Prevalence of Painful Lesions of the Digits and Risk Factors Associated with Digital Dermatitis, Ulcers and White Line Disease on Swiss Cattle Farms.

The first aim of this study was to calculate the prevalence of painful lesions of the digits ("alarm" lesions; ALs) in Swiss dairy herds and cow-calf operations over a three-year study period. The following ALs were included in the calculation: the M2 stage of digital dermatitis (DD M2), ulcers (U), white line fissures (WLF) of moderate and high severity, white line abscesses (WLA), interdigital phlegmon (IP) and swelling of the coronet and/or bulb (SW). Between February 2020 and February 2023, digit disorders were electronically recorded during routine trimmings by 40 specially trained hoof trimmers on Swiss cattle farms participating in the national claw health programme. The data set used consisted of over 35,000 observations from almost 25,000 cows from 702 herds. While at the herd-level, the predominant AL documented in 2022 was U with 50.3% followed by WLF with 38.1%, at the cow-level, in 2022, it was DD M2 with 5.4% followed by U with 3.7%. During the study period, within-herd prevalences of ALs ranged from 0.0% to a maximum of 66.1% in 2020. The second aim of this study was to determine herd- and cow-level risk factors associated with digital dermatitis (DD), U and white line disease (WL) in dairy cows using data from 2022. While for DD, analysed herd-level factors appeared to have a greater effect on the probability of its occurrence, the presence of U and WL was mainly associated with the analysed cow-level factors. The risk for DD increased with a higher herd trimming frequency. Herds kept in tie stalls had a lower risk for DD and WL and a higher risk for U compared to herds kept in loose housing systems. Herds with predominantly Holstein Friesian cows as well as Holstein Friesian cows had a higher risk for the occurrence of DD compared to herds and cows of other breeds. With increasing parity, cows had a higher risk of developing U and WL, whereas for DD, parity was negatively associated with prevalence. Cows trimmed during the grazing period had a higher risk of U and WL than cows trimmed during the housing period. These findings may contribute to improve management measures affecting the health of the digits in farms with structures similar to those evaluated in the current study, such as small herds with frequent access to pasture. Further research is warranted to demonstrate how measures addressing the current results combined with those of individual herd risk assessments might contribute to an improvement in the health of the digits in the respective dairy herds.

Farm-level risk factors for digital dermatitis in dairy cows in mountainous regions.

Reduction of risk factors for bovine digital dermatitis (BDD) is crucial in current disease control. However, risk factors that might arise especially in mountainous regions are unknown until now, and an adapted BDD control program is consequently missing. The objective of this observational case-control study was to identify farm-level risk factors for BDD in dairy herds in mountainous regions. To investigate predictors for the occurrence of BDD, 100 farms were visited and information about herd characteristics and management practices, potentially relevant explanatory variables for either introduction or establishment of BDD, were gathered by completing a questionnaire with the farmer or herd manager. Within-herd prevalences of BDD assessed during 3 routine claw trimmings with an interval of 6 mo before the survey were used to define cases (BDD within-herd prevalence of ≥26% during each claw trimming) and controls (no BDD cases in each of the 3 routine claw trimmings before the survey). Data were analyzed using 2 separate binomial generalized linear models according to either establishment or introduction of BDD. After prescreening, 15 of 23 explanatory variables were included in the final analysis, which showed 3 variables related to introduction and establishment, each being significantly associated with the occurrence of BDD within a farm. Results of model 1 (i.e., aspects related to BDD introduction) revealed that access to mountain pastures during the summer season (odds ratio, 95% confidence interval: 0.12, 0.04-0.35), participation in dairy shows (0.32, 0.11-0.94), and the number of new animals introduced into the farm during the last 2 yr (1.28, 1.12-1.52) were significantly associated with the occurrence of BDD. Model 2 (i.e., aspects related to BDD establishment) showed that cows kept in freestalls were at higher risk for BDD compared with those kept in tiestalls (20.65, 1.59-649.37). Furthermore, number of days between diagnosis and treatment of a BDD lesion (10.31, 3.55-81.21) and the amount of concentrate feeding (median 5 kg) per cow and day (7.72, 2.46-6.47) were positively associated with BDD occurrence. In conclusion, the findings of this study provide a set of risk factors that are associated with BDD status within herds in mountainous regions. These results may help in development of adapted control programs for BDD in dairy cows.

