Scott M. Alter

Impact of Popularity Indications on Readers' Selective Exposure to Online News

Selecting news online may differ from traditional news choices, as most formal importance indicators in traditional media do not convert directly to online news. However, online portals feature news recommendations based on collaborative filtering. To investigate how recommendations affect information choices, 93 participants browsed online news that featured explicit (average rating) or implicit (times viewed) recommendations or no recommendations (control group) while news exposure was logged. Participants picked more articles if the portal featured explicit recommendations, and stronger explicit recommendations instigated longer exposure to associated articles. Implicit recommendations produced a curvilinear effect with longer exposure for low and high numbers.

Intranasal naloxone delivery is an alternative to intravenous naloxone for opioid overdoses.

INTRODUCTION This study proposes that intranasal (IN) naloxone administration is preferable to intravenous (IV) naloxone by emergency medical services for opioid overdoses. Our study attempts to establish that IN naloxone is as effective as IV naloxone but without the risk of needle exposure. We also attempt to validate the use of the Glasgow Coma Scale (GCS) in opioid intoxication. METHODS A retrospective chart review of prehospital advanced life support patients was performed on confirmed opioid overdose patients. Initial and final unassisted respiratory rates (RR) and GCS, recorded by paramedics, were used as indicators of naloxone effectiveness. The median changes in RR and GCS were determined. RESULTS Three hundred forty-four patients who received naloxone by paramedics from January 1, 2005, until December 31, 2007, were evaluated. Of confirmed opioid overdoses, change in RR was 6 for the IV group and 4 for the IN group (P = .08). Change in GCS was 4 for the IV group and 3 for the IN group (P = .19). Correlations between RR and GCS for initial, final, and change were significant at the 0.01 level (rho = 0.577, 0.462, 0.568, respectively). CONCLUSION Intranasal naloxone is statistically as effective as IV naloxone at reversing the effects of opioid overdose. The IV and IN groups had similar average increases in RR and GCS. Based on our results, IN naloxone is a viable alternative to IV naloxone while posing less risk of needle stick injury. Additionally, we demonstrated that GCS is correlated with RR in opioid intoxication.

News Selection Patterns as a Function of Race: The Discerning Minority and the Indiscriminating Majority

This study examines whether White majority and Black minority members differ in selecting news stories that featured either individuals of their own group or dissimilar others. Hypotheses derived from social-cognitive theory, social comparison theory, and distinctiveness theories were tested utilizing unobtrusive observations of news story selections. This selective exposure research design overcomes methodological constraints of previous experimental studies that employed self-reports and forced-exposure techniques to measure responses of Blacks and Whites to race-specific media sources. Our sample consisted of 112 Blacks and 93 Whites, who browsed 10 online news stories while exposure was unobtrusively logged via software. The news site displayed equal numbers of Black and White characters, with the pictures associated with the news stories rotated across participants. Results indicate that Whites showed no preference based on the race of the character featured in the news story. In contrast, Blacks strongly preferred news stories featuring Blacks and spent more than twice the reading time on them compared to exposure to news stories featuring Whites.

Naloxone in cardiac arrest with suspected opioid overdoses

INTRODUCTION Naloxones use in cardiac arrest has been of recent interest, stimulated by conflicting results in both human case reports and animal studies demonstrating antiarrhythmic and positive ionotropic effects. We hypothesized that naloxone administration during cardiac arrest, in suspected opioid overdosed patients, is associated with a change in cardiac rhythm. METHODS From a database of 32,544 advanced life support (ALS) emergency medical dispatches between January 2003 and December 2007, a retrospective chart review was completed of patients receiving naloxone in cardiac arrest. Forty-two patients in non-traumatic cardiac arrest were identified. Each patient received naloxone because of suspicion by a paramedic of acute opioid use. RESULTS Fifteen of the 36 (42%) (95% confidence interval [CI]: 26-58) patients in cardiac arrest who received naloxone in the pre-hospital setting had an improvement in electrocardiogram (EKG) rhythm. Of the participants who responded to naloxone, 47% (95% CI: 21-72) (19% [95% CI: 7-32] of all study subjects) demonstrated EKG rhythm changes immediately following the administration of naloxone. DISCUSSION Although we cannot support the routine use of naloxone during cardiac arrest, we recommend its administration with any suspicion of opioid use. Due to low rates of return of spontaneous circulation and survival during cardiac arrest, any potential intervention leading to rhythm improvement is a reasonable treatment modality.

