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ABSTRACT: To demonstrate the three-dimensional (3D) orthodontic force systems of three commercial closing T-loop archwires using a new method and to quantify the force systems of the T-loop archwires.
An orthodontic force tester (OFT) and a custom-made dentoform were developed to measure force systems. The system simulated the clinical environment for an orthodontic patient requiring space closure, which included measurement of three force components along, and three moment components about, three clinically defined axes on two target teeth. The archwires were attached to the dentoform and were activated following a standard clinical procedure. The resulting force system was measured using the OFT.
The force systems of the T-loops on the teeth were 3D. Activation in one direction resulted in force and moment components in other directions (side effects). The six force and moment components as well as the moment-to-force ratios in the clinically defined coordinate system were quantified.
The commercial archwires do not provide force systems for pure translation. Quantification of the force system is critical for the selection and design of optimal orthodontic appliances.
The Angle Orthodontist 07/2010; 80(4):566-70. · 1.21 Impact Factor
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ABSTRACT: To determine if there is a significant difference in the clinical outcomes of cases treated with 0.018-inch brackets vs 0.022-inch brackets according to the American Board of Orthodontics (ABO) Objective Grading System (OGS).
Treatment time and the ABO-OGS standards in alignment/rotations, marginal ridges, buccolingual inclination, overjet, occlusal relationships, occlusal contacts, interproximal contacts, and root angulations were used to compare clinical outcomes between a series of 828 consecutively completed orthodontic cases (2005-2008) treated in a university graduate orthodontic clinic with 0.018-inch- and 0.022-inch-slot brackets.
A two-sample t-test showed a significantly shorter treatment time and lower ABO-OGS score in four categories (alignment/rotations, marginal ridges, overjet, and root angulations), as well as lower total ABO-OGS total score, with the 0.018-inch brackets. The ANCOVA-adjusting for covariants of discrepancy index, age, gender, and treatment time-showed that the 0.018-inch brackets scored significantly lower than the 0.022-inch brackets in both the alignment/rotations category and total ABO-OGS score.
There were statistically, but not clinically, significant differences in treatment times and in total ABO-OGS scores in favor of 0.018-inch brackets as compared with the 0.022-inch brackets in a university graduate orthodontic clinic (2005-2008).
The Angle Orthodontist 05/2010; 80(3):528-32. · 1.21 Impact Factor
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Allon N Friedman,
Matthew Strother,
Sara K Quinney,
Stephen Hall,
Susan M Perkins, Edward J Brizendine,
Margaret Inman,
Gerardo Gomez,
Zak Shihabi,
Sharon Moe,
Lang Li
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ABSTRACT: Identifying methods to accurately measure the glomerular filtration rate (GFR) in obese individuals without kidney overt kidney disease is necessary to understanding the pathophysiology and natural history of obesity-related kidney disease.
Using a cross-sectional design, iohexol clearance and disposition was measured, an optimal sampling schedule was identified, and the reliability of GFR-estimating methods was described in 29 obese individuals with normal serum creatinine levels. Iohexol disposition was measured using population pharmacokinetics. The agreement with GFR-estimating equations was assessed by intraclass coefficients.
Mean age was 44 ± 10 years, body mass index 45 ± 10, creatinine 0.7 ± 0.2 mg/dl (62 ± 18 μmol/l) , and cystatin C 0.83 ± 0.18 mg/dl (8.3 ± 1.8 mg/l). Iohexol disposition fit a two-compartment model and 5 sampling windows were identified over a 4-hour period to optimize model accuracy and minimize blood draws. Precision was not compromised with this sampling design. Neither creatinine nor cystatin C were linearly correlated with the measured GFR though cystatin C was independent of body composition. Agreement was fair to poor between the measured GFR and GFR-estimating equations.
This study offers a rigorous method to study obesity-related kidney disease and improve upon suboptimal GFR-estimating methods.
Nephron Clinical Practice 01/2010; 116(3):c224-34. · 2.04 Impact Factor
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ABSTRACT: The Joint Commission requires "appropriate assessment" of patients presenting with painful conditions. Compliance is usually assessed through retrospective chart analysis. We investigate the discrepancy between observed physician pain assessment and that subsequently documented in the medical record.