"Non-healing" claw horn lesions in dairy cows: Clinical, histopathological and molecular biological characterization of four cases.

The increasing prevalence of bovine digital dermatitis (BDD) contributes to a higher occurrence of secondary infections of exposed corium with Treponema spp. in bovine claws. "Non-healing" claw horn lesions (NHL) clinically resemble BDD lesions. They are severe, cause chronic lameness, and may persist for several months. They poorly respond to standard treatments of BDD and represent a serious welfare issue. In this study, four cases of NHL were classified clinically either as BDD-associated axial horn fissures (BDD-HFA; n = 3) or BDD-associated sole ulcer (BDD-SU; n = 1). In all four cases, pronounced multifocal keratinolysis of the stratum corneum, ulceration, and severe chronic lymphoplasmacytic perivascular to interstitial dermatitis were observed. All lesional samples tested positive for Treponema spp., Fusobacterium (F.) necrophorum, and Porphyromonas (P.) levii by PCRs. BDD-HFA lesions contained Treponema pedis as revealed by genetic identities of 93, 99, and 100%. Treponemes in the BDD-SU lesion were 94% homologous to Treponema phylotype PT3. Fluorescent in situ hybridization (FISH) revealed extensive epidermal infiltration by treponemes that made up > 90% of the total bacterial population in all four lesions. FISH also tested positive for P. levii and negative for F. necrophorum in all four cases, whilst only one BDD-HFA contained Dichelobacter nodosus. Our data point to BDD-associated treponemes and P. levii constituting potential etiological agents in the development of "non-healing" claw horn lesions in cattle.

Incubation characteristics, growth performance, carcass characteristics and meat quality of Saxonian Chicken and German Langshan bantam breeds in a free-range rearing system.

BACKGROUND/INTRODUCTION: In the absence of evidence-based findings for Saxonian Chicken (SaChi) and German Langshan bantam (GLB), which are indigenous endangered German fancy chicken breeds, the objective of the present study was to characterise their growth performance and meat potential in an extensive free-range system METHODS: A total of 340 hatching eggs from SaChi and 439 eggs from GLB were provided by private breeders, from which 263 SaChi (77.3%) and 174 GLB (39.6%) hatched (p < 0.001) RESULTS: By week 20, SaChi reached body weights of 2362.3 ± 315.3 g (mean ± SD; roosters) and 1624.7 ± 158.9 g (hens), while GLB weighed 1089.7 ± 148.3 g (roosters) and 820.4 ± 89.5 g (hens). Fitting the non-linear regression of growth data to the Gompertz function estimated asymptotic body weights of 3131.4, 2363.9, 1359.2 and 1107.3 g, with inflection point times of 10.5, 10.3, 9.2 and 9.3 weeks in male SaChi, female SaChi, male GLB and female GLB, respectively. Moderate plumage damage was observed on days 18, 35, 53, 70 and 105 in SaChi and on days 53, 70 and 105 in GLB, while all birds presented completely intact plumage on day 140. Using a binary logistic regression model, breed, age and sex were shown to affect the plumage condition (p < 0.001 each). Roosters were slaughtered in week 20. No breed effects were detected in the carcass yield (SaChi: 68.8 ± 1.7%, GLB: 69.7 ± 1.8%) (p = 0.135) or abdominal fat share (SaChi: 0.89 ± 0.15%, GLB: 1.08 ± 0.14%) (p = 0.281). The percentage of valuable cuts (breast fillets and legs) in the carcass was 43.8 ± 1.9% for SaChi and 43.1 ± 3.0% for GLB (p = 0.490) DISCUSSION/CONCLUSIONS: In conclusion, this study provides insights into the performance traits and welfare indicators during the rearing of two endangered German chicken breeds.

Avian leukosis virus (ALV) is highly prevalent in fancy-chicken flocks in Saxony.

