Browsing by Author "Severance, HW"

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    Assault rifles; definitions, evolutionary history and medical consequences.
    (Journal of the Mississippi State Medical Association, 1990-12) Severance, HW
    In summary, the evolutionary history of assault rifles may be of interest to some medical practitioners. It is important to realize that the term "assault rifle" is incorrectly and overused in the lay press. As a rough generalization, the wounds from such weapons may fall in between those of handguns on one side and full-sized rifles on the other. The major caveat is that there can be major variations in the severity of any wound by any weapon and though it may be of some help in analyzing potential damage, knowledge of the inflicting weapon does not replace the need for good, well established principles of wound management.
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    Changes in Medical Therapy and Lifestyle After Anatomical Versus Functional Testing for Coronary Artery Disease: The PROMISE Trial (PROspective Multicenter Imaging Study for Evaluation of Chest Pain)
    (CIRCULATION, 2015-11-10) Ladapo, JA; Hoffman, U; Lee, KL; Coles, AL; Huang, M; Mark, DB; Dolor, RL; Pelberg, RA; Budoff, M; Sigurdsson, G; Severance, HW; Douglas, PS
    Introduction: Diagnostic testing may represent a “teachable moment” for patients newly presenting with symptoms suggestive of CAD and requiring further evaluation, and may influence risk factor management, independent of test results. However, little is known about changes in medications and lifestyle after anatomical versus functional testing. Hypothesis: Patients assigned to coronary CTA will report greater use of preventive medications and lifestyle practices. Methods: We randomly assigned 10,003 symptomatic patients (53% women; mean age 61 yrs) to anatomical testing with CTA or functional testing (exercise ECG, nuclear stress, or stress echocardiography). We assessed use of preventive medications (aspirin, statin, beta blocker, and ACEi/ARB) and lifestyle practices (heart healthy diet, regular exercise, smoking, and obese/overweight status [BMI>25]) at 60 days. Chi-square tests assessed between-group changes (initiation or discontinuation). Multivariable logistic regression models assessed the association between testing strategy and prevalence of medication use or lifestyle practices. Results: There were no differences in medications or lifestyle practices at baseline. At 60 days, the CTA strategy was associated with a higher proportion of patients newly initiating aspirin (11.6% vs 7.6%), statin (12.7% vs 6.2%), and beta blockers (8.2% vs 5.4%), compared to functional testing (p<0.0001 for each). The CTA strategy was also associated with a higher incidence of weight loss among obese/overweight patients (2.8% vs 2.4%), but the difference was not significant (p=0.051). Overall prevalences of aspirin (aOR=1.55), statin (aOR=2.04), and beta blocker (aOR=1.32) use were higher after CTA (p<0.001 for each). Eating a healthy diet (54.7% vs 50.8%) was increased after CTA (aOR=1.13 p=0.004), whereas obese/overweight status was reduced (aOR=0.79 p=0.047). Exercise and smoking cessation increased similarly in both arms. Benefits of CTA for statin use and weight loss persisted after adjusting for test results. Conclusions: Among patients with suspected CAD, anatomical testing is associated with greater favorable changes in preventive medical and lifestyle practices. This may represent a long term benefit of a CTA testing strategy.
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    Differences between chest pain observation service patients and admitted "rule-out myocardial infarction" patients.
    (Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 1997-07) Dallara, J; Severance, HW; Davis, B; Schulz, G

    Objective

    To compare and contrast the patient characteristics of ED patients at low risk for acute cardiac ischemia who were assigned to a chest pain observation service vs those admitted to a monitored inpatient bed for "rule-out acute myocardial infarction" (R/O MI).

    Methods

    This was a retrospective, cross-sectional comparison of adult patients considered at relatively low risk for cardiac ischemia and who were evaluated in 1 of 2 settings: a short-term observation service and an inpatient monitored bed. All patients had an ED final diagnosis of "chest pain," "R/O MI," or "unstable angina" during the 7-month study period. Demographic features and presenting clinical features were examined as a function of site of patient evaluation.

    Results

    Of 531 study patients, 265 (50%) were assigned to the observation service. Younger age (OR = 1.75, 95% CI 1.26, 2.44, for each decrement of 20 years), the complaint of "chest pain" (OR = 2.35, 95% CI 1.34, 4.12), and the absence of prior known coronary artery disease (OR = 1.64, 95% CI 1.13, 2.38) were the principal independent factors associated with assignment to a chest pain observation service bed.

    Conclusions

    Patients evaluated in a chest pain observation service appear to have different clinical characteristics than other individuals admitted to a monitored inpatient bed for "R/O MI." Investigators should address differences in clinical characteristics when making outcome comparisons between these 2 patient groups.
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    Profound muscle weakness and hypokalemia due to clay ingestion.
    (Southern medical journal, 1988-02) Severance, HW; Holt, T; Patrone, NA; Chapman, L
    We have presented the case of a 43-year-old woman with severe myositis due to clay ingestion and hypokalemia. EMG studies revealed a pattern consistent with myositis, and muscle biopsy showed a nonspecific diffuse myositis. The clay was shown to act as a potassium binder. With potassium replacement and discontinuance of clay ingestion, the symptoms and signs abated and laboratory values returned to normal.
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    Sickle cell vaso-occlusive pain crisis in adults: alternative strategies for management in the emergency department.
    (Southern medical journal, 1992-08) Sanders, DY; Severance, HW; Pollack, CV
    The gene for sickle cell disease is carried by 8% of the African-American population in the United States. The primary care physician is often called upon to recognize and treat one of the major sequelae of sickle cell disease--vaso-occlusive pain crisis. An injectable nonsteroidal anti-inflammatory drug has recently become available and may offer some improvement in outcome of vaso-occlusive pain crises. We present five case reports reviewing various current therapeutic options, including newer pharmacologic agents, and comment on alternatives to impatient management of pain crises. The use of the emergency department short-term observation unit as an alternative to hospitalization is discussed.
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    The Prtotocol-Provided Clinical Research Model as an Evolving Research Opportunity for Community-Based Hospitals and Health Care Facilities
    (Technology and Innovation, 2016) Severance, HW; Spiegel, KM
    There is an evolving model of protocol-provided clinical research that has become more standardized as a research pathway over the last several decades. This model, with reduced research-specific infrastructure requirements and whose trial processes, management, and business operations are very similar to those of standard-of-care clinical and business operations performed by community-based patient-care facilities, now offers a pathway for traditionally non-university-affiliated “nonacademic” community-based hospitals and health care facilities to enter into the arena of clinical research.