A comparison of coping assessed by ecological momentary assessment and retrospective recall

Recent research suggests that retrospective coping assessments may not correspond well with day-to-day reports. The authors extended this work by examining the correspondence between short-term (within 48 hr) retrospective coping reports and momentary reports recorded via a palm-top computer close in time to when the stressor occurred. There was relatively poor correspondence between the 2 assessments. Some reports of momentary coping were not reported retrospectively, and some coping reported retrospectively was not reported at the time the stressor occurred. Cognitive coping was more likely to be underreported retrospectively; behavior coping was overreported. Participants were consistent in their discrepancies, but there was no correspondence between discrepancy rates and demographic or personality variables.

Ethical issues of cardiopulmonary resuscitation: current practice among emergency physicians

OBJECTIVE

To determine current practice and attitudes among emergency physicians (EPs) regarding the initiation and termination of CPR.

METHODS

An anonymous survey was mailed to randomly selected EPs. Main outcome measures included respondents' answers to questions regarding outcome of resuscitation, and current practice regarding initiation, continuation, and termination of resuscitation for victims of cardiopulmonary arrest.

RESULTS

The 1,252 respondents were from all 50 states, a variety of practice settings, and varying board certification. Most (78%) respondents honor legal advance directives regarding resuscitation. Few (7%) follow unofficial documents, or verbal reports of advance directives (6%). Many (62%) make decisions regarding resuscitation because of fear of litigation or criticism. A majority (55%) have recently attempted numerous resuscitations despite expectations that such efforts would be futile. Most respondents indicated that ideally, legal concerns should not influence physician practice regarding resuscitation (78%), but that in the current environment, legal concerns do influence practice (94%).

CONCLUSIONS

Most EPs attempt to resuscitate patients in cardiopulmonary arrest, regardless of futility, except in cases where a legal advance directive is available. Many EPs' decisions regarding resuscitation are based on concerns of litigation and criticism, rather than their professional judgment of medical benefit or futility. Compliance with patients' wishes regarding resuscitation is low unless a legal advance directive is present. Possible solutions to these problems may include standardized guidelines for the initiation and termination of CPR, tort reform, and additional public education regarding resuscitation and advance directives.

Profound bradycardia related to long bone fracture manipulation

A 69-year-old male presented to the Emergency Department (ED) with a left comminuted femur fracture. Manipulation of the fractured leg resulted in profound bradycardia, necessitating cessation of the procedure in the ED. Various causes of sinus bradycardia, including vagal-mediated responses, as well as management of vagal-mediated bradycardia are discussed.

Fever in geriatric emergency patients: clinical features associated with serious illness

STUDY OBJECTIVE

To determine the clinical significance of fever in geriatric emergency department patients.

DESIGN

Case series with follow-up.

SETTING

Urban, university-affiliated community hospital.

PARTICIPANTS

Consecutive patients over the age of 65 years who presented to the ED during a 12-month period with an oral temperature of 100.0 degrees F (37.8 degrees C) or higher.

RESULTS

We considered the following features indicators of serious illness: positive blood culture(s), related death within 1 month of ED visit, need for surgery or other invasive procedure, hospitalization for 4 or more days, IV antibiotics for 3 or more days, and repeat ED visit within 72 hours for related condition. Four hundred eighty-nine patients were eligible for study. Of the 470 patients with complete follow-up data, 357 (76.0%) had indicators of serious illness. Clinical features found to be independently associated with serious illness included oral temperature of 103 degrees F (39.4 degrees C) or more, respiration rate of 30 or more, leukocytosis of 11.0 x 10(9)/L or more, presence of an infiltrate, and pulse of 120 or more. At least one indicator of serious illness was present in 63 of 128 patients (49.6%) with none of these independently predictive clinical features. The most common final diagnoses were pneumonia (24.0%), urinary-tract infection (21.7%), and sepsis (12.8%).

CONCLUSION

Fever among geriatric ED patients frequently marks the presence of serious illness. All such patients should be strongly considered for hospital admission, particularly when certain clinical features are present. The absence of abnormal findings does not reliably rule out the possibility of serious illness.

Presentations and emergency department evaluation of HIV infection

Patients with HIV infection may present with a wide variety of symptomatology, both related and unrelated to HIV infection. Evaluation should be conducted in an orderly fashion and should focus on the involved system, with particular attention to ruling out treatable infection, malignancy, or other HIV-related disease process.