The current prevalence of avian leukosis virus (ALV) in fancy chickens in Germany is unknown. Therefore, 537 cloacal swabs from 50 purebred fancy-chicken flocks in Saxony were tested for the presence of the ALV p27 protein using a commercial antigen-capture ELISA. The detection rate was 28.7% at the individual-animal level and 56.0% at the flock level. Phylogenetic analysis of PCR products obtained from 22 different flocks revealed the highest similarity to ALV subtype K. When classifying breeds by their origin, ALV detection rates differed significantly. Evaluation of questionnaire data revealed no significant differences between ALV-positive and negative flocks regarding mortality.

Effects of Selective Dry Cow Treatment on Intramammary Infection Risk after Calving, Cure Risk during the Dry Period, and Antibiotic Use at Drying-Off: A Systematic Review and Meta-Analysis of Current Literature (2000-2021).

The objectives of this paper were (i) to perform a systematic review of the literature over the last 21 yr and (ii) to evaluate the efficacy of selective dry cow treatment (SDCT) vs. blanket dry cow treatment (BDCT) in dairy cows regarding the risk of intramammary infection (IMI) after calving, new IMI risk after calving, cure risk during the dry period, and a reduction in antibiotic use at drying-off by meta-analysis. The systematic search was carried out using the databases PubMed, CAB Direct, and ScienceDirect. A meta-analytical assessment was performed for each outcome of interest using random-effects models, and the relative risk (RR) for IMI and cure or the pooled proportion for antibiotic use was calculated. The final number of included studies was n = 3 for IMI risk after calving and n = 5 for new IMI risk after calving, cure risk during the dry period, and antibiotic use. The RR levels for IMI (RR, 95% confidence interval [CI]: 1.02, 0.94-1.11; p = 0.592), new IMI (RR, 95% CI: 1.06, 0.94-1.20; p = 0.994), and cure (RR, 95% CI: 1.00, 0.97-1.02; p = 0.661) did not differ significantly between SDCT and BDCT. Substantial heterogeneity was observed between the trials regarding the pooled proportion of antibiotic use within the SDCT groups (I2 = 97.7%; p < 0.001). This meta-analysis provides evidence that SDCT seems to be an adequate alternative to BDCT regarding udder health with a simultaneous reduction in antibiotic use. Limitations might arise because of the small number of studies included.

Effects of calcium supplementation, incomplete milking, and vitamin D3 injection on serum total calcium concentration during the first 24 hours after parturition in dairy cows fed an anionic diet during late gestation.

OBJECTIVE: To evaluate various strategies for prevention of subclinical hypocalcemia (SH) during the first 24 hours after parturition in dairy cows. ANIMALS: 165 multiparous German Holstein cows from 1 herd. PROCEDURES: All cows were fed a ration with a moderate dietary cation-anion difference (approx 0 mEq/100 g of dry matter; anionic diet) for the last 2 to 3 weeks of gestation. In the first part of a 2-part study, cows were randomly assigned to 1 of 4 treatment groups (no calcium supplementation [n = 30], oral administration of a calcium bolus alone [34] or in combination with IV administration of 500 mL of a calcium solution [34] or incomplete milking during the first 24 hours after parturition [34]). In part 2, cows in their fifth or greater parity were randomly assigned to receive vitamin D3 (20,000 U/kg, IM; n = 15) 7 days before the predicted calving date or a control group (18). A calcium bolus was orally administered within 30 minutes after parturition to all cows of part 2. Serum total calcium (Cat) concentration was measured immediately after parturition and every 2 hours thereafter for 24 hours and compared among treatment groups. Subclinical hypocalcemia was defined as a Cat concentration < 2.00 mmol/L. RESULTS: In part 1, the mean ± SD Cat concentration during the 24 hours after parturition for the IV-treated group (2.28 ± 0.42 mmol/L) was greater than that for the other 3 groups, each of which had a mean Cat concentration < 2.00 mmol/L. In part 2, the mean Cat concentration for the vitamin D3-treated cows was greater than that for control cows and remained above 2.00 mmol/L for the duration of the observation period. CONCLUSIONS AND CLINICAL RELEVANCE: Intramuscular administration of vitamin D3 or IV administration of a calcium solution in combination with oral administration of a calcium bolus might alleviate SH during the first 24 hours after parturition in dairy cows fed an anionic diet during late gestation.