External blood loss estimation using the MAR Method.

BACKGROUND An element lacking in medical education is training to estimate blood volumes. Therefore, health care workers currently use visual estimation as their only means of determining blood volumes, which has shown to be highly inaccurate. This study proposes and tests a new method using ones fist to determine external blood loss. METHODS Increments of human whole blood were measured and used to compare fist size to surface area of blood present. A formula was created averaging blood per fist, hereafter known as the MAR Method. Two scenarios were staged using set quantities of blood (75 and 750 mL). Participants estimated blood volumes before and after being taught the MAR Method in a 1-minute session. Errors in estimation before and after using the MAR Method were compared. RESULTS The MAR Method was created using a fist to cover a surface area of blood that equals 20 mL. A total of 74 participants had errors of 120% and 73% for visualization of the small and large pools, respectively. For the smaller volume, the average error from the mean decreased by 76% (P < .0001), and the interquartile range of errors decreased by 60%. For the larger volume, the average error from the mean reduced by 40% (P < .0001), and the interquartile range of errors reduced by 45%. CONCLUSION Use of the MAR Method improves blood volume estimations. After less than 1 minute of instruction, participants were able to determine blood volumes with improved accuracy and precision.

Nosocomial and community-acquired infection rates of patients treated by prehospital advanced life support compared with other admitted patients ☆

OBJECTIVES Nosocomial infections are a large burden to both patients and health care organizations, causing hospitals to take measures in an attempt to reduce microorganism transmission. Patients treated by emergency medical services are one population that has not been studied regarding infection rates. This study examines admitted patients treated by advanced life support (ALS) and their likelihood of having community-acquired and nosocomial infections. METHODS A retrospective cohort study was conducted of 154 318 admitted patients between 2003 and 2007. Subjects identified as having either community-acquired or nosocomial infections were grouped based on infection type and ALS treatment. The proportion of infected patients among total hospital admissions in each of these groups was calculated and compared using odds ratios (ORs). RESULTS A total of 5418 patients had at least 1 infection while admitted (3653 nosocomial, 1765 community). The probability of an ALS patient getting a nosocomial infection was 3.20% versus 2.28% for non-ALS patients (OR, 1.42; 95% confidence interval [CI], 1.28-1.57). There was no significant difference in community-acquired infections between ALS and non-ALS-treated groups (1.22% vs 1.14%; OR, 1.08; 95% CI, 0.92-1.26). CONCLUSIONS Despite having similar rates of community-acquired infections, patients admitted after ALS treatment had significantly greater risk for nosocomial infections. Because causality is not established, it remains unknown whether paramedic interventions contributed to the increased rate. Quite possibly, these patients are more susceptible to virulent organisms; however, prospective research is needed to identify causal relationships. Thus, treatment by ALS can be used as an identifier of patients at an increased risk of acquiring nosocomial infections.

Intubation of prehospital patients with curved laryngoscope blade is more successful than with straight blade

Objective Direct laryngoscopy can be performed using curved or straight blades, and providers usually choose the blade they are most comfortable with. However, curved blades are anecdotally thought of as easier to use than straight blades. We seek to compare intubation success rates of paramedics using curved versus straight blades. Methods Design: retrospective chart review. Setting: hospital‐based suburban ALS service with 20,000 annual calls. Subjects: prehospital patients with any direct laryngoscopy intubation attempt over almost 9 years. First attempt and overall success rates were calculated for attempts with curved and straight blades. Differences between the groups were calculated. Results 2299 patients were intubated by direct laryngoscopy. 1865 had attempts with a curved blade, 367 had attempts with a straight blade, and 67 had attempts with both. Baseline characteristics were similar between groups. First attempt success was 86% with a curved blade and 73% with a straight blade: a difference of 13% (95% CI: 9–17). Overall success was 96% with a curved blade and 81% with a straight blade: a difference of 15% (95% CI: 12–18). There was an average of 1.11 intubation attempts per patient with a curved blade and 1.13 attempts per patient with a straight blade (2% difference, 95% CI: −3–7). Conclusions Our study found a significant difference in intubation success rates between laryngoscope blade types. Curved blades had higher first attempt and overall success rates when compared to straight blades. Paramedics should consider selecting a curved blade as their tool of choice to potentially improve intubation success.

