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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjsurg.2008.07.032 Byline: Thomas M. Schmelzer, A. Britton Christmas, Dennis A. Taylor, B. Todd Heniford, Ronald F. Sing Keywords: Pulmonary embolism; Inferior vena cava filter; Vena cava filter retrieval; Anticoagulation Abstract: Vena cava filters (VCFs) are indicated in patients with active venous thromboembolism and are a contraindication to therapeutic anticoagulation. When patients can be anticoagulated, VCFs can be removed; however, patients often have anticoagulation discontinued during the retrieval procedure, leaving them at risk for pulmonary embolism (PE). The authors evaluated their experience with retrieving VCFs in therapeutically anticoagulated patients. Author Affiliation: Carolinas Medical Center, Department of Surgery, Division of Minimally Invasive and Gastrointestinal Surgery, Charlotte, NC, USA Article History: Received 3 May 2008; Revised 8 July 2008

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.annemergmed.2006.09.019 Byline: E. Brooke Lerner (a)(f), Graham Nichol (b), Daniel W. Spaite (c), Herbert G. Garrison (d), Ronald F. Maio (e) Abstract: To determine the cost of an emergency medical services (EMS) system, researchers, policymakers, and EMS providers need a framework with which to identify the components of the system that must be included in any cost calculations. Such a framework will allow for cost comparisons across studies, communities, and interventions. The objective of this article is to present an EMS cost framework. This framework was developed by a consensus panel after analysis of existing peer-reviewed and non-peer-reviewed resources, as well as independent expert input. The components of the framework include administrative overhead, bystander response, communications, equipment, human resources, information systems, medical oversight, physical plant, training, and vehicles. There is no hierarchical rank to these components; they are all necessary. Within each component, there are subcomponents that must be considered. This framework can be used to standardize the calculation of EMS system costs to a community. Standardizing the calculation of EMS cost will allow for comparisons of costs between studies, communities, and interventions. Author Affiliation: (a) Department of Emergency Medicine and Department of Community and Preventive Medicine, University of Rochester, Rochester, NY (Lerner) (b) University of Washington-Harborview Center for Prehospital Emergency Care and Emergency Services, Harborview Medical Center, University of Washington, Seattle, WA (Nichol) (c) Arizona Emergency Medicine Research Center, Department of Emergency Medicine, College of Medicine, University of Arizona, Tucson, AZ (Spaite) (d) Department of Emergency Medicine, East Carolina University, Greenville, NC (Garrison) (e) Department of Emergency Medicine, University of Michigan, Ann Arbor, MI (Maio) (f) Department of Emergency Medicine at the Medical College of Wisconsin, Milwaukee, WI Article History: Received 31 May 2006; Revised 21 September 2006; Accepted 22 September 2006 Article Note: (footnote) Supervising editor: Donald M. Yealy, MD, Funding and support: This work was funded by the National Highway Traffic Safety Administration through Cooperative Agreement DTNH22-98-H-05117 awarded to the National Association of State EMS Directors., Reprints not available from the authors.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjsurg.2006.08.068 Byline: B. Lauren Paton, David G. Jacobs, B. Todd Heniford, Kent W. Kercher, Marc Zerey, Ronald F. Sing Keywords: Inferior vena cava filters; Deep vein thrombosis; Pulmonary embolism; Bedside procedures Abstract: Vena cava filter insertion (VCF) is traditionally performed in a radiology suite or in the operating room. We reviewed our experience of bedside VCF insertion in the intensive care unit (ICU) performed by general surgeons. Author Affiliation: Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Medical Education Bldg 6A, Charlotte, NC 28203, USA Article History: Received 15 April 2006; Revised 10 August 2006

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.annemergmed.2006.01.012 Byline: E. Brooke Lerner (a), Ronald F. Maio (b), Herbert G. Garrison (c), Daniel W. Spaite (d), Graham Nichol (e) Abstract: The evaluation of the impact of out-of-hospital emergency care is a relatively new research focus. As such, there is a compelling need to determine how finite health care resources should be used in this setting. The objective of this study is to conduct a structured review of published economic evaluations of out-of-hospital emergency care to assess its economic value. Author Affiliation: (a) Department of Emergency Medicine and Department of Community and Preventive Medicine, University of Rochester, Rochester, NY (b) Department of Emergency Medicine, University of Michigan, Ann Arbor, MI (c) Department of Emergency Medicine, East Carolina University, Greenville, NC (d) Department of Emergency Medicine, College of Medicine, University of Arizona, Tucson, AZ (e) University of Washington-Harborview Center for Prehospital Emergency Care and Emergency Services, Harborview Medical Center, University of Washington, Seattle, WA. Article History: Received 9 November 2005; Revised 5 January 2006; Accepted 6 January 2006 Article Note: (footnote) Supervising editor: Donald M. Yealy, MD, Funding and support: This work was funded by the National Highway Traffic Safety Administration through Cooperative Agreement DTNH22-98-H-05117 awarded to the National Association of State EMS Directors. The sponsor played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript., Reprints not available from the authors.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2005.05.011 Byline: Ronald F. Grossman (a), John C. Rotschafer (b), James S. Tan (c) Keywords: Antibiotics; Community-associated pneumonia; Healthcare-associated; Hospital-acquired; Quinolones; Ventilator-associated Abstract: Respiratory tract infections (RTIs) that may require hospitalization include acute exacerbations of chronic bronchitis (AECB), community-acquired pneumonia (CAP), and hospital-acquired pneumonia (HAP), which includes ventilator-associated pneumonia (VAP). Healthcare-associated pneumonia (HCAP) is treated similar to HAP and may be considered with HAP. For CAP requiring hospitalization, the current guidelines for the treatments of RTIs generally recommend either a [beta]-lactam and macrolide combination or a fluoroquinolone. The respiratory fluoroquinolones (levofloxacin, gatifloxacin, moxifloxacin, and gemifloxacin) are excellent antibiotics due to high levels of susceptibility among gram-negative, gram-positive, and atypical pathogens. The fluoroquinolones are active against >98% of Streptococcus pneumoniae, including penicillin-resistant strains. Fluoroquinolones are also recommended for AECB requiring hospitalization. Evidence from clinical trials suggests that levofloxacin monotherapy is as efficacious as combination ceftriaxone-erythromycin therapy in the treatment of patients hospitalized with CAP. For early-onset HAP, VAP, and HCAP without the risk of multidrug resistance, ceftriaxone, ampicillin-sulbactam, ertapenem, or one of the fluoroquinolones is recommended. High-dose, short-course therapy regimens may offer improved treatment due to higher drug concentrations, more rapid killing, increased adherence, and the potential to reduce development of resistance. Recent studies have shown that short-course therapy with levofloxacin, azithromycin, or telithromycin in patients with CAP was effective, safe, and tolerable and may control the rate of resistance. Author Affiliation: (a) University of Toronto, Toronto, Ontario, Canada (b) University of Minnesota, Minneapolis, Minnesota, USA (c) Northeastern Ohio Universities College of Medicine, Akron, Ohio, USA.

Tumor necrosis factor (TNF) alpha may be involved in embryo implantation and placenta formation, according to a laboratory study. TNF alpha caused trophoblast cells to produce urokinase-type plasminogen activator at three times normal levels. The trophoblast is the layer of embryonic tissue that forms the placenta and in order to do this, it must invade uterine tissue.