Adenosine for the treatment of supraventricular tachycardia in the ED

To determine the safety and efficacy of intravenous adenosine as used in the emergency department (ED) for the treatment of presumed supraventricular tachycardia, the investigators performed a retrospective chart review in an urban, university-affiliated ED. Seventy-two consecutive patients were treated with intravenous adenosine for presumed supraventricular tachycardia. Of the 72 patients who were treated with adenosine, 46 patients had a confirmed diagnosis of supraventricular tachycardia. Of these, 39 of 46 (84.8%) converted to sinus rhythm after treatment. Of patients who successfully converted to sinus rhythm, none had recurrent tachycardia or required additional pharmacotherapy. Arrhythmias not successfully treated among the initially misdiagnosed patients were atrial fibrillation (n = 11), atrial flutter (n = 7), tachycardia of other origin (n = 5), and ventricular tachycardia (n = 2). No clinically significant adverse effects were noted among the study population. Intravenous adenosine is a safe and efficacious treatment for the emergent treatment of supraventricular tachycardia, including unstable patients (with hypotension and/or chest pain). It is also safe among patients initially presumed to have supraventricular tachycardia, who are later diagnosed with other arrhythmias.

Daily stress and the trajectory of mood: spillover, response assimilation, contrast, and chronic negative affectivity

Experience sampling methodology was used to examine the effects of current and prior problems on negative mood within and across days. Forty male community residents wore signal watches and kept dairy records of problem occurrence and mood 8 times a day for 8 consecutive days. Trait negative affectivity (NA), prior mood, and concurrent stress were related to mood during the day. Mood in response to a current problem was worse if the prior time had been problem free than if the prior time had been stressful. High NA Ss were more reactive to concurrent stressors than were low NAs, but the effect was small. NA and current-day stress were the major influences of mood across days. High NAs were more distressed by current-day problems and recovered more slowly from problems of the preceding day. The benefits of conceptualizing the effects of daily stressors on mood in terms of spillover, response assimilation, habituation, and contrast are discussed.

Daily stress and the trajectory of mood: spillover, response assimilation, contrast, and chronic negative affectivity

Experience sampling methodology was used to examine the effects of current and prior problems on negative mood within and across days. Forty male community residents wore signal watches and kept dairy records of problem occurrence and mood 8 times a day for 8 consecutive days. Trait negative affectivity (NA), prior mood, and concurrent stress were related to mood during the day. Mood in response to a current problem was worse if the prior time had been problem free than if the prior time had been stressful. High NA Ss were more reactive to concurrent stressors than were low NAs, but the effect was small. NA and current-day stress were the major influences of mood across days. High NAs were more distressed by current-day problems and recovered more slowly from problems of the preceding day. The benefits of conceptualizing the effects of daily stressors on mood in terms of spillover, response assimilation, habituation, and contrast are discussed.

Acute intoxication

Acute alcohol intoxication is a commonly encountered clinical presentation in Emergency Medicine. Its role should be considered in many Emergency Department presentations, specifically in major and minor trauma, and in gastrointestinal, metabolic, neurologic, and psychiatric disorders. The differential diagnosis of change in mental status must be considered in all intoxicated patients. Management of intoxicated patients is generally supportive although complications of chronic alcoholism should be considered. Management should consist of correction of complications resultant from intoxication, as well as observation and the provision of a safe environment for the patient during the recovery phase of acute intoxication.

Relationship between JAS- and FTAS-Type A behavior and non-CHD illness: A prospective study controlling for negative affectivity

In addition to posing a risk for coronary heart disease (CHD), Type A behavior has been suggested as a risk factor for non-CHD illness. Past evidence, however, has relied chiefly on retrospective studies of self-reported illness that failed to control for the potentially confounding effects of negative affectivity. The present investigation was an 18-month prospective study of Type A behavior and medical records of illness in which chronic negative affectivity was also assessed. Negative affectivity was associated with retrospective self-reported illness, but only Type A, as measured by the Jenkins Activity Survey (JAS) and the Framingham Type A Scale (FTAS), predicted medical records of subsequent illness severity and number of illness-related medical visits. Controlling for negative affectivity did not reduce these significant relationships. It was concluded that persons scoring high on the JAS or the FTAS may be a greater risk of minor illness when objective measures of illness are assessed over a period of 1 year or more. Alternative explanations and future directions for research are discussed.

Relationship between JAS- and FTAS-Type A behavior and non-CHD illness: a prospective study controlling for negative affectivity

In addition to posing a risk for coronary heart disease (CHD), Type A behavior has been suggested as a risk factor for non-CHD illness. Past evidence, however, has relied chiefly on retrospective studies of self-reported illness that failed to control for the potentially confounding effects of negative affectivity. The present investigation was an 18-month prospective study of Type A behavior and medical records of illness in which chronic negative affectivity was also assessed. Negative affectivity was associated with retrospective self-reported illness, but only Type A, as measured by the Jenkins Activity Survey (JAS) and the Framingham Type A Scale (FTAS), predicted medical records of subsequent illness severity and number of illness-related medical visits. Controlling for negative affectivity did not reduce these significant relationships. It was concluded that persons scoring high on the JAS or the FTAS may be a greater risk of minor illness when objective measures of illness are assessed over a period of 1 year or more. Alternative explanations and future directions for research are discussed.