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Biomedical subjects

S W Wright

Publications and source records attributed to S W Wright.

At least 55 records · Page 3Linked to original sources
PubMed1994

Funding in the emergency medicine literature: 1985 to 1992.

STUDY OBJECTIVE: To examine the rate and source of funding of research articles published in the emergency medicine literature. DESIGN: Review of all nonmilitary US research articles published in Annals of Emergency Medicine, American Journal of Emergency Medicine, and Journal of Emergency Medicine during the years 1985 and 1992. METHODS: Data on research methodology, number of authors, number of institutions, and funding source were collected. MEASUREMENTS AND MAIN RESULTS: One hundred sixty-nine articles met the entry criteria published in 1985, and 207 met the criteria in 1992. Retrospective studies, case series, clinical trials, and laboratory studies were the most common research methodologies in both years. The number of multicenter studies increased between the two years (P < .006). The rate of funding increased from 21.3% in 1985 to 29.0% in 1992. The funding sources, however, did not change significantly between the two years. Funded studies published in the emergency medicine literature are less likely to be federally funded and more likely to be funded by industrial sources than studies published in the literature of other specialties. CONCLUSION: The majority of research articles published in the three journals during the two years did not list a source of funding. This is in contrast to other specialties, in which the majority of published research is funded. The emergency medicine literature relies more heavily on private industry funding than does the literature of other specialties.

Emergency Medicine↗
PubMed1994

Pertussis seroprevalence in emergency department staff.

STUDY OBJECTIVE: The purpose of this study was to look at the prevalence of pertussis immunity in emergency department employees. DESIGN: Prospective, observational study conducted in September 1992. SETTING: A university hospital ED. PARTICIPANTS: A convenience sample of 73 ED employees. INTERVENTIONS: Blood was collected from ED staff and assayed for antibody to pertussis toxin and filamentous hemagglutinin. RESULTS: Ninety-nine percent of the subjects reported childhood immunization. Geometric mean titers were 3.6 (geometric SD, 3.2) enzyme-linked immunosorbent assay (ELISA) units for pertussis toxin and 12.1 (geometric SD, 3.3) ELISA units for filamentous hemagglutinin. These titers are comparable to those previously reported in other adults not immunized since childhood and are substantially lower than the levels commonly seen in children or adults following immunization. Titers did not differ significantly between male and female subjects or between subjects with or without a recent prolonged cough, family members with a cough, or small children in the household. CONCLUSION: Most ED staff members have low levels of antibody to pertussis and may be at risk for acquiring the disease from infected children or adults, with subsequent risk of transmission to susceptible patients. Booster immunization with an acellular pertussis vaccine has been shown to be safe and immunogenic in adults and may be appropriate for adult ED personnel to reduce these risks.

Adult↗
PubMed1993

Comparison of midazolam and diazepam for conscious sedation in the emergency department.

STUDY OBJECTIVE: To compare the efficacy of diazepam and midazolam when used for conscious sedation in emergency department patients. DESIGN: Prospective, randomized, double-blind, multicenter trial. SETTING: Three university EDs. TYPE OF PARTICIPANTS: Patients requiring one of the following procedures: abscess drainage, joint reduction, extensive suturing, chest tube insertion, or lumbar puncture. INTERVENTIONS: Diazepam (2.5 mg/mL) or midazolam (1 mg/mL) was administered until the desired level of sedation was achieved to a maximum of 5 mL. Fentanyl citrate was administered if needed for pain. MEASUREMENTS AND MAIN RESULTS: Thirty-three patients received diazepam and 36 received midazolam. Patients receiving midazolam had a greater degree of early sedation (P < .05), a higher 90-minute alertness scale score (P < .05), more patients ready for discharge at 90 minutes (P = .05), significantly less recall for the procedure (P < .02), and less pain on injection (P < .01) than patients who were given diazepam. CONCLUSIONS: Diazepam and midazolam are both effective for conscious sedation in ED patients. Midazolam causes less pain on injection, a significantly greater degree of early sedation, and a more rapid return to baseline function.

Adolescent↗
PubMed1993

Myth of the dangerous sternal fracture.