Radiology report “disclaimers” increase the use of abdominal CT in the work-up of pediatric abdominal pain☆☆☆

Objective: Pediatric abdominal pain is commonly evaluated in the emergency department (ED) initially by ultrasonography (U/S). Radiology reports often include commentary about U/S limitations and possible need for additional testing or evaluation independent of study interpretation. We sought to determine if presence of a “disclaimer” is associated with additional imaging. Methods: Design: Retrospective cohort. Setting: Community ED with volume of 85,000 annual visits. Population: Consecutive ED patients <21‐years‐old with appendix U/S over 12‐months. Radiologist reports were assessed for disclaimers and if definitive diagnoses of appendicitis were made. The incidence of subsequent CT imaging was determined and group differences between categories were calculated. Results: 441 eligible patients were identified with average age 11.7 years. Of all U/S studies, 26% were definitive for appendicitis and 74% were non‐definitive. Disclaimers were included on 60% of all studies, including 13% of definitive studies and 76% of non‐definitive studies. 25% of all studies including a disclaimer had follow‐up CT versus 10% of studies without a disclaimer (15% difference; 95% CI: 9–21). For patients with definitive interpretations, 6% had follow‐up CT with no significant difference between groups with or without a disclaimer. For patients with non‐definitive studies, 26% with a disclaimer had follow‐up CT scans versus 13% without a disclaimer (13% difference; 95% CI: 4–22). Conclusions: Appendix ultrasound interpretations often include a disclaimer, which leads to a 150% increase in follow‐up CT imaging. We suggest that radiologists consider the impact of including such a disclaimer, knowing that this may contribute to possible unnecessary imaging.

Evaluating clinical care in the prehospital setting: Is Rapid Emergency Medicine Score the missing metric of EMS?

Introduction: The Rapid Emergency Medicine Score (REMS) was developed to predict emergency department patient mortality. Our objective was to utilize REMS to assess initial patient acuity and evaluate clinical change during prehospital care. Methods: All non‐cardiac arrest emergency transports from April 1, 2013 to March 31, 2014 were analyzed from a single EMS agency. Using age, pulse rate, mean arterial pressure, respiratory rate, oxygen saturation, and Glasgow Coma Scale, initial and final REMS were calculated. Change in REMS was calculated by initial minus final with a positive number indicating clinical improvement. Descriptive analyses were performed calculating means and 95% confidence intervals. Results: There were 61,346 patients analyzed with an average initial REMS of 4.3 (95% CI: 4.2–4.3) and an average REMS change of 0.37 (95% CI: 0.36–0.38). Those patients classified with the highest dispatch priority had the highest initial REMS (5.8; 95% CI: 5.5–6.2) and the greatest change (0.95; 95% CI: 0.72–1.17). Patients transported with high priority had greater initial REMS, as well as greater improvement in REMS (high priority 7.3 [95% CI: 7.1–7.4], change 0.61 [95% CI: 0.53–0.69]; middle priority 5.3 [95% CI: 5.2–5.4], change 0.55 [95% CI: 0.51–0.59]; low priority 3.9 [95% CI: 3.8–3.9], change 0.32 [95% CI: 0.31–0.33]). Conclusion: Descriptive analyses indicate that as dispatch and transport priorities increased in severity so too did initial REMS. The largest change in REMS was seen in patients with the highest dispatch and transport priorities. This indicates that REMS may provide system level insight into evaluating clinical changes during care.

Repeat acute abdomen and hemoperitoneum during the same pregnancy due to a ruptured ectopic treated by salpingostomy.

Abstract A leading cause of maternal mortality in the first trimester is hemorrhage due to a ruptured ectopic pregnancy. With the advent of tube salvage surgery, ectopic pregnancies can be removed while ensuring hemostasis and preserving the integrity of the fallopian tube. A major drawback of tube salvage surgery is the significant risk of persistent trophoblastic tissue being left behind. We report a case of a 30 year old female who presented to the ED with acute abdomen and hemoperitoneum due to a ruptured ectopic pregnancy. She was treated with salpingostomy and the pathologic report confirmed removal of the ectopic pregnancy. After an initially uneventful post‐operative recovery, she presented to the ED 27 days later with signs of acute abdomen and hemoperitoneum. Surgical intervention confirmed a ruptured ectopic pregnancy in the same site as previous, and salpingectomy was performed, after which the patient recovered without complications. The increased risk of persistent trophoblastic tissue associated with tube salvage surgery can lead to subsequent reoperation for tubal rupture. Patients undergoing these procedures should be closely monitored in the following weeks and undergo serial &bgr;‐hCG testing in order to confirm successful removal of the ectopic.