Activation of emergency medical services for acute stroke in a nonurban population: the T.L.L. Temple Foundation Stroke Project

BACKGROUND AND PURPOSE: Activating emergency medical services (EMS) is the most important factor in reducing delay times to hospital arrival for stroke patients. Determining who calls 911 for stroke would allow more efficient targeting of public health initiatives. METHODS: The T.L.L. Temple Foundation Stroke Project is an acute stroke surveillance and intervention project in nonurban East Texas. Prospective case ascertainment allowed chart abstraction and structured interviews for all hospitalized stroke patients to determine if EMS was activated, and if so, by whom. RESULTS: Of 429 validated strokes, 38.0% activated EMS by calling 911. Logistic regression analysis comparing those who called 911 with those who did not activate EMS found that individuals who were employed were 81% less likely to have EMS activated (OR 0.19, 95% CI 0.04 to 0.63). Of the 163 cases in which 911 was called, the person activating EMS was: self (patient), 4.3%; family member of significant other, 60. 1%; paid caregiver, 18.4%; and coworker or other, 12.9%. Significant associations between the variables age group (P=0.02), insurance status (P=0.007), and living alone (P=0.05) with who called 911 was found on chi(2) analysis. CONCLUSIONS: Educational efforts directed at patients themselves at risk for stroke may be of low yield. To increase the use of time dependent acute stroke therapy, interventions may wish to concentrate on family, caregivers, and coworkers of high-risk patients. Large employers may be good targets to increase utilization of EMS services for acute stroke.     

Comparison study of a long-pulse pulsed dye laser and a long-pulse pulsed alexandrite laser in the treatment of port wine stains.

BACKGROUND: Port wine stains (PWSs) are commonly treated by the pulsed dye laser. Recently, a long-pulse pulsed alexandrite laser was used to treat bulky vascular malformations. OBJECTIVE: In the present study, we compare the efficacy and complications of the long-pulse pulsed dye laser (LPPDL) and the long-pulse pulsed alexandrite laser (LPPAL) in the treatment of PWSs. METHODS: Eleven patients with Fitzpatrick skin types III-IV were enrolled in this study. One section of each patient's PWS was treated with LPPDL and another section was treated with LPPAL. The patients' PWSs were evaluated for efficacy of elimination of erythema and for treatment-related side effects. RESULTS: Both LPPDL and LPPAL treatment are effective in the treatment of PWSs. Hyperpigmentation was seen in two areas treated with LPPDL and in three areas treated with LPPAL. Hypopigmentation was seen in one area treated with LPPAL, but not in any of the areas treated with LPPDL. There was no scarring. CONCLUSION: LPPAL works best with hypertrophic, purple PWSs, while LPPDL yields better clinical improvements with the flat, pink PWSs. Targeting of deoxyhemoglobin, deeper penetration, and higher fluence may explain the effectiveness of LPPAL in purple, hypertrophic PWSs. However, there is a risk of dyspigmentation when using the LPPAL.     

Prevalence of partner violence against 7,443 African American, White, and Hispanic women receiving care at urban public primary care clinics

Given inconclusive findings regarding racial/ethnic differences in risk for intimate partner violence (IPV), this study will estimate annual prevalence and severity of IPV and associated risk factors of homicide among a multiethnic population of English- and Spanish-speaking African American, White, and Hispanic women receiving public primary health care. A personal interview survey was conducted using three measurement instruments including a brief two-question screen. The sample consisted of 7,443 women, aged 18-44 years, receiving care at urban, primary health care clinics in southern Texas. White women disclosed abuse at a rate of 8.9%, followed by African American women at 6.0% and Hispanic women at 5.3%. More abuse was reported by White and African American women compared to Hispanic women. Use of a brief two-question screen provides racial/ethnic specific surveillance data for patient care programming and can track progress toward decreasing violence against women.     

A rare case of neurological dysfunction due to severe hyponatremia after carotid artery endarterectomy: A review of the clinical approach to hyponatremia

Development of severe hyponatremia after carotid endarterectomy procedure is rare. Several pathophysiological mechanisms related to the carotid endarterectomy procedure may infer an increased risk of developing this complication in specific populations.