Do the residents in the emergency department appropriately manage patients with acute asthma attack? A study of self-criticism

The objective of this study was to investigate the management of patients with asthma attack admitted to the emergency department (ED) in terms of compliance with international guidelines. The records of patients with asthma who were admitted to a university-based ED between December 2001 and December 2002 were evaluated. A total of 72 cases with available data were evaluated retrospectively. Twenty-six patients (36.1%) were admitted more than once during the study period. The number of multiple admissions ranged from 2 (15 patients, 20.0%) to 11 (2 patients, 2.8%). Peak expiratory flow (PEF) measurements were recorded in 17 patients (23.6%) on presentation. Pulse and respiratory rates were recorded in 70 (97.0%) and 67 patients (93.0%), respectively. Thirty-four patients (47.2%) underwent chest x-ray; results were normal in most patients. Salbutamol was the most commonly used drug as first-line therapy. Ipratropium bromide (inhaled) and systemic corticosteroids were added to the salbutamol in 47 (65.2%), 42 (58.4%), and 32 patients (44%), respectively. Pulmonologists were consulted in only 7 cases (9.7%). Thirty patients (43.4%) were prescribed corticosteroids on discharge. The role of functional parameters in determining asthma severity and monitoring treatment effects should be emphasized in clinical practice. Finally, more prevalent use of management guidelines will help determine their usefulness.     

Genetic engineering of Enterobacter aerogenes with the Vitreoscilla hemoglobin gene: cell growth,survival, and antioxidant enzyme status under oxidative stress

Hemoglobins in unicellular organisms, like the one here in the bacterium Vitreoscilla, have greater chemical reactivity than their homologues in multicellular organisms. They can catalyze redox reactions and may protect cells against oxidative stress. The ability of Vitreoscilla hemoglobin to complement deficiencies of terminal cytochrome oxidases in Escherichia coli also suggests that this hemoglobin can receive electrons during respiration. In this study, a recombinant strain of Enterobacter aerogenes engineered to produce the Vitreoscilla Hb was investigated with regard to its susceptibility to oxidative stress. The culture response to oxidative stress produced by exogenously applied hydrogen peroxide was characterized in terms of cell growth, survival and the activities of two key antioxidant enzymes (catalase and superoxide dismutase). The influence of the physiological state of the cells and different media upon these culture dynamics was determined. Results showed that the hemoglobin-expressing strain is quite distinct in terms of growth/survival properties and activity of antioxidant enzymes from that of non-hemoglobin counterparts.     

Clinical decision-making using computers: opportunities and limitations

This paper deals with the use of information technology in order to make clinical decisions in dentistry. Since there is a large number of available systems and ongoing projects using computers, we first identify and describe major streams, as well as singular specialties. We underline the need for standards for data format and exchange in addition to the ability of different systems to communicate with each other. We conclude with a five-step recommendation to transform a dental office into digital and how to implement a computer-aided clinical decision support system, which provides action-oriented support in order to reduce the likelihood of human error during dental treatment.     

Capabilities of computerized clinical decision support systems: the implications for the practicing dental professional

This article presents the use of captured data within the range of patient care activities of the dental practitioner with an emphasis on prosthodontic activities. It describes the use of computer technology in dentistry during a typical patient encounter in a dental care facility. The oral health record, the need for speech recognition technology, and existing documentation software are discussed. Ongoing development of the capabilities of Clinical Decision Support (CDS) systems is becoming an important part of the oral health setting; including systems applicable to prosthodontics. These systems all rely on a common standardized structure for the electronic (oral) health record (EHR/EOHR). Current developments in radiological technology and digital imaging are explained as well as fundamentals of decision support systems clarified. Recent developments in the representation of domain knowledge as well as the implementation of a dental nomenclature and metathesaurus are also presented. A quality matrix identifies target values for dental informatics while demonstrating an "importance-weighting" of dental characteristics.     

Evaluation of central neuropathy in type II diabetes mellitus by multimodal evoked potentials

The electrophysiological results in 51 patients with diabetes mellitus type II were compared with those in 30 age and sex matched healthy control subjects. Peripheral and cortical latencies of median and tibial somatosensory evoked potentials (SEP), bilateral I-III and I-V interpeak latencies (IPL) of brainstem auditory evoked potentials (BAEP), bilateral P100 latency of visual evoked potentials (VEP) and bilateral cortical latency and central motor conduction time of motor evoked potentials (MEP) were evaluated. We observed prolonged latencies suggestive of central neuropathy in DM type II. It has been shown that most of the electrophysiological parameters in patients with DM type II correlate with the duration of the disease, some of them with the age of the patient, and few of them with the onset of the disease. To our knowledge, there is no correlation between the electrophysiological parameters and the level of glycemia or the degree of metabolic control. We conclude that central and peripheral neuropathies in DM are related to the duration of the disease and not to the degree of hyperglycemia and metabolic control.     

Surgical treatment of strabismus fixus associated with high myopia

A 55-year-old woman had convergent strabismus fixus associated with high myopia. Bilateral medial rectus recession and loop myopexy of lateral and medial rectus muscles was performed. The clinical characteristics and the possible surgical treatment modalities were discussed. This surgery seems effective on both the restoration of dislocation of the eyeball and the improvement of ocular motility.     

Automatic evaluation of prosodic features of tracheoesophageal substitute voice

In comparison with laryngeal voice, substitute voice after laryngectomy is characterized by restricted aero-acoustic properties. Until now, an objective means of prosodic differences between substitute and normal voices does not exist. In a pilot study, we applied an automatic prosody analysis module to 18 speech samples of laryngectomees (age: 64.2 ± 8.3 years) and 18 recordings of normal speakers of the same age (65.4 ± 7.6 years). Ninety-five different features per word based upon the speech energy, fundamental frequency F₀ and duration measures on words, pauses and voiced/voiceless sections were measured. These reflect aspects of loudness, pitch and articulation rate. Subjective evaluation of the 18 patients’ voices was performed by a panel of five experts on the criteria “noise”, “speech effort”, “roughness”, “intelligibility”, “match of breath and sense units” and “overall quality”. These ratings were compared to the automatically computed features. Several of them could be identified being twice as high for the laryngectomees compared to the normal speakers, and vice versa. Comparing the evaluation data of the human experts and the automatic rating, correlation coefficients of up to 0.84 were measured. The automatic analysis serves as a good means to objectify and quantify the global speech outcome of laryngectomees. Even better results are expected when both the computation of the features and the comparison method to the human ratings will have been revised and adapted to the special properties of the substitute voices.