[Chronic oversupply with copper as a potential herd health problem on a German dairy farm - Diagnostic value of different sample types for assessment of copper supply in dairy cows]. / Chronische Kupferüberversorgung als mögliches Bestandsproblem in einer deutschen Milchviehherde.

In contrast to sheep, chronic copper oversupply or toxicity represent infrequent events in cattle. This case report describes a chronically elevated exposure to copper arising from excessive supplementation of mineral feedstuff leading to a herd health problem in a German Holstein dairy herd. For diagnosis on herd level, 10 cows of both the close-up (VB) and high-yielding (HL) groups were selected and blood as well as urine samples were collected. Clinical chemistry investigation of these samples only revealed slightly raised activities of liver enzymes in cows of the HL group. Analysis of the total mixed ration (TMR) of both groups revealed a significant oversupply with copper, zinc, cobalt, and selenium. On the basis of these findings, the copper content of urine, feces, pigmented hair as well as plasma ceruloplasmin activity were measured additionally. Liver biopsies were performed in cows of the HL group and in heifers, the latter of which had received a mineral feed for young cattle according to the manufacturer's instructions. Results indicated increased fecal copper in both HL and VB groups as well as above normal or high-normal values of hepatic copper and cobalt resp. selenium, zinc, and manganese in the HL cows. In contrast, heifers had physiological amounts of trace elements in their liver tissues. This report demonstrates the suitability of fecal analysis and TMR for a reliable assessment of copper supply, while blood, urine, and hair failed to represent appropriate sample types. In order to attain a dependable diagnosis of potential copper oversupply, a liver biopsy - which may also be performed in buiatric practice - is deemed necessary.

Clinical Chemistry Investigations in Recumbent and Healthy German Holstein Cows After the Fifth Day in Milk.

INTRODUCTION: Recumbency is a frequent symptom occurring throughout lactation. Its cause can be related to the energy or mineral metabolism, or to trauma or infectious diseases. We compared various clinical chemistry parameters between healthy and recumbent cows and between cows with different causes of recumbency and determined if hypocalcaemia manifests in later lactation. MATERIAL AND METHODS: Recumbent (n = 32) and healthy (n = 32) German Holstein cows were studied. After clinical examination, a serum sample was taken to measure the concentrations of Mg, Ca, Fe, Na, K, Pi, ß-hydroxybutyrate, total bilirubin, non-esterified fatty acids (NEFA), urea, and creatinine as well as activities of alkaline phosphatase, aspartate aminotransferase (AST), creatine kinase (CK), and γ-glutamyl transferase in recumbent cows > 5 d in milk and control cows matched for age, lactation number, and pregnancy stage. RESULTS: In recumbent cows, mean serum concentrations of NEFA, bilirubin, and CK were statistically higher, while those of Fe, K, and Pi were significantly lower. Parameters compared between different recumbency diagnoses showed some descriptive Fe, K, urea, and AST differences, but these were not statistically significant. CONCLUSION: The results show that only a limited number of parameters have diagnostic besides therapeutic value. Although of minor importance in our study, hypocalcaemia should be considered a cause of recumbency, even outside the typical risk period of parturient paresis.

Comparison of the therapeutic efficacy of salicylic acid paste with a polyurethane wound dressing for the treatment of digital dermatitis lesions in dairy cows.