This was an observational study using a trained investigator watching bedside interactions of emergency physicians. Using a priori definitions, the investigator recorded whether the patient volunteered the presence of pain, physician inquiry about pain, attempts to quantify the pain, treatment offered/rendered, and any assessment of the response to therapy. An independent investigator subsequently assessed the patient's chart for documentation of pain assessment, therapy rendered, and response to treatment. Children younger than 5 years and patients with major trauma, altered mental status, or nontraumatic chest pain were excluded. The institutional review board approved the protocol, the physicians agreed to participate in an "ergonomic study" without knowing the exact nature of data collection, and patients released their records.
The investigator observed 209 patient encounters. Physicians acknowledged the patients' pain 98.1% of the time but documented its presence in 91.7%. Physicians attempted to quantify the patient's pain in 61.5% of encounters but documented that attempt in only 38.9%. Treatment was offered in 79.9% and recorded in 31.7% of charts. When treatment was offered, the patient's response to the therapy was recorded only 28% of the time.
Physicians almost always assess and treat patient pain but infrequently record those efforts. The patient's chart is a poor surrogate marker for pain assessment and care by emergency physicians and may not be suitable for use as a compliance assessment tool. Research methodology using retrospective chart analysis may be affected by this phenomenon, suggesting the potential for underestimation of patient pain assessment and treatment by emergency physicians.
Annals of emergency medicine 04/2008; 52(4):383-9. · 4.23 Impact Factor
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Diabetes care 12/2007; 30(11):2859-60. · 8.09 Impact Factor
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ABSTRACT: Propofol is a sedative agent gaining popularity for Emergency Department Procedural Sedation (EDPS). However, some institutions across the country continue to restrict the use of propofol secondary to safety concerns. The purpose of our study was to evaluate the complication rate of EDPS with propofol. We conducted a prospective, observational, multi-center study of EDPS patients aged > or = 18 years, consenting to procedural sedation with propofol. Eighty-two patients from two Level I trauma centers were enrolled between August 1, 2002 and January 31, 2003. Transient hypoxemia was the only noted sedation complication. Nine patients (11%) had brief hypoxemia. The combined average hypoxemia time was 1.2 min (SD 0.4), and in all instances responded to simple airway maneuvers or increased oxygen concentration. No patient required advanced airway maneuvers such as intubation or even positive pressure ventilation. EDPS with propofol seems to be safe in our population.
Journal of Emergency Medicine 11/2007; 33(4):355-61. · 1.31 Impact Factor
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ABSTRACT: We conducted a study to assess the correlation of bispectral index (BIS) to 2 clinical sedation scales.
This was a prospective, observational study. The BIS number was recorded at baseline and every 30 seconds. One investigator separately monitored the patients for depth of sedation using the Observer's Assessment of Alertness/Sedation and the Continuum of Depth of Sedation scales.
During the 6-month period, 75 patients were enrolled. The Spearman correlation between the BIS and the Observer's Assessment of Alertness/Sedation was 0.59 (95% confidence interval [CI], 0.44-0.74). The Spearman correlation between the BIS and the Continuum of Depth of Sedation was 0.53 (95% CI, 0.36-0.70). The mean minimum BIS for patients without a complication was 70 (SD, 15.9) compared with 68 (SD, 12.9) for patients with a complication (difference = 2; 95% CI, -7-11).
Our study demonstrated moderate correlation between BIS and the 2 clinical sedation scales. The correlation is not strong enough to be used reliably in a clinical setting. The mean minimum BIS scores were not significantly different for those with sedation complications vs those without complications.
The American journal of emergency medicine 11/2007; 25(8):918-24. · 1.54 Impact Factor
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ABSTRACT: The medical education literature contains few publications about the phenomenon of grade inflation. The authors' clinical clerkship grading scale suffered from apparent inflation relative to the recommended university distribution. The investigators hypothesized that a simple change of the shift grading cards, using explicit criteria, would decrease this grade inflation and aid to redistribute the shift evaluations.
This was a before-and-after study examining medical student shift evaluation grades. Evaluators and students were blinded to the purpose of the card change and were unaware that a study was being conducted. Beginning June 1, 2005, the authors altered the shift evaluation cards from the previous four choices of honors, high pass, pass, or fail to five choices of upper 5%, upper 25%, expected, below expected, or far below expected, and explicit grading criteria were provided. No other interventions to alter the grade distribution occurred. Data were collected on all evaluations from June 1, 2004, to March 31, 2005 (before change), and compared with data on all evaluations from June 1, 2005, to March 31, 2006 (after change).
A total of 3,349 evaluations were analyzed: 1,612 before the card change and 1,737 after the change. The grade distribution before the card change was as follows: honors, 22.6%; high pass, 49.0%; pass, 28.4%; and fail, 0%. This compared with the following ratings after the card change: upper 5%, 9.8%; upper 25%, 41.2%; expected, 46.2%; below expected, 2.8%; and far below expected, 0% (p < 0.001).