STUDY OBJECTIVE: To look at the hospital course and the outcome of patients with an isolated sternal fracture. DESIGN: Retrospective analysis of hospital records. SETTING: A large urban Level I trauma center. TYPE OF PARTICIPANT: Blunt trauma patients with an isolated sternal fracture. Patients with other chest radiograph abnormalities were excluded, as were those with abnormal admission ECGs. MEASUREMENTS AND MAIN RESULTS: Thirty-one patients with an isolated sternal fracture were identified. No patient developed new ECG changes or arrhythmias during the hospital stay. Cardiac enzymes were elevated in one patient (3.2%). No patient had any adverse cardiopulmonary outcome attributable to the sternal fracture. CONCLUSION: The outcome of patients with an isolated sternal fracture and a normal ECG is very good. Routine admission and cardiac monitoring do not appear to be warranted in this subset of patients with a sternal fracture.

Adult↗
PubMed1992

Synthesis, chemical, and biological properties of vinylogous hydroxamic acids: dual inhibitors of 5-lipoxygenase and IL-1 biosynthesis.

Vinylogous hydroxamic acids (3-(N-hydroxy-N-alkylamino)-2-propen-1-ones, VHA) were prepared as antiinflammatory agents. The synthesis, chemical properties, and in vitro biological activities of these relatively unexplored compounds are described. The VHAs were prepared by condensation of the appropriate N-substituted hydroxylamine with any of the three reagents: a 1,3-dicarbonyl compound (method A); a vinylogous amide (method B); or an alkynone (method C). The VHAs exist as one or more tautomers in solution with the relative proportions of each being dependent upon the structure of the VHA, solvent, and pH. VHAs undergo some of the typical reactions of hydroxamic acids as well as those of vinylogous amides. VHAs are active as inhibitors of 5-lipoxygenase and of IL-1 biosynthesis in vitro, which do not inhibit other enzymes of the arachidonic acid cascade. They have been shown by ESR studies to bring about inhibition of soybean type 1 15-lipoxygenase by reduction of the active site iron.

Animals↗
PubMed1992

Novel 1-(pyridylphenyl)-1-phenyl-2-imidazolylethanols with topical antiinflammatory activity.

The synthesis, biological evaluation, and structure-activity relationships of a series of 1-(pyridylphenyl)-1-phenyl-2-imidazolylethanols are described. These compounds show potent dose-dependent topical antiinflammatory activity in murine models of skin inflammation. This effect is likely due to inhibition of cytochrome P450 and consequent reduction in levels of 12R-HETE in the skin. These compounds were examined for their ability to inhibit the oxidative metabolism of arachidonic acid; they specifically inhibit the formation of prostacyclins in mouse macrophages. To study the effects of structure on the in vivo activity, three general features of the molecules were varied: the position of attachment of the pyridine nucleus (A), the second aromatic residue (B), and the nitrogen base on the ethanol chain (C). 1-[4-(4-Pyridyl)phenyl]-1-(4-fluorophenyl)-2- imidazolylethanol (2a, DuP 983) shows a very attractive profile of antiinflammatory activity and has been selected for clinical evaluation as a topical antiinflammatory agent.

Administration, Topical↗
PubMed1992

Cervical spine injuries in blunt trauma patients requiring emergent endotracheal intubation.

Airway management in the blunt trauma patient is complicated by the potential for causing or exacerbating an injury to the cervical cord if an unstable cervical fracture is present. The records of 987 blunt trauma patients who required emergent endotracheal intubation over a 5-year period were retrospectively reviewed to determine the incidence and type of cervical spine injury and the incidence of injury based on airway management. Sixty of the patients (6.1%) had a cervical fracture; 53 were potentially unstable injuries by radiographic criteria. Twenty patients had neurologic deficits prior to intubation. Twenty-six patients with unstable injuries were intubated orally, 25 nasally, and two by cricothyrotomy. One patient developed a neurologic deficit after nasotracheal intubation. Because of a possible selection bias in which severely injured patients were preferentially referred to this trauma center, the true incidence of cervical spine injuries may be lower than the 6.1% we found. The authors conclude that the incidence of serious cervical spine injury in a very severely injured population of blunt trauma patients is relatively low, and that commonly used methods of precautionary airway management rarely lead to neurologic deterioration.

Adolescent↗
PubMed1992

Conscious sedation in the emergency department: the value of capnography and pulse oximetry.