There is little evidence of the efficacy of artificial polymers for controlling bovine digital dermatitis (BDD) as a major problem of intensive dairy productions worldwide. We therefore aimed to compare salicylic acid (SA)-based paste with a polyurethane (PU) wound dressing on a German Holstein dairy farm over a maximum 56-d period. On d 0, 109 ft with active BDD lesions from 109 cows were randomly assigned to two treatment groups: (1) SA group received a topical SA-containing paste and (2) PU group was treated with a PU wound dressing. Dressing changes were performed according to manufacturer's instructions until clinical cure (transition from active M1 or M2 to non-active M4 or healed M0 stages), whereby a clinical scoring of lesions was additionally conducted. Data from 100 ft could be analyzed (nSA = 54; nPU = 46). There was a significant reduction of the lesion score over time within each group (SA: d 0-d 14; PU: d 0-d 28, p < .05). Score differences between first (d 0) and second (SA: d 7; PU: d 14) as well as between first and third (SA: d 14; PU: d 28) evaluation did not differ significantly (p > .05). The proportion of clinically cured cows was higher in SA than in PU on d 14 (96.3 vs. 32.6%) as well as on d 28 (100 vs. 54.3%) after initial treatment (p < .05). Analysis of survival to cure in a Cox regression model showed that hazard ratio (HR) was higher for SA with PU as baseline (HR: 6.324, 95% CI: 3.625-11.033, p < .05). However, while BDD scores at enrollment did not differ between treatments (p > .05), PU had a significantly lower final BDD score (p < .05). In conclusion, evidence on the efficacy of PU bandages to treat BDD lesions is provided and further studies on bacteriological cure as well as recurrence rates are needed.

Detection of Coxiella burnetii DNA and anti-Coxiella burnetii IgG antibodies in precolostral blood samples of stillborn calves in an endemically infected Holstein dairy herd.

Coxiella burnetii (C. burnetii), an intracellular zoonotic bacterium causing Q fever, occurs widely in cattle herds. After invasion of the pregnant uterus and initial localization in the placenta, active C. burnetii infections may spread to the fetus hematogenously or by the amniotic-oral route and thus may cause abortion, premature delivery, stillbirth, and weak offspring (APSW) complex. In a case-control study, we investigated precolostral blood samples of 56 stillborn calves and 30 live births from a dairy herd endemically infected with C. burnetii "C-cluster" strains and an increased stillbirth rate in primiparous cows. Within the group of the stillborn calves, four precolostral blood samples (7.1%) were tested positive for C. burnetii DNA by PCR and one serum sample (1.8%) positive for anti-C. burnetii IgG antibodies by a commercial ELISA test, respectively. Neither C. burnetii DNA nor anti-C. burnetii IgG antibodies were detected in the samples of calves being born alive. In conclusion, we demonstrated that coxiellaemia and precolostral seroconversion occurred sporadically in stillborn calves from this endemically infected herd. Due to the low detection rates, C. burnetii could not be confirmed to be the cause of the increased stillbirth rate.

A rare case of monozygotic iniodymic diprosopiasis in a German Holstein calf.

Craniofacial duplication abnormity is a rare phenomenon in buiatric practice. This report attends to a male German Holstein calf which could be classified as a diprosopic iniodymus. A fetus exhibiting a doubled face was delivered after fetotomy. To our knowledge, this is the first description of diprosopiasis with two cranial cavities as well as two separate encephala in a calf showing the potential extent of duplication. Throughout this work also the question is answered of whether this malformation in a bovine species arose from one embryo or rather, there is a dizygotic background by genotyping of tissue samples from both parts of the diprosopus. Regarding etiology, not only hereditary dispositions including among others a failed function of the signaling molecule Sonic hedgehog mediating regulation of craniofacial morphogenesis, but also incompletely separated monozygotic twins are discussed.

The association between money and opinion in academic emergency medicine.

OBJECTIVES: Financial conflicts of interest have come under increasing scrutiny in medicine, but their impact has not been quantified. Our objective was to use the results of a national survey of academic emergency medicine (EM) faculty to determine if an association between money and personal opinion exists. METHODS: We conducted a web-based survey of EM faculty. Opinion questions were analyzed with regard to whether the respondent had either 1) received research grant money or 2) received money from industry as a speaker, consultant, or advisor. Responses were unweighted, and tests of differences in proportions were made using Chi-squared tests, with p<0.05 set for significance. RESULTS: We received responses from 430 members; 98 (23%) received research grants from industry, while 145 (34%) reported fee-for-service money. Respondents with research money were more likely to be comfortable accepting gifts (40% vs. 29%) and acting as paid consultants (50% vs. 37%). They had a more favorable attitude with regard to societal interactions with industry and felt that industry-sponsored lectures could be fair and unbiased (52% vs. 29%). Faculty with fee-for-service money mirrored those with research money. They were also more likely to believe that industry-sponsored research produces fair and unbiased results (61% vs. 45%) and less likely to believe that honoraria biased speakers (49% vs. 69%). CONCLUSION: Accepting money for either service or research identified a distinct population defined by their opinions. Faculty engaged in industry-sponsored research benefitted socially (collaborations), academically (publications), and financially from the relationship.