A simple change in shift evaluation cards to include more explicit grading criteria resulted in a significant change in grade distribution and greatly decreased grade inflation.
Academic Emergency Medicine 04/2007; 14(3):283-6. · 1.86 Impact Factor
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ABSTRACT: Traumatic brain injury from automobile crashes is a major source of trauma deaths. The investigation of crashes to understand factors of occupant injuries is an established practice. Our objective was to evaluate the association between vehicle G forces (G) sustained on impact and brain injury in motor sports crashes.
We analyzed data regarding Indy Racing League (IRL) car crashes from 1996 to 2003 and compared the likelihood of head injury in those drivers who were in a vehicle that sustained an impact of > or =50 G versus those with a lesser impact. The mean maximal G for those with head injury was compared with those without head injury.
We analyzed 374 crashes. A driver in a crash with an impact of > or =50 G developed a head injury 16.0% (30/188) versus 1.6% (3/186) in those of <50 G (P < 0.001). The mean peak G for those with head injury was 79.6 (SD 28.5) versus 50.6 (SD 28.0) in those with no head injury (P < 0.001).
Findings were that IRL car crashes with peak vehicle G > or = 50 were associated with the development of traumatic brain injuries.
Medicine & Science in Sports & Exercise 03/2006; 38(2):246-9. · 4.43 Impact Factor
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ABSTRACT: The purpose of this study was to examine the performance of the Patient Health Questionnaire (PHQ)-9, a 9-item depression scale, as a screening and diagnostic instrument for assessing depression in stroke survivors.
As part of a randomized treatment trial for poststroke depression (PSD), subjects with and without PSD completed the PHQ-9, a 9-item summed scale, with scores ranging from 0 (no depressive symptoms) to 27 (all symptoms occurring daily). Subjects endorsing 2 or more symptoms of depression were administered the criterion standard Structured Clinical Interview for Depression (SCID). Receiver operating characteristic analysis was used to examine the sensitivity and specificity of the PHQ-9
Of 316 subjects enrolled, 145 met SCID criteria for major depression or other depressive disorder, and 171 were not depressed. PHQ-9 scores discriminated well between subjects with any versus no depressive disorder, with an area under the curve (AUC) of 0.96, as well as between subjects with and without major depression (AUC=0.96). The AUC was similar regardless of patient age, gender, or ethnicity. A PHQ-9 score > or =10 had 91% sensitivity and 89% specificity for major depression, and 78% sensitivity and 96% specificity for any depression diagnosis.
The PHQ-9 performs well as a brief screener for PSD with operating characteristics similar or superior to other depression measures and similar to its characteristics in a primary care population. Moreover, PHQ-9 scores discriminate equally well between those with and without PSD regardless of age, gender, or ethnicity.
Stroke 04/2005; 36(3):635-8. · 5.73 Impact Factor
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ABSTRACT: Previous studies have established that essential information is inconsistently provided during the transfer of extended care facility (ECF) patients to the emergency department (ED). The authors tested the hypothesis that a one-page, standard ECF-to-ED transfer form would change the rate of successful documentation of ECF patient information.
The design was a pre- and postintervention investigation. The setting was the Methodist Hospital ED, an urban teaching facility in Indianapolis, Indiana. The population included consecutive patients transferred from ECFs to the ED. The intervention consisted of the introduction of a one-page, standard ECF-to-ED transfer form that listed 11 data elements that are critical for patient care. The completed form was to be sent with patients transferred to the ED. Successful documentation was defined as the recording of at least nine of 11 data elements.
In the preintervention period, the ED received 130 transfers from 41 ECFs. Sixty-five of 130 transfers were from ten ECFs, which were the targets of the intervention. In the postintervention period, 72 consecutive transfers from ten ECFs were studied. Postintervention, the proportion of transfers with successful documentation was 77.8% (56 of 72), an increase of 19.3% (95% CI = 4.0% to 34.7%) over the preintervention period. In 31.9% (23 of 72) of postintervention ED transfers, the transfer form was transported with the patient. Successful documentation was achieved in 22 (95.6%) of these 23 transfers.
Use of a one-page, standard ECF-to-ED transfer form increased the amount of essential data provided to the ED.