STUDY OBJECTIVE: The purpose of this observational study was to describe the use of nasal capnography and pulse oximetry in monitoring heavily sedated emergency department patients. DESIGN: Prospective, nonblinded, nonrandomized, noncontrolled clinical trial. SETTING: The study was conducted in a tertiary-care hospital with 36,000 annual ED visits. TYPE OF PARTICIPANTS: Twenty-seven patients requiring sedation with benzodiazepines and/or narcotics for painful procedures. INTERVENTIONS: The ventilatory status of each patient was monitored with a capnometer by nasal cannula as well as a pulse oximeter before, during, and after administration of the sedative agents. MEASUREMENTS: Vital signs, nasal end-tidal CO2 (PETCO2) measurements, and oxygen saturation were measured at baseline, during the procedure, and for a two-hour observation period after the procedure. MAIN RESULTS: The average PETCO2 increased from 35.9 to 42.1 mm Hg during the procedure while the oxygen saturation dropped from an average of 98% to 94.3%. One patient developed clinically significant apnea after the procedure that was picked up by the apnea alarm, and eight additional patients developed clinically silent hypoxemia and increased PETCO2 during the procedure. CONCLUSION: The use of pulse oximetry is recommended for the detection of unrecognized hypoxemia during conscious sedation. Capnography by nasal cannula appears to be a useful modality in monitoring during conscious sedation, but further research and clinical experience are required before routine use can be recommended.

Adolescent↗
PubMed1992

Ketorolac for sickle cell vaso-occlusive crisis pain in the emergency department: lack of a narcotic-sparing effect.

STUDY OBJECTIVE: To determine if a single dose of intramuscular ketorolac given on presentation to the emergency department has a narcotic-sparing effect in adult patients with sickle cell vaso-occlusive crisis pain. DESIGN: A prospective, randomized, single-dose, double-blind study. SETTING: ED of a university hospital and an affiliated county hospital. TYPE OF PARTICIPANTS: Eighteen adult patients who presented to the ED with sickle cell crisis pain a total of 24 times. INTERVENTIONS: Patients were randomized to receive either ketorolac 60 mg IM or placebo on presentation to the ED. Subjects were administered meperidine on presentation and then received a standardized dose of meperidine every 30 minutes during the four-hour observation period based on the severity of pain. MEASUREMENTS AND MAIN RESULTS: The 12 subjects in the ketorolac group received an average of 231 +/- 92 mg meperidine, whereas the 12 subjects in the placebo group received an average meperidine dose of 250 +/- 85 mg (P = .61). CONCLUSION: The use of intramuscular ketorolac did not lead to a clinically significant reduction in the requirement for narcotics during the four-hour ED treatment period.

Acute Disease↗
PubMed1991

Reduction of the active-site iron by potent inhibitors of lipoxygenases.

Lipoxygenases are non-heme iron dioxygenases that catalyze the oxygenation of polyunsaturated fatty acids. Using soybean lipoxygenase-1 as a model, we have shown that two classes of lipoxygenase inhibitors currently in development as potential antiinflammatory agents obtain a significant amount of their potency by reducing the lipoxygenase active-site iron from the active ferric state to the inactive ferrous state. It is not surprising that the members of the first of these classes, the 2-benzyl-1-naphthols, are reducing agents. The members of the second class, the N-alkyl-hydroxamic acids, were not anticipated to be sufficiently strong reducing agents to be oxidized by the lipoxygenase ferric center; that they are provides additional evidence for that iron having a high reduction potential. This brings to (at least) five the number of classes of lipoxygenase inhibitors that are capable of reducing the active-site ferric ion and suggests the generality of this approach in the rational design of lipoxygenase inhibitors.

Binding Sites↗
PubMed1990

Midazolam use in the emergency department.

Midazolam is the first water-soluble benzodiazepine. As with other benzodiazepines it has amnestic, sedative, hypnotic, anxiolytic, and anticonvulsant properties. Midazolam is about two to four times more potent than diazepam. Midazolam has been extensively used for a variety of outpatient procedures, but there has been no documentation of its safety in emergency department patients. The authors retrospectively reviewed all patients receiving midazolam during a 2-year period at the University of Cincinnati Center for Emergency Care. The study population consisted of 389 patients (men 56%; women 44%) with an average age of 33.3 years. Midazolam was used intravenously for sedation before a wide variety of painful procedures and for agitation control. The average dose was 3.86 mg, with a range of 0.5 mg to 20.0 mg. The majority of patients (79.2%) received narcotics or sedative/hypnotic agents in addition to midazolam. There was an overall complication rate of 1.0%. Two patients (0.5%) developed clinically significant respiratory depression after midazolam use. Both patients had also received fentanyl citrate and the respiratory depression was reversed with naloxone. Two patients (0.5%) receiving several other drugs developed short periods of hypotension. There were no apparent long term sequelae. The authors conclude that midazolam can be safely used in the emergency department setting. Careful dosing and titration to the desired clinical effects is mandatory. Patients should be closely monitored to maximize safety.