A review of the federal guidelines that inform and influence relationships between physicians and industry.

The effective delivery and continued advancement of health care is critically dependent on the relationship between physicians and industry. The private sector accounts for 60% of the funding for clinical research and more than 50% of the funding sources for physician education. The nature of the physician-industry relationship and the role of the physician as a gatekeeper for health care make this association vulnerable to abuse if certain safeguards are not observed. This article will review the current federal guidelines that affect the physician-industry relationship and highlight several illustrative cases to show how the potential for abuse can subvert this relationship. The recommendations and "safe harbors" that have been designed to guide business relationships in health care are discussed.

One-year medical outcomes and emergency department recidivism after emergency department observation for cocaine-associated chest pain.

STUDY OBJECTIVE: Chest pain is the most common complaint among cocaine users who present to the emergency department (ED) seeking care, and many hospital resources are applied to stratify cocaine users in regard to future cardiac morbidity and mortality. Little is known about the longitudinal cardiac and noncardiac medical outcomes of cocaine users who have been stratified to an ED observation period after their ED visit. We examine 1-year cardiac outcomes in a low- to intermediate-risk sample of patients with cocaine-associated chest pain in an urban ED, as well as examine ED recidivism at 1 year for cardiac and noncardiac complaints. METHODS: Prospective consecutive cohort study of patients (18 to 60 years) who presented to an urban Level I ED with cocaine-associated chest pain and were risk stratified to low to intermediate cardiac risk. Exclusion criteria were ECG suggestive of acute myocardial infarction, increased serum cardiac markers, history of acute myocardial infarction or coronary artery bypass graft, hemodynamic instability, or unstable angina. Baseline interviews using validated measures of health functioning and substance use were conducted during chest pain observation unit stay and at 3, 6, and 12 months. ED utilization during the study year was abstracted from the medical chart. Zero-inflated Poisson regression analyses were conducted to predict recurrent ED visits. RESULTS: Two hundred nineteen participants (73%) were enrolled, 65% returned to the ED post-index visit, and 23% returned for chest pain; of these, 66% had a positive cocaine urine screening result. No patient had an acute myocardial infarction within the 1-year follow-up period. Patients with continued cocaine use were more likely to have a recurrent ED visit (P<.001), but these repeated visits were most often related to musculoskeletal pain (21%) and injury (30%), rather than potential cardiac complaints. CONCLUSION: Patients with cocaine-associated chest pain who have low to intermediate cardiac risk and complete a chest pain observation unit protocol have a less than 1% rate of myocardial infarction in the subsequent 12 months.

Illicit stimulant use in a United States heart failure population presenting to the emergency department (from the Acute Decompensated Heart Failure National Registry Emergency Module).

Illicit stimulant drug use may have a profound clinical impact in acute decompensated heart failure (ADHF). The chronic use of cocaine and methamphetamine may lead to overt cardiomyopathy and ADHF. The Acute Decompensated Heart Failure National Registry Emergency Module (ADHERE-EM) collected data on patients presenting to emergency departments with ADHF at 83 geographically dispersed hospitals in the United States. This registry was queried to determine the rate of self-reported illicit drug use in emergency department patients presenting with ADHF and compare these patients with those without illicit drug use. The registry enrolled 11,258 patients with ADHF with drug use data from January 2004 to March 2006. Of these patients, 594 (5.3%) self-reported current or past stimulant drug use. Compared with nonusers, these patients were more likely to be younger (median age 49.7 vs 76.1 years), to be African American (odds ratio 11.9, 95% confidence interval 9.8 to 14.4), and to have left ventricular ejection fractions <40% (odds ratio 3.4, 95% confidence interval 2.8 to 4.2). Admitted users had no difference in mortality (adjusted odds ratio 0.83, 95% confidence interval 0.25 to 2.72) compared with nonusers. In conclusion, data from ADHERE-EM suggest that a clinically important percentage of patients with ADHF report the use of illicit stimulant drugs. Although these patients are younger with a greater degree of LV dysfunction, they did not have greater risk-adjusted mortality.