Academic Emergency Medicine 03/2005; 12(2):114-8. · 1.86 Impact Factor
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ABSTRACT: To prospectively quantify the number of unrecognized missed out-of-hospital intubations by ground paramedics using emergency physician verification as the criterion standard for verification of endotracheal tube placement.
The authors performed an observational, prospective study of consecutive intubated patients arriving by ground emergency medical services to two urban teaching hospitals. Endotracheal tube placement was verified by emergency physicians and evaluated by using a combination of direct visualization, esophageal detector device (EDD), colorimetric end-tidal carbon dioxide (ETCO(2)), and physical examination.
During the six-month study period, 208 out-of-hospital intubations by ground paramedics were enrolled, which included 160 (76.9%) medical patients and 48 (23.1%) trauma patients. A total of 12 (5.8%) endotracheal tubes were incorrectly placed outside the trachea. This comprised ten (6.3%) medical patients and two (4.2%) trauma patients. Of the 12 misplaced endotracheal tubes, a verification device (ETCO(2) or EDD) was used in three cases (25%) and not used in nine cases (75%).
The rate of unrecognized, misplaced out-of-hospital intubations in this urban, midwestern setting was 5.8%. This is more consistent with results of prior out-of-hospital studies that used field verification and is discordant with the only other study to exclusively use emergency physician verification performed on arrival to the emergency department.
Academic Emergency Medicine 07/2004; 11(6):707-9. · 1.86 Impact Factor
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ABSTRACT: The objective of this study was to determine the impact of Emergency Medicine (EM) faculty presence on timely thrombolytic therapy for acute myocardial infarction in the Emergency Department (ED). We performed a retrospective study of data regarding acute myocardial infarction patients in the ED of a large urban teaching hospital. Data were collected from January 1, 1998 to December 31, 1999 when EM faculty were not present in the ED and from January 1, 2001 to December 31, 2002 when they were. We compared median time from patient arrival to thrombolytics, percent of patients receiving thrombolytics within 30 min of arrival, and percent of patients with indications for primary revascularization who received it before and after EM faculty presence. The results indicate that EM faculty presence resulted in a decrease in median time from arrival to thrombolytic administration of 17 min (95% CI: 9, 28). Before EM faculty presence, the median time was 44 min as compared to 24 min post-EM faculty presence. Patients received thrombolytic therapy within 30 min 25.8% of the time before EM faculty presence as compared to 65.4% with EM faculty presence; an absolute increase of 39.6% (95% CI: 23.0%, 56.3%). Primary revascularization occurred in 56.9% of eligible patients pre-EM faculty presence and 81.4% post-EM faculty presence; an increase of 24.5% (95% CI: 13.6%, 35.4%). We conclude that the introduction of Emergency Medicine faculty significantly improved the quality of care for acute myocardial infarction patients in a large urban Emergency Department.
Journal of Emergency Medicine 05/2004; 26(3):279-83. · 1.31 Impact Factor
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ABSTRACT: To measure actual emergency medicine (EM) resident interaction time with faculty and to investigate the potential to use direct observation as an assessment tool for the core competencies. By 2006 all EM residencies must implement resident assessment techniques of the six Accreditation Council for Graduate Medical Education core competencies. Emergency medicine educators recommend direct observation as the optimal evaluation tool for patient care, systems-based practice, interpersonal and communication skills, and professionalism. Continuous faculty presence in the emergency department (ED) is widely believed to facilitate direct observation as an assessment technique.
Observational study of EM resident-faculty interaction time during two-hour periods. Study venues included two EDs, two trauma services, inpatient medicine, adult and pediatric intensive care units (ICUs), and a pediatric outpatient clinic. Using a priori definitions, the authors categorized faculty-EM resident interaction time as direct observation of patient care, indirect patient care, or non-patient care activities, and calculated total faculty interaction time. Subjects were blinded to the nature of the study, and data gathering was encrypted.
Two hundred seventy observation periods of two hours each were conducted, sampling 32 EMR1, 33 EMR2-3, 41 EM, and 38 non-EM faculty. The mean total faculty interaction time ranged from a high of 30% (95% CI = 20% to 41%) in the pediatric ICU to a low of 10% (95% CI = 3% to 16%) on internal medicine wards. Overall, EM faculty interaction time was 20% (95% CI = 18% to 22%). Direct observation by faculty ranged from a high of 6% for EMR2-3s in the critical care areas of the ED (95% CI = 3% to 9%) to a low of 1% (95% CI = 0% to 2%) on internal medicine wards. Overall ED direct observation time was 3.6% (95% CI = 2.6% to 4.7%). Emergency department direct observation did not vary within EM resident training level or by ED site. Direct observation varied by treatment area within the EDs, with the critical care areas being substantially higher (6%) than the noncritical care areas (1%).
