytes expressing alpha2beta2, alpha2beta4, alpha3beta2, alpha3beta4, alpha4beta2, or alpha4beta4. Efficacy (relative to acetylcholine) and potency were measured electrophysiologically with oocytes expressing alpha3beta4, alpha4beta2, and alpha4beta4. Hydroxy, dimethylamino, and trifluoromethanesulfonate analogs had affinities too low for accurate measurement. The bromo analog had affinities 4- to 55-fold greater at beta2 than at beta4-containing receptors, modestly greater efficacy at alpha4beta4 than at alpha4beta2, and 5- to 10-fold greater potency at a4beta4 than at alpha3beta4 or alpha4beta2. The fluoro analog displayed affinities 52- to 875-fold greater at beta2- than at beta4-containing receptors, efficacy at alpha4beta4 receptors 3-fold greater than at alpha4beta2 and alpha3beta4, and was equipotent at all receptors tested. The norchloro analog showed affinities 114- to 3500-fold greater at beta2- than at beta4-containing receptors, 2-fold greater efficacy at alpha4beta2 and alpha4beta4 than at alpha3beta4, and 4- to 5-fold greater potency at alpha4beta4 and alpha3beta4 than at alpha4beta2. The amino analog displayed affinities 10- to 115-fold greater at beta2- than at beta4-containing receptors, 3-fold greater efficacy at alpha3beta4 than at alpha4beta2, and 2- to 4-fold greater potency at alpha3beta4 and alpha4beta4 than at alpha4beta2. Although these compounds displayed a variety of differences in affinity, efficacy, and potency, with one exception (binding affinity and functional potency at alpha4beta4 receptors) there were no significant correlations among these properties.     

Evaluation of a self‐efficacy enhancement program to prevent pressure ulcers in patients with a spinal cord injury

Aim

This study developed a self‐efficacy enhancement program and evaluated its effects on the self‐care behaviors, self‐care knowledge, and self‐efficacy regarding pressure ulcer prevention in patients with a spinal cord injury.

Methods

This was a multicenter randomized controlled trial. Six hospitals were invited to recruit patients with a spinal cord injury who were undergoing rehabilitation after receiving acute treatment. These hospitals were randomly allocated into experimental (three hospitals) or control (three hospitals) groups and 47 patients participated (24 in the experimental group and 23 in the control group). The experimental group was given an 8 week self‐efficacy enhancement program for pressure ulcer prevention. The self‐efficacy enhancement program consisted of small‐group face‐to‐face intervention (education and skills training), education with computer animation, phone counseling, face‐to‐face counseling, and self‐management records. The control group only received a pressure ulcer prevention information booklet. Self‐care knowledge, self‐efficacy, self‐care behaviors, and pressure ulcer incidence were measured at baseline and after the 8 week self‐efficacy enhancement program.

Results

The experimental group showed a significantly greater improvement in self‐care knowledge, self‐efficacy, and self‐care behaviors for pressure ulcer prevention than did the control group. One participant in the control group developed a pressure ulcer, while none of the participants in the experimental group developed a pressure ulcer; this difference was not statistically significant.

Conclusions

The self‐efficacy enhancement program enabled patients with a spinal cord injury to engage in continued self‐care behaviors and helped them to improve their knowledge and self‐efficacy concerning pressure ulcer prevention.

     

3M Adper Prompt自酸蚀黏结剂治疗超声洁牙术后牙本质敏感症的临床观察

目的：观察3M Adper Prompt自酸蚀黏结剂和Gluma脱敏剂治疗牙本质过敏症的临床疗效。方法洁牙术后确诊为牙本质敏感症的116例232颗牙采取自身配对设计分为2组,试验组用3M Adper Prompt自酸蚀粘结剂脱敏治疗,对照组用Gluma脱敏剂进行脱敏治疗,在统一的疗效标准下进行即刻、1个月的疗效比较。结果即刻疗效比较二者无显著性差异。而一个月3M Adper Prompt自酸蚀黏结剂的疗效明显优于Gluma脱敏剂。结论3M Adper Prompt是一种比较理想的脱敏剂。     

Ivabradine in combination with beta-blocker therapy for the treatment of stable angina pectoris in every day clinical practice

Purpose  

The anti-anginal efficacy of the selective I_f inhibitor ivabradine has been demonstrated in controlled clinical trials. However, there is limited information about the safety and efficacy of a combined treatment of ivabradine with beta-blockers, particularly outside of clinical trials in every day practice. This analysis from the REDUCTION study evaluated the safety and efficacy of a combined therapy of beta-blockers and ivabradine in every day practice.     

