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R Wears

Publications and source records attributed to R Wears.

13 recordsLinked to original sources
PubMed2001

Citation characteristics of research published in Emergency Medicine versus other scientific journals.

STUDY OBJECTIVE: We sought to examine how a cohort of published emergency medicine research is cited in scientific journals. METHODS: Data were collected on all research submitted to the 1991 Society for Academic Emergency Medicine meeting and subsequently published. Outcome measures included all citations of these studies found in journals listed in the Science Citation Index, as well as the impact factors (citations per manuscript per year) of citing journals. RESULTS: Two hundred four of the 493 submitted studies were published and met study entry criteria; the average article was cited 2.04 times a year during the study period. Twelve percent were never cited, and 39% were cited only once or twice. Thirty percent were published in non-emergency medicine journals, and these were cited at least twice as often (and by almost 3 times as many journals) as apparently similar studies published in emergency medicine journals. The percentage of studies never cited by anyone was about threefold higher when published in emergency medicine journals. Forty-two percent of the citations of research published in emergency medicine journals came from within the specialty. Emergency medicine journals provided only 16% of the citations of emergency medicine research published in non-emergency medicine journals because these studies were cited 3 times as often by authors in other disciplines. Rejection of research for presentation at the meeting did not predict the number or quality of citations or citing journals. CONCLUSION: Research submitted to the Society for Academic Emergency Medicine meeting and subsequently published is cited about as often as the average scientific journal article but receives more impact, is cited more widely, and is more likely to be cited by a broader range of authors when published by non-emergency medicine journals. The ability of emergency medicine journals to compete with larger non-emergency medicine journals for their larger audiences may help shape perceptions of the specialty.

Emergency Medicine↗
PubMed1994

Percutaneous endoscopic gastrostomy in a general hospital: prospective evaluation of indications, outcome, and randomised comparison of two tube designs.

The indications for percutaneous endoscopic gastrostomy (PEG) and patient outcome, were examined prospectively in the setting of a general hospital. In the course of 26 months, 76 patients underwent PEG (median age 62 years (range 18-99)) and were followed up for 6887 patient days. The median (range) duration of PEG feeding was 93 (3-785) days. The procedure was carried out for neurological indications in 76% of cases (stroke 51%) and 53% of patients were severely malnourished (body mass index < 17 kg/m2) at the time of referral. In 12 (16%) patients swallowing recovered and the PEG was removed after a median (range) of 55 days (20-150). Three (4%) deaths were related to PEG (one oesophageal perforation, one haemorrhage, and one aspiration pneumonia). One patient developed peritonism and ileus, which resolved with conservative treatment. Minor complications included local sepsis 3%, tube blockage 12%, and tube connector leak 5%. During seven days of observation, demands on nursing time for routine care of the PEG were the same as for nasogastric tube feeding, median (range) 21 (4-42) v 16 (4-40) min/day respectively, but in about half the latter cases the tube had to be replaced at least once. Over 15 months, 29 patients were randomised to receive a 1.9 mm inner, 2.9 mm (9F) outer diameter Fresenius and 27 a 3.0 mm inner, 4.0 mm (12F) outer diameter Bower polyurethane tube and were followed for 2920 and 2388 patient days respectively. There was no difference in the insertion time (median (range) 20 (10-45) v 24 (10-45) min respectively) or number of patients with complications (three v eight patients NS), although there were more minor mechanical problems (three v 12, p < 0.01) with the 12F tube. The internal anchoring device of the 12F tube allowed its non-endoscopic removal, a method applicable too 16% of cases. No tubes were removed because of blockage.

Adolescent↗
PubMed1993

Case report: mediastinal lymphadenopathy in eosinophilic pneumonia.

Chronic eosinophilic pneumonia is a relatively rare disorder characterized radiologically by non-segmental homogenous consolidation in the lung periphery [1]. We present a patient who had marked mediastinal lymphadenopathy as well as the more typical radiological features, which resolved rapidly with treatment.

Adult↗
PubMed1993

The high frequency of upper gastrointestinal pathology in patients with fecal occult blood and colon polyps.

Colon polyps are commonly detected in the workup of fecal occult blood (FOB). It is, however, unclear whether colon polyps can adequately explain FOB. Our aim was to determine the frequency of upper gastrointestinal (UGI) pathology in patients with and without UGI symptoms and with and without risk factors for UGI pathology (such as smoking, drinking alcohol, taking nonsteroidal anti-inflammatory medications, or the presence of associated chronic diseases) who have colon polyps and FOB. Among our 67 study patients with colon polyps and FOB, 79% had associated UGI lesions. Presence or absence of UGI symptoms, risk factors associated with UGI lesions, and polyp characteristics such as size, location, number, and histology, did not appreciably affect this high frequency. Ulcers were the most common lesions in both symptomatic and asymptomatic patients. We conclude that patients with colon polyps found in the evaluation of FOB are likely to have concomitant UGI pathology, and UGI workup should be considered in both symptomatic and asymptomatic patients.

Colonic Polyps↗
PubMed1993

Chest pain associated with nutcracker esophagus: a preliminary study of the role of gastroesophageal reflux.