Faculty direct observation time of EM residents was low in all training venues studied. Direct observation was the highest in ED critical care areas and lowest on medicine ward rotations. Emergency medicine faculty involved simultaneously in routine ED teaching, supervision, and patient care rarely performed direct observation, despite their continuous physical presence. This finding suggests that alternative strategies may be required to assess core competencies through direct observation in the ED.
Academic Emergency Medicine 03/2004; 11(2):149-55. · 1.86 Impact Factor
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ABSTRACT: To determine if droperidol i.v. is as effective as prochlorperazine i.v. in the emergency department (ED) treatment of uncomplicated headache, a randomized, controlled, blinded study was conducted in the Emergency Departments of two urban teaching hospitals. Patients >or= 18 years old with crescendo-onset headache were eligible for inclusion. Ninety-six patients (48 in each group) were randomized to receive droperidol 2.5 mg i.v. or prochlorperazine 10 mg i.v. Baseline characteristics were similar between the two study groups. For the main study outcome, 83.3% in the droperidol group and 72.3% in the prochlorperazine group reported 50% pain reduction at 30 min (p <.01; one-sided test of equivalence). The mean decrease in headache intensity was 79.1% (SD 28.5%) in the droperidol group and 72.1% (SD 28.0%) in the prochlorperazine group (p =.23). It is concluded that droperidol i.v. provided a similar reduction of headache as achieved with prochlorperazine i.v. with a similar incidence of akathisia.
Journal of Emergency Medicine 02/2004; 26(2):145-50. · 1.31 Impact Factor
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ABSTRACT: We conduct a study to determine the rate of adverse events (anaphylactoid and cardiorespiratory) associated with the use of oral N-acetylcysteine by the intravenous route for the treatment of suspected acetaminophen poisoning and to examine specific variables that may be associated with adverse events.
We conducted a retrospective medical record review with explicit criteria. All patients who received oral N-acetylcysteine by the intravenous route from September 1995 to September 2001 were included. Patients were identified by cross-matching 3 databases. Adverse events were divided into categories of cutaneous, systemic, or life threatening. Five reviewers abstracted charts by using a standardized data collection form. Interrater reliability was calculated by using 24 medical records abstracted by all 5 reviewers.
There were 7 adverse events identified in 187 patients (3.7%; 95% confidence interval 1.0% to 6.5%). Six adverse events were cutaneous and responded rapidly to antihistamines. One adverse event was life threatening but not clearly related to N-acetylcysteine. A high rate of antihistamine exposure (53%) was identified before the administration of N-acetylcysteine. Interrater agreement was higher than 95%.
Intravenous administration of an oral solution of N-acetylcysteine is associated with a low rate of adverse events and should be considered for selected patients with suspected acetaminophen poisoning.
Annals of Emergency Medicine 01/2004; 42(6):741-50. · 4.13 Impact Factor
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ABSTRACT: Introduction: Despite being banned as a pesticide, thallium still results in human and animal poisonings. Current recommended treatments include the use of the chemical Prussian Blue. Limitations in its availability may result in Prussian Blue not being obtainable in the thallium-poisoned patient. The chelator 2,3-Dimercaptosuccinic acid (DMSA) is currently FDA-approved for use in childhood lead poisoning and has been reported to be beneficial in treating other heavy metal poisonings. The objective of this study was to determine the efficacy of DMSA as a treatment for thallium poisoning by studying mortality and whole-brain concentrations in thallium poisoned rats. Material and Methods: Rats were gavaged with 30 mg/kg of thallium. After 24 hours they were randomized to DMSA (n=20) 50 mg/kg twice daily for 5 days, Prussian Blue (n=20) 50 mg/kg twice daily for 5 days, or control (n=30). Animals were monitored twice daily for weight loss and mortality. Animals losing greater than 20% of their starting weight were euthanized and counted as a mortality. All surviving rats at 120 hours had their brains harvested and digested and underwent subsequent thallium analysis. Results: The rate of survival in DMSA-treated animals compared to control was 45% vs. 21%, p=0.07. Mean whole-brain thallium concentrations between DMSA and control rats were 3.4 vs. 3.0 μg/g, p=0.06. Prussian Blue–treated rats had significantly improved survival (70% vs. 21%, p<0.01) and lower whole-brain thallium concentrations (1.6 vs. 3.0 μg/g, p<0.01 tissue) compared to controls. Conclusion: DMSA failed to reduce brain thallium concentrations in rats poisoned with thallium and had an indeterminate effect on mortality while Prussian Blue significantly reduces both brain thallium concentrations and mortality.
