• Mark DG, Vinson DR. Low-risk chest pain in the emergency department: Should we be focusing on better follow-up instead of accelerated testing? JAMA Intern Med. 2014;174(6):1009-1010.  Excerpt

• Tricomi AJ, Magid DJ, Rumsfeld JS, Vinson DR, et al. Missed opportunities for reperfusion therapy for ST-segment elevation myocardial infarction:  results of the Emergency Department Quality in Myocardial Infarction (EDQMI) Study.  Amer Heart J. 2008;155:471-477.    PubMed

Presented at the American Heart Association Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke, Washington, DC, May 2007

 

• Vinson DR, Magid DJ, Brand DW, et al. Patient sex and quality of emergency department care for patients with acute myocardial infarction. Amer J Emerg Med. 2007;25:996-1003.  PubMed

Presented at the 2004 American College of Emergency Physicians’ Research Forum, San Francisco, CA

• Masoudi FA, Magid DJ, Vