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At least 19 recordsLinked to original sources
PubMed1998

International development of emergency medical systems: educational techniques for the future.

An ongoing collaborative partnership between the University of Massachusetts Medical Center, Boston University Medical Center, the Armenian Ministry of Health, and the Emergency Hospital of Yerevan, Armenia has been established since 1993. The primary goal of this partnership is to reform and improve the delivery of emergency medical care through a process of education and training that is reproducible, practical, and self-sustaining for the advancement of health care into the future. A six-step educational process was developed, using Armenia as the initial model site for this format. Through the development of a regional training center and two emergency medicine training curricula, the partnership has trained over 1800 health care workers and first responders. Preliminary results from pre- and post-course examinations show a significant overall improvement in scores. An ongoing trauma database collection also shows significant improvement in the number of advanced life support measures being implemented since the inception of this educational training programme. This educational strategy has subsequently been replicated in nine similar partnerships in other countries of the New Independent States, formed after the dissolution of the former Soviet Union in 1990. We believe this six-step educational format is effective for the development and improvement of emergency medical systems in developing countries worldwide.

Armenia↗
PubMed1977

Relation between smoking and age of natural menopause. Report from the Boston Collaborative Drug Surveillance Program, Boston University Medical Center.

The relation of cigarette smoking to natural menopause has been evaluated in two independent sets of data. In both, at each age from 44 to 53 years, more current smokers were post-menopausal compared to "never" smokers. In the first set of data the age-standardised proportions of women who were postmenopausal were 35, 36, 43, and 49%, respectively, for never smokers, ex-smokers, and current smokers of 1/2 and greater than or equal to 1 pack per day. The corresponding proportions for the second set were 53, 59, 60 and 65%.

Adult↗
PubMed1977

Oral contraceptives and hepatitis. A report from the Boston Collaborative Drug Surveillance Program, Boston University Medical Center.

History of oral-contraceptive use was compared between 68 women with a hospital-discharge diagnosis of acute hepatitis and 1142 women who had been admitted for other reasons to the same hospitals during the same period. The risk of admission to hospital for hepatitis for users of oral contraceptives was estimated to be 3-3 times that for non-users (95% confidence interval, 1-8--6-3). This overall association was almost entirely attributable to a strong association among women under 25 years of age. Among users of oral contraceptives, duration of use tended to be shorter for hepatitis patients than for controls.

Acute Disease↗
PubMed1985

Group G streptococcal bacteremia. The clinical experience at Boston University Medical Center and a critical review of the literature.

Twenty-six patients with bacteremia caused by group G streptococci were seen during a 29-month period. Our findings suggest that the epidemiology of these infections has not changed appreciably during the last 15 years. The disease occurs most commonly as an acute community-acquired infection in older persons with underlying conditions predisposing to skin breakdown. Patients with these bacteremias fall into three categories: those with associated cutaneous infection only; those with serious focal infection; and those with probable infection. Underlying neoplastic conditions were relatively uncommon (25%) in our series compared with others (65%). In contrast to recent reports emphasizing this complication, endocarditis was uncommon in our patients. A prompt response to therapy with beta-lactam antibiotics occurred in most of our patients.

Adult↗
PubMed1978

Drug-induced gastrointestinal bleeding. Report from the Boston Collaborative Drug Surveillance Program, Boston University Medical Center.

Rates of drug-induced gastrointestinal bleeding were estimated from data on 16 646 consecutively monitored medical inpatients who had no known predisposing illness. Heparin, warfarin, ethacrynic acid, steroids, and aspirin-containing drugs were associated with gastrointestinal bleeding and were estimated to account for about two-thirds of such bleeds. Major gastrointestinal bleeding, defined as bleeding severe enough to require transfusion, occurred in only 57 patients (0.3%).

Anticoagulants↗
PubMed2001

Treatment of vitamin D deficiency due to Crohn's disease with tanning bed ultraviolet B radiation.

In Crohn's disease, severe skeletal demineralization, secondary hyperparathyroidism, and muscle weakness can occur. This may be caused by impaired vitamin D absorption, resulting from extensive intestinal disease and resection of duodenum and jejunum, where vitamin D is absorbed. We report a 57-year-old woman with a long history of Crohn's disease and short-bowel syndrome who had only 2 feet of small intestine remaining after 3 bowel resections. She was taking a daily multivitamin containing 400 IU of vitamin D(3) and was dependent on total parenteral nutrition that contained 200 IU of vitamin D and calcium (18 mEq in a 1-L bag infused over 8 hours daily) for a period of 36 months. Despite the above replacement, she complained of bone pain and muscle weakness, and she continued to be vitamin D-deficient with a 25(OH)D level <20 ng/mL. She was then exposed to ultraviolet B (UVB) radiation in a tanning bed wearing a 1-piece bathing suit for 10 minutes, 3 times a week for 6 months at the General Clinical Research Center, Boston University Medical Center. She tolerated the irradiation well without evidence of erythema. After 4 weeks, her serum 25(OH)D level increased by 357% from 7 to 32 ng/mL, parathyroid hormone level decreased by 52% from 92 to 44 pg/mL, and the serum calcium level increased from 7.8 to 8.5 mg/dL. After 6 months of UVB treatment, her serum 25(OH)D level was maintained in the normal range and was free of muscle weakness, and bone and muscle pain.

Bone and Bones↗
PubMed1998

The use of radiographs to evaluate shoulder pain in the ED.

