http://hdl.handle.net/2027.42/78363 2013-05-24T08:43:41Z http://hdl.handle.net/2027.42/78141 Bacterial Pneumonias during an Influenza Pandemic: How Will We Allocate Antibiotics? Cinti, Sandro K.; Barnosky, Andrew R.; Gay, Steven E.; Goold, Susan Dorr; Lozon, Marie M.; Kim, Kristin; Rodgers, Phillip E.; Baum, Nancy M.; Cadwallender, Bruce A.; Collins, Curtis D.; Wright, Carrie M.; Winfield, Robert A. We are currently in the midst of the 2009 H1N1 pandemic, and a second wave of flu in the fall and winter could lead to more hospitalizations for pneumonia. Recent pathologic and historic data from the 1918 influenza pandemic confirms that many, if not most, of the deaths in that pandemic were a result of secondary bacterial pneumonias. This means that a second wave of 2009 H1N1 pandemic influenza could result in a widespread shortage of antibiotics, making these medications a scarce resource. Recently, our University of Michigan Health System (UMHS) Scarce Resource Allocation Committee (SRAC) added antibiotics to a list of resources (including ventilators, antivirals, vaccines) that might become scarce during an influenza pandemic. In this article, we summarize the data on bacterial pneumonias during the 1918 influenza pandemic, discuss the possible impact of a pandemic on the University of Michigan Health System, and summarize our committee's guiding principles for allocating antibiotics during a pandemic. 2009-09-01T00:00:00Z http://hdl.handle.net/2027.42/75653 A Comparison of Data Sources for Motor Vehicle Crash Characteristic Accuracy Grant, Robert J.; Gregor, Mary Ann; Beck, Paul W.; Maio, Ronald F. Objective: To determine the accuracy of police reports (PRs), ambulance reports (ARs), and emergency department records (EDRs) in describing motor vehicle crash (MVC) characteristics when compared with an investigation performed by an experienced crash investigator trained in impact biomechanics. Methods: This was a cross-sectional, observational study. Ninety-one patients transported by ambulance to a university emergency department (ED) directly from the scene of an MVC from August 1997 to April 1998 were enrolled. Potential patients were identified from the ED log and consent was obtained to investigate the crash vehicle. Data describing MVC characteristics were abstracted from the PR, AR, and medical record. Variables of interest included restraint use (RU), air bag deployment (AD), and type of impact (TI). Agreements between the variables and the independent crash investigation were compared using kappa. Interrater reliability was determined using kappa by comparing a random sample of 20 abstracted reports for each data source with the originally abstracted data. Results: Agreement using kappa between the crash investigation and each data source was 0.588 (95% CI = 0.508 to 0.667) for the PR, 0.330 (95% CI = 0.252 to 0.407) for the AR, and 0.492 (95% CI = 0.413 to 0.572) for the EDR. Variable agreement was 0.239 (95% CI = 0.164 to 0.314) for RU, 0.350 (95% CI = 0.268 to 0.432) for AD, and 0.631 (95%= 0.563 to 0.698) for TI. Interrater reliability was excellent (kappa > 0.8) for all data sources. Conclusions: The strength of the agreement between the independent crash investigation and the data sources that were measured by kappa was fair to moderate, indicating inaccuracies. This presents ramifications for researchers and necessitates consideration of the validity and accuracy of crash characteristics contained in these data sources. 2000-08-01T00:00:00Z http://hdl.handle.net/2027.42/75492 Noninvasive Ventilation Outcomes in 2,430 Acute Decompensated Heart Failure Patients: An ADHERE Registry Analysis Tallman, Thomas A.; Peacock, W. Frank; Emerman, Charles L.; Lopatin, Margarita; Blicker, Jamie Z.; Weber, James; Yancy, Clyde W. 2008-04-01T00:00:00Z http://hdl.handle.net/2027.42/75409 Lack of Agreement in Pediatric Emergency Department Discharge Diagnoses from Clinical and Administrative Data Sources Gorelick, Marc H.; Knight, Stacey; Alessandrini, Evaline A.; Stanley, Rachel M.; Chamberlain, James M.; Kuppermann, Nathan; Alpern, Elizabeth R. 2007-07-01T00:00:00Z