09/2003; 41(2):137-142.
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ABSTRACT: We determine whether buffering ocular tetracaine hydrochloride reduces the pain of instillation.
We conducted a prospective, randomized, double-blind, 2-treatment, 2-period crossover, single center study of healthy volunteers 18 years of age or older. Participants were randomized to receive either 2 drops of buffered or plain tetracaine in a randomly assigned eye. After a mean wash out period of 24 days (range 7 to 54 days), participants returned to have 2 drops of the other medication instilled in the same eye. The participants recorded the pain of instillation on a 100-mm visual analog scale (VAS) immediately and 5 minutes after instillation. Adverse events were also recorded at these intervals. The primary outcome measure was the intensity of pain as measured on a VAS immediately after instillation.
Sixty persons were enrolled in the study, with 100% follow up. Immediately after instillation, the adjusted mean VAS score for buffered tetracaine was 29.1 mm, and the adjusted mean VAS score for plain tetracaine was 16.0 mm. The estimated difference was 13.1 mm (95% confidence interval 6.9 to 19.3 mm).
Buffering of tetracaine hydrochloride significantly increases the pain of its instillation in healthy volunteers, suggesting that pain with instillation of ocular anesthetics is not dependent on low pH.
Annals of Emergency Medicine 07/2003; 41(6):827-31. · 4.13 Impact Factor
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ABSTRACT: Hyperbaric oxygen therapy (HBO) has promise as a treatment for acute stroke. This study was conducted to evaluate the efficacy, safety, and feasibility of using HBO in acute ischemic stroke.
We conducted a randomized, prospective, double-blind, sham-controlled pilot study of 33 patients presenting with acute ischemic stroke who did not receive thrombolytics over a 24-month period. Patients were randomized to treatment for 60 minutes in a monoplace hyperbaric chamber pressurized with 100% O2 to 2.5-atm absolute (ATA) in the HBO group or 1.14 ATA in the sham group. Primary outcomes measured included percentage of patients with improvement at 24 hours (National Institutes of Health Stroke Scale [NIHSS]) and 90 days (NIHSS, Barthel Index, modified Rankin Scale, Glasgow Outcome Scale). Secondary measurements included complications of treatment and mortality at 90 days.
Baseline demographics were similar in both groups. There were no differences between the groups at 24 hours (P=0.44). At 3 months, however, a larger percentage of the sham patients had a good outcome defined by their stroke scores compared with the HBO group (NIHSS, 80% versus 31.3%; P=0.04; Barthel Index, 81.8% versus 50%; P=0.12; modified Rankin Scale, 81.8% versus 31.3%; P=0.02; Glasgow Outcome Scale, 90.9% versus 37.5%; P=0.01) with loss of statistical significance in a intent-to-treat analysis.
Although our HBO protocol appears feasible and safe, it does not appear to be beneficial and may be harmful in patients with acute ischemic stroke.
Stroke 03/2003; 34(2):571-4. · 5.73 Impact Factor
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ABSTRACT: The purposes of this study were to evaluate the bladder-anal reflex (BAR) latency in asymptomatic women and determine the pathway of the reflex using selective anesthesia and neuromuscular block.
Urinary incontinence, voiding dysfunction, and pelvic organ prolapse are common problems in women. Evaluation of pelvic nerve function often augments the clinical assessment of these women. Urethral-anal and clitoral-anal reflex testing have been reported as methodologies to assess patients with neurogenic disorders. A bladder-anal reflex is also obtainable but has not been reported previously in the literature. Twenty-two subjects and two patients were recruited for evaluation of the BAR.
This study has allowed us to estimate reference ranges for BAR latency and threshold. We defined the upper limit of these reference ranges as two standard deviations above their respective means. For the BAR latency, the upper limit of the reference range is 91 msec. Any latency value above this limit should be considered abnormal. The upper limit for the BAR threshold reference range is 37.7 mA. Lower thresholds are not thought to be clinically meaningful due to the presence of several low sensory thresholds in this asymptomatic normal population.
The BAR was obtainable in asymptomatic women and compatible with known anatomy and innervation of the lower urinary tract.
Neurourology and Urodynamics 02/2003; 22(7):683-6. · 2.96 Impact Factor