A review of our 402 motility records of patients undergoing evaluation of noncardiac chest pain identified 40 patients with the diagnosis of nutcracker esophagus. Gastroesophageal reflux was found in 13 of 20 patients (65%) who underwent pH studies, and endoscopy detected one patient with erosive esophagitis. Thus, at least 14 (35%) of our nutcracker esophagus patients had evidence of reflux. Twelve of these subjects agreed to enter an open-label therapeutic trial. After 8 wk of intensive antireflux treatment with high doses of ranitidine or omeprazole, repeat 24-h pH studies and endoscopy demonstrated normalization of pH parameters and healing of esophagitis in all patients. Ten (83%) patients obtained significant symptomatic improvement in frequency of pain episodes, number of days with pain, and pain severity. However, repeat manometry showed normalization of motor findings in only two (18%) patients. These observations warrant further placebo-controlled trials. Until more information is available, the results of this study suggest that gastroesophageal reflux should be excluded in patients with noncardiac chest pain and nutcracker esophagus before initiation of smooth muscle relaxant therapy.

Adult↗
PubMed1990

Reduced survival with increasing plasma osmolality in elderly continuing-care patients.

The results reported here are from a 2-year follow-up study of 58 elderly patients in a continuing-care unit. Most of these patients were in a hyperosmolar state at the time of entry (mean plasma osmolality 304 +/- 8 mOsmol/kg). The survival of those patients with the highest osmolality (greater than 308 mOsmol/kg) was significantly reduced (p = 0.025), with an increased mortality at 2 years (15/20 patients, p = 0.053). There was no correlation between age and plasma osmolality (r = 0.02) and the effect of osmolality on survival was independent of age. Hyperosmolality was either a marker for, or a cause of, increased mortality in this group of frail elderly patients.

Aged↗
PubMed1989

Elderly female patients in continuing care: why are they hyperosmolar?

We have shown that the majority of elderly female patients in continuing care are in a hyperosmolar state. Thirty-two out of thirty-nine subjects had an osmolality greater than 295 mosm/kg and the mean osmolality was 302 +/- 8 mosm/kg (range 280-317 mosm/kg). No significant relationship was found with the degree of confusion (rs = 0.31; p greater than 0.05). In the second part of the study neither the measured degree of hydration, or any acute, small increases in fluid input influenced the plasma osmolality.

Aged↗
PubMed1988

Analysis of multiple organ system failure in trauma and nontrauma patients.

Multiple organ failure (MOF), a syndrome of recent evolution, has resulted from advancements in both surgical and trauma care. A prospective study of organ failure (OF) was conducted for 203 consecutive admissions to the surgical intensive care unit (SICU) between September 1986 and June 1987. Diagnosis, operations, age, OF, outcome, and culture data were recorded for each patient. OF definitions consistent with the literature were used to identify pulmonary, renal, hepatic, cardiovascular (CVS), gastrointestinal (GI), hematologic-coagulation, and central nervous system (CNS) failure. Eighty-two patients developed OF (40.4% incidence). The distribution of OF was 65 per cent trauma (T) and 35 per cent nontrauma (NT). Combined mortality for OF was 46 per cent (T = 34% and NT = 69%). The mortality of organ failure increased with the number of failed systems in the total population as well as in both T and NT groups. For the total population, the mortality by number of systems failed was no system, 1.3 per cent; one system, 13 per cent; two systems, 34.5 per cent; three systems, 75 per cent; four or more systems, 92.9 per cent. The incidence and mortality for each system is listed. Sepsis occurred in 62.1 per cent of NT patients (88.9% mortality) and in 30.2 per cent of T patients (31.3% mortality). Mortality was weakly associated with age in groups matched for severity of OF.

Adult↗
PubMed1986

Rapid assay of serum theophylline levels.

Many patients with chronic obstructive pulmonary disease (COPD) are symptom free when they receive an oral theophylline regimen. When these patients present to the emergency department with an acute exacerbation of their disease, the emergency physician faces a dilemma regarding appropriate therapy with IV aminophylline. The patient's serum theophylline level is unknown. A blind loading dose may result in inadequate treatment or iatrogenic toxicity. The Ames Seralyzer is an immunoassay photometer that determines serum theophylline levels. We studied 90 patients with uncomplicated exacerbations of COPD treated in our ED before and after the installation of the Seralyzer. Theophylline levels measured by the Seralyzer had a high correlation with those measured by the hospital laboratory Abbott TDX (r = 0.914). Obtaining the theophylline level took a mean of only 0.46 hours with the Seralyzer, compared with 2.13 hours with the hospital laboratory. The time from presentation to theophylline loading was 1.87 hours, compared with 3.28 hours with the hospital laboratory group, resulting in significantly greater relief of respiratory distress at three hours after arrival in the Seralyzer group. The measured theophylline level was very poorly correlated with the physician's estimate of the level based on history (r = 0.353). We conclude that the Seralyzer provided accurate assessment of levels, enabled earlier theophylline loading of patients and lessened delays, and decreased the probability of theophylline toxicity.

Adult↗
PubMed1980

Unrecognized tracheal intubation: a complication of the esophageal obturator airway.

Esophageal obturator airway (EOA) use is not without risk. We present here the fatal cases of three patients in whom the trachea was inadvertently intubated with the EOA. In all three cases, the presence of tracheal intubation was unrecognized during the initial prehospital resuscitation, but was recognized and documented in the emergency department.

Emergencies↗