This study was conducted to describe the utilization of plain radiography in the initial evaluation of shoulder pain in the emergency department (ED) and assess the feasibility of developing guidelines for the selective use of shoulder radiographs by determining whether clinical variables are able to discriminate between subjects having therapeutically informative versus uninformative X-rays. The study was a chart review of all adult ED patients presenting to the Boston University Medical Center Hospital (Boston, MA) between January 1994 and January 1996 with a chief complaint that included shoulder pain. Subjects with X-rays were classified into two groups, those with therapeutically informative X-rays (ie, identified conditions requiring specific therapy) and those with therapeutically uninformative X-rays (ie, did not result in specific therapy). Recursive partitioning techniques were then used to identify clinical variables that best distinguished between therapeutically informative and uninformative radiographs. Three hundred twelve patients were included in the analysis, of whom 185 (59%) had shoulder X-rays performed. Thirty-seven (20%) radiographs were therapeutically informative, including 13 glenohumeral dislocations, 3 acromioclavicular joint separations, and 21 fractures. Deformity present on shoulder examination was the strongest discriminating variable and correctly classified 21 of 23 subjects as having informative X-rays. Of the remaining patients (n = 162), only those older than 43.5 years with a history of a precipitating fall (n = 40) had a high likelihood of having therapeutically informative X-rays. No patients without a deformity or precipitating fall (n = 90) had an informative X-ray. These data show that X-rays for the initial evaluation of shoulder pain in the ED are overutilized. This preliminary model suggests that clinical variables are able to distinguish between patients with informative versus uninformative X-rays. Prospective studies are needed to derive valid decision rules for selective use of shoulder radiographs in the ED.

Adolescent↗
PubMed1998

An estimate of the annual direct cost of treating cutaneous melanoma.

BACKGROUND: Although the survival benefits of early stage melanoma have been clearly documented, the potential economic impact of early versus late stage disease has not been assessed. OBJECTIVE: Our purpose was to estimate the annual direct cost of diagnosing and treating melanoma, based on the number of projected cases of melanoma entering each stage in 1997. METHODS: A model was constructed with assumptions derived from the literature and clinical experience at the Massachusetts General Hospital Melanoma Center and the Boston University Medical Center. Cost estimates were based on 1997 Boston area Medicare reimbursements. RESULTS: The annual direct cost of treating newly diagnosed melanoma in 1997 was estimated to be $563 million. Stage I and II disease each comprised about 5% of the total cost; stage III and stage IV disease consumed 34% and 55% of the total cost, respectively. About 90% of the total annual direct cost of treating melanoma in 1997 was attributable to less than 20% of patients (those patients with advanced disease, that is, stage III and stage IV). CONCLUSION: In addition to the potential survival advantages, aggressive primary prevention through sun protection and intensive screening to enhance earlier detection should reduce the economic burden of melanoma care.

Biopsy↗
PubMed1996

Relationship of cardiovascular risk factors to racial differences in femoral bypass surgery and abdominal aortic aneurysmectomy in Massachusetts.

UNLABELLED: Atherosclerosis is more severe in blacks than in whites, but abdominal aortic aneurysms, which have traditionally been thought to have an atherosclerotic etiology, appear to be less common in blacks. Because of this incongruity, we compared risk factor profiles in patients undergoing abdominal aortic aneurysm repair and patients undergoing femoral bypass for atherosclerotic occlusive disease. A dual case-control study was conducted, first, comparing patients who had undergone aneurysmectomy to a control group of patients who had undergone appendectomy; and then comparing patients who had undergone femoral bypass surgery to the same appendectomy controls. We initially used hospital discharge data for the entire state of Massachusetts and, in a second phase, data obtained from a review of medical records from Boston University Medical Center Hospital and Boston City Hospital. The statewide database indicated that rates of femoral bypass surgery were higher in blacks than in whites, but after adjusting for differences in hypertension, diabetes, and low socioeconomic status, the black/white odds ratio for femoral bypass fell to 1.44 (95% confidence interval: 1.08, 1.92). A similar analysis based on the hospital chart review, provided better control of confounding and indicated that there was no racial difference in rates of femoral bypass after correcting for other risk factors (odds ratio = 0.94; 95% confidence interval: 0.40, 2.22; p = 0.90). In contrast, the statewide database found higher rates of abdominal aortic aneurysm surgery in whites, and particularly in white males. Smoking and hypertension were strong risk factors for aneurysmectomy, but diabetes mellitus and socioeconomic status were not. After adjusting for other variables, the black/white odds ratio for aneurysmectomy was 0.29 (95% confidence interval: 0.07, 1.23; p = 0.09). CONCLUSIONS: Substantial differences are found in the risk factor profiles for aneurysmal disease and femoral atherosclerotic occlusive disease. Diabetes is a particularly strong risk factor for femoral disease, but not for aneurysmal disease. In addition, blacks had higher rates of femoral bypass surgery in Massachusetts, but the apparent racial difference appeared to be due to a greater prevalence of hypertension, smoking, and diabetes in blacks. In contrast, abdominal aortic aneurysms occurred predominantly in white males, and adjustment for other risk factors further accentuated the greater risk in whites.

Adult↗
PubMedDate not supplied

Guidelines for developing an effective electrical safety program.

This paper describes the steps and key factors involved in preparing an Electrical Safety Program tailored to meet the needs and resources of a patient care facility. The effectiveness of the program depends upon how well the Safety Committee completes the tasks involved. The Electrical Safety Program in use at Boston University Medical Center is described.

Accident Prevention↗