自我效能理论在哮喘患者护理中的应用

目的 探讨自我效能理论在哮喘患者护理中的应用.方法 选择2007年3月～2008年5月我院呼吸内科门诊的支气管哮喘患者179例,将患者随机分为干预组和对照组,均按常规治疗护理.干预组在此基础上采用增强自我效能的护理途径和方法 .分别在患者入院、治疗3个月后进行1次自我效能感量表(GSES)问卷调查和肺功能测定.结果 两组患者人院时GSES评分差异无统计学意义(P>0.05),而干预组采用增强自我效能的护理途径和方法 ,3个月后GSES评分明显提高,与对照组比较,差异有统计学意义(P<0.05);干预后两组的FVC、FEV1和PEFR均有显著性增加(P<0.05).结论 自我效能能增强哮喘患者的治疗效果.     

三种中药熏蒸法对重症监护病房空气消毒效果比较

目的比较艾条、苍术、诃子等3种中药熏蒸法空气消毒效果。方法采用自然沉降法采样和检测方法对3种熏蒸法消毒空气的效果进行了检测。结果用艾条约1.33 g/m3点燃熏蒸,对重症监护病房空气中自然菌消除率为90%,菌数由消毒前的867 cfu/m3下降到82 cfu/m3。用苍术约3 g/m3烟熏,对室内空气中自然菌消除率为84%,菌数由消毒前的863 cfu/m3下降到137 cfu/m3。用诃子0.5 g/m3烟熏,对室内空气中自然菌消除率为78%,菌数由消毒前的860 cfu/m3下降到182 cfu/m3。结论3组中草药熏蒸消毒对室内空气中自然菌均有一定杀灭效果,艾条熏蒸比另两者效果更好。     

石杉碱－甲治疗小儿语言发育迟缓

INTRODUCTIONLanguagedelaymeansthatchildinlanguagedevelopmentcannotcatchup，understandandexpressinlanguagelikenormalchildrenwiththesameage，andcannotcommunicatefreelylikenormalchil－drenbecauseofsomereasonsinanticipatedtime．Themainreasonsoflanguagedelayincludebrainfunctiontardy，hearingobstacles，relatedorgansabnormalandsoon．Currentmajortreatmentislan－guagerehabilitation犤１－２犦．Wetreated３７childrenwithlanguagedelaycausedfrombrainfunctiondevelopmenttardywithhuperzineAandacquiredsome…     

替牙期非龋源性乳牙根尖周脓肿临床分析

目的:探讨替牙期非龋源性乳牙根尖周脓肿的发病原因及疗效评价.方法:对符合入选要求的37例经治患儿的42颗患牙进行松动度、龈沟完整度、患牙牙合接触的检查,并记录发病牙位;再把患儿随机分成3组,1组(开髓引流+药物)、2组(切开排脓+药物)以及3组(单纯药物)分别采取对应的治疗方案;观察治疗后1-3天的疗效.结果:替牙期冠部完整乳牙根尖周脓肿的发病原因与乳牙松动度及龈沟完整度高度相关,且多发于乳后牙,但与牙合接触无相关;乳牙根尖周脓肿的前期治疗方案中,"开髓引流+药物"和"切开排脓+药物"明显优于"单纯药物"治疗.结论:替牙期非龋源性乳牙根尖周脓肿的主要病因为乳牙松动度及龈沟完整度,前期治疗的最佳方案为开髓引流辅以全身抗菌治疗.     

莫西沙星治疗253例脑卒中相关性肺炎病例分析

目的 分析莫西沙星治疗253例脑卒中相关性肺炎的疗效.方法 应用盐酸莫西沙星氯化钠注射液400 mg静脉滴注,每日1次,使用3～7 d,主要以临床疗效评价标准和细菌学评价标准为疗效观察指标,收集相关数据,进行统计处理.结果 253例早期脑卒中相关性肺炎患者经莫西沙星治疗总有效率达95.3%,细菌总清除率达84.2%.结论 莫西沙星是临床治疗早期脑卒中相关性肺炎的有效抗菌药物之一.     

