A study of 96 high-risk, but uneventful pregnancies was performed. Overt hyperglycemia was excluded after 24 weeks of gestation by fasting serum glucose >110 mg, serum glucose of >140 mg two hours after a large breakfast (group 1, 44 subjects) or >140 mg two hours after a standard glucose load (group 2, 52 subjects). A significant linear correlation between the two-hour postprandial serum glucose and birth weight was found in group 1 (r = 0.29, p > 0.05). There was a random correlation (r = -0.002, p < 0.4) in group 2. It is suggested that the dietary habits were an important variable.

Birth Weight↗

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EMS-initiated refusal and alternative methods of transport.

OBJECTIVES: 1) To describe characteristics of patient transport protocols in those U.S. cities that sanction EMS-initiated refusal of transport; and 2) to describe the frequency and type of alternatives to emergency ambulance transport. METHODS: EMS systems in every one of the 200 largest cities in the United States were surveyed by telephone regarding EMS-initiated refusal policies, involvement of physicians in the decision-making process, and the presence or absence of alternatives to EMS transport. RESULTS: 100% of the target population responded to the telephone survey. Only 34 (17%) EMS systems have written protocols that allow EMS providers to refuse emergency ambulance transport for patients judged to have minor illness or injury after examination. Twenty-one (62%) of these EMS systems do not require on-line physician approval for EMS-initiated refusals. Seven (21%) EMS systems that allow refusal of transport also have a formalized alternative transport program in place. Nationwide, only 19 (10%) cities surveyed offer some type of alternative to ambulance transport, most commonly taxi and minivan. CONCLUSION: The authors report the first national survey of EMS-initiated refusal practices. Few urban EMS systems have implemented this policy to decrease utilization by persons with low-acuity illness or injury. This may be related to the fact that few EMS systems currently have alternatives to emergency ambulance transport.

Clinical Protocols↗

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The chromosomes of the muskrat.

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Animals↗

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Archives. Priceless heritage.

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Archives↗

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Miracle worker in middle age.

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Anniversaries and Special Events↗

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Carotid endarterectomy without pre-operative angiography.

Carotid endarterectomy is being performed with increasing frequency without the benefit of preoperative angiography, based purely on duplex scanning. The available data attest to its safety, with the caveats that the duplex scan is unimpeachable, and that the symptoms and duplex scan findings are consistent. Given the well documented risk of stoke as a consequence of cerebral angiography being at least 1%, the elimination of this risk by the omission of contrast angiography would reduce the neurological morbidity and mortality rate of the diagnosis and treatment of carotid bifurcation disease by approximately 50%. The available data make a compelling case for carotid endarterectomy based on duplex scanning, without preoperative angiography, as the preferred approach to treatment of carotid artery stenosis.

Cerebral Angiography↗

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Outcomes of a brief inpatient treatment program for mood and anxiety disorders.

Findings are reported from a study on outcomes of a brief psychiatric inpatient treatment program (7-day average) for 67 patients with mood and anxiety disorders. Multiple outcomes measures were completed by patients, family members, and clinicians at admission, discharge, and 3 months after discharge. Findings included significant improvement from admission to discharge, with maintenance of gains 3 months later and few readmissions. Implications for psychiatric nursing practice in today's health care environment are discussed.

Adult↗

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