Risk stratification in women enrolled in the Acute Decompensated Heart Failure National Registry Emergency Module (ADHERE-EM).

OBJECTIVES: It has been reported that the mortality risk for heart failure differs between men and women. It has been postulated that this is due to differences in comorbid features. Variation in risk profiles by gender may limit the performance of stratification algorithms available for heart failure in women. This analysis examined the ability of a published risk stratification model to predict outcomes in women. METHODS: The Acute Decompensated Heart Failure National Registry Emergency Module (ADHERE-EM) database was used. Characteristics, treatments, and outcomes for men and women were compared. The ADHERE registry classification and regression tree (CART) analysis was used for the risk stratification evaluation. RESULTS: Of 10,984 ADHERE-EM patients, 5,736 (52.2%) were women. In-hospital mortality was similar between men and women (p = 0.727). Significant differences (p < 0.0002) were noted by gender in all three variables in the CART model (blood urea nitrogen [BUN] > or = 43 mg/dL, systolic blood pressure < 115 mm Hg, and serum creatinine > or = 2.75 mg/dL). However, the CART model effectively stratified both genders into distinct risk groups with no significant difference in mortality by gender within stratified groups. CONCLUSIONS: The ADHERE Registry CART tool is effective at predicting risk in ED patients, regardless of gender.

Management of ST-segment elevation myocardial infarction in EDs.

Emergency department (ED) physicians are critical in the accurate diagnosis, efficient management, and treatment of patients with ST-segment elevation myocardial infarction. The initial reperfusion strategy involves the choice between mechanical reperfusion using primary percutaneous coronary intervention and pharmacologic treatment with fibrinolytics. The benefits of these approaches are time dependent, and practices vary according to institutional resources and local guidelines. Nevertheless, the need for early intervention and the use of certain therapies are well recognized. Therefore, ED physicians must be aware of all treatment options available, including the use of adjunctive therapies. Initial treatment should include beta-blockers, aspirin (or clopidogrel if aspirin is contraindicated), nitroglycerin, and analgesia, regardless of reperfusion strategy. Clopidogrel is now approved as an adjunctive therapy for patients undergoing fibrinolysis as their reperfusion therapy. Both unfractionated heparin and low-molecular-weight heparin are feasible adjunctives in patients with ST-segment elevation myocardial infarction undergoing reperfusion therapy. In addition, multiple new antithrombin agents are being investigated. The choice adjunctive treatments should be based on specific patient populations and on the initial reperfusion strategy.

Academic emergency medicine faculty and industry relationships.

OBJECTIVES: The authors surveyed the membership of the Society for Academic Emergency Medicine (SAEM) about their associations with industry and predictors of those associations. METHODS: A national Web-based survey inviting faculty from the active member list of SAEM was conducted. Follow-up requests for participation were sent weekly for 3 weeks. Information was collected on respondents' personal and practice characteristics, industry interactions, and personal opinions regarding these interactions. Raw response rates were reported and a logistic regression was used to generate descriptive statistics. RESULTS: Responses were received from 430 members, representing 14% of the 3,183 active members. Respondents were 83% male and 86% white, with 96% holding an MD degree (24% with an additional postdoctoral degree). Most were at the assistant (37%) or associate (25%) professor rank, with 51% holding at least one leadership position. Most respondents (82%) reported some type of industry interaction, most commonly the acceptance of food or beverages (67%). Respondents at the associate professor rank or higher were more likely to receive payments from industry (51% vs. 22%, odds ratio [OR] = 3.7). CONCLUSIONS: This survey suggests that interactions between industry and academic EM faculty are common and increase with academic rank, but not with years in practice or leadership influence. The number and type of interactions are consistent with those reported by a national sampling of other physician specialties.