Adolescent↗
PubMed1989

Aeromedical transport of patients with post-traumatic cardiac arrest.

Patients experiencing cardiac arrest secondary to trauma make up 8% to 15% of air ambulance scene flights in reported series. Our study examined the role of aggressive physician intervention at the accident scene in conjunction with rapid air transport to a trauma center in reducing the mortality after post-traumatic cardiac arrest. We retrospectively studied 67 patients who experienced cardiac arrest before the arrival of the flight team. Fifty-eight patients were victims of blunt trauma, and nine sustained penetrating trauma. Forty-seven patients were transported to the base hospital; 20 were pronounced dead at the scene after resuscitation attempts were made. Six patients developed a pulse and blood pressure and were hospitalized; none survived to hospital discharge. Review of autopsy data revealed that the majority of patients had head or thoracoabdominal injuries or both that were incompatible with life. We conclude that physician intervention at the scene and rapid aeromedical transport are not likely to improve mortality after traumatic cardiac arrest.

Adolescent↗
PubMed1989

The safety of fentanyl use in the emergency department.

Fentanyl citrate is a synthetic narcotic 1,000 times as potent as meperidine. It produces minimal hemodynamic effects and is characterized by a rapid onset of sedation and analgesia, a relatively short duration of action (approximately 30 to 40 minutes), and rapid reversal with opiate antagonists. These properties make fentanyl an ideal drug for emergency department use. The safety of fentanyl use in an adult ED population has not previously been studied. We retrospectively reviewed the charts of 841 patients who received fentanyl at the University of Cincinnati Center for Emergency Care between January 1985 and June 1988. The study population included 497 (59%) men and 344 (41%) women, with an average age of 33 years. The average dose of fentanyl was 180 micrograms (range, 25 to 1,400 micrograms). Six patients (1%) experienced mild side effects including nausea (one), emesis (two), urticaria (one), and pruritus (two). Nine patients (1%) developed more serious complications including six cases (0.7%) of respiratory depression and three cases (0.4%) of hypotension. Two of 183 patients (1%) who received midazolam and two of nine patients (22%) who received haloperidol developed respiratory depression. Four of the six patients with respiratory depression and two of the three patients with hypotension were intoxicated. All of the complications were transient, and none resulted in hospitalization. We conclude that fentanyl is a safe drug for use in the ED. To maximize safety, we recommend careful dosing and titration, close patient monitoring, and the availability of naloxone hydrochloride and resuscitation equipment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Toxic shock syndrome: a review.

TSS is a recently described acute febrile illness characterized by hypotension, rash, desquamation, and multisystemic involvement. While most common in menstruating women, TSS also occurs in men and non-menstruating women. It is now known that the disease is caused by one or more toxins produced by the S aureus organism. Treatment of TSS consists primarily of fluid resuscitation and supportive care. Anti-staphylococcal antibiotics are indicated primarily to reduce the rate of recurrence in menstrually related cases. In wound-related TSS, antibiotics are necessary to treat the primary wound infection and to prevent recurrent disease. Currently, the case fatality rate is stable at less than 3% and the major long-term complication of survivors is the risk of recurrence.

Emergencies↗
PubMed1988

Endothelial cell proliferation in vitro after incubation with anticoagulant and antiplatelet drugs.

An in vitro tissue culture model was used in the evaluation of various anticoagulant and antiplatelet drugs on endothelial cell proliferation and eicosanoid production. Low concentrations, less than normally achieved plasma concentrations of various heparins (beef lung, porcine intestinal and low molecular weight heparin from porcine intestine), increased endothelial cell growth. Higher concentrations showed a decrease for regular heparins, most marked for beef lung heparin -45%, compared to -21% for porcine intestinal heparin, but still an increase, +22%, was noted for low molecular weight heparin. Of the antiplatelet drugs, ibuprofen and dazoxiben reduced plating efficiency and endothelial cell proliferation. Of the antiplatelet drugs, all but dipyridamole reduced prostacyclin metabolite production. The difference in endothelial cell proliferation between heparins is of great interest and warrants further investigation.

Animals↗