Augmentation of the anti-tumor therapeutic efficacy of long-term cultured T lymphocytes by in vivo administration of purified interleukin 2

Spleen cells from C57BL/6 mice immunized in vivo with a syngeneic Friend virus-induced leukemia, FBL-3, were specifically activated by culture for 7 d with FBL-3, then nonspecifically induced to proliferate in vitro for 12 d by addition of supernatants from concanavalin A- stimulated lymphocytes containing interleukin 2 (IL-2). Such long-term cultured T lymphocytes have previously been shown to specifically lyse FBL-3 and to mediate specific adoptive therapy of advanced disseminated FBL-3 when used as an adjunct to cyclophosphamide (CY) in adoptive chemoimmunotherapy. Because the cultured cells are dependent upon IL-2 for proliferation and survival in vitro, their efficacy in vivo is potentially limited by the availability of endogenous IL-2. Thus, the aim of the current study was to determine whether exogenously administered purified IL-2 could augment the in vivo efficacy of long- term cultured T lymphocytes. Purified IL-2 alone or as an adjunct to CY as ineffective in tumor therapy. However, IL-2 was extremely effective in augmenting the efficacy of IL-2-dependent long-term cultured T lymphocytes in adoptive chemoimmunotherapy. The mechanism by which IL-2 functions in vivo is presumably by promoting in vivo growth and/or survival of adoptively transferred cells. This assumption was supported by the findings that IL-2 did not enhance the modest therapeutic efficacy of irradiated long-term cultured cells that were incapable of proliferating in the host and was ineffective in augmenting the in vivo efficacy of noncultured immune cells that are not immediately dependent upon exogenous IL-2 for survival.     

莫沙比利联合奥美拉唑治疗反流性食管炎的疗效观察

目的观察莫沙比利联合奥美拉唑治疗反流性食管炎的临床疗效。方法按照随机对照原则将69例反流性食管炎患者分为两组进行研究。对照组34例:莫沙必利5 mg,每日3次口服。治疗组35例:在对照组的基础上给予奥美拉唑20mg,每日一次口服。治疗8周后观察两组的临床疗效。结果治疗组及对照组患者临床症状改善总有效率分别为91.4%和73.5%;显效率分别为65.7%和44.1%,两组总有效率、显效率相比较,差异均具有显著性(P<0.05)。结论奥美拉唑联合莫沙比利治疗反流性食管炎有较好的协同治疗作用,疗效好,安全可靠,值得临床推广应用。     

左乙拉西坦添加治疗难治性癫癎的临床观察

目的：观察左乙拉西坦（LEV）添加治疗难治性癫痫的临床疗效和安全性。方法：对32例难治性癫痫患者进行LEV添加治疗的开放性自身对照研究,观察疗效及不良反应3～12个月。结果：LEV添加治疗3月时总有效率达62．5％,无发作比例为18．75％,与基线比较有显著差异（P〈0．001）,4～12月疗效与近期相仿。特发性癫痫和症状性癫痫总有效率无统计学差异。1年保留率为66．67％。3例出现体重增加、性格改变等不良反应,停药后消失。结论：LEV添加治疗难治性癫痫有良好疗效,且不良反应轻,保留率高。     

131I治疗分化型甲状腺癌肺转移的短期疗效及影响因素

目的探讨131I治疗分化型甲状腺癌（DTC）肺转移的短期疗效及影响因素。方法47例DTC肺转移患者于甲状腺癌手术后接受131I治疗,首次治疗的131I剂量为3．7～7．4GBq（100—200mCi）,结合患者具体情况,采用空腹1次口服法。治疗后3个月评价短期疗效。分析年龄、性别、首次131I治疗剂量、首次治疗前血清甲状腺球蛋白（Tg）水平以及肺部转移灶特点对131I治疗短期疗效的影响。结果首次131I治疗结束后3个月,共治愈13例（28％）、好转16例（34％）、无效18例（38％）,有效率62％（29／47）。6例患者接受131I治疗2—3次,病情曾明显好转,其后复发,再经131I治疗后无效。女性患者疗效优于男性,首次治疗前血清Tg水平较低者的疗效优于水平较高者（P均〈0．05）。结论131I治疗DTC肺转移有效,性别、首次治疗前血清Tg水平可能与131I治疗DTC肺转移的疗效有关。     

卡培他滨联合多西他赛新辅助化疗治疗局部晚期乳腺癌疗效及安全性分析

目的 探讨卡培他滨与多西他赛的新辅助化疗方案对局部晚期乳腺癌的疗效及安全性。方法 对本院收治的46例局部晚期乳腺癌患者，在常规治疗的基础上，每个疗程的d1静脉点滴多西他赛（75 mg／m^2），随后2周每天口服卡培他滨2次（1000 mg／m^2），3周为一个疗程。如此持续3～4个疗程。分析其疗效及安全性。结果 临床疗效总有效率为84．8％（39／46），其中5例（10．9％）为病理完全缓解。不良反应有粒细胞减少、脱发、手足综合征及腹泻等。结论 卡培他滨与多西他赛联合使用的化疗方案对局部晚期乳腺癌效果较好，依从性高，可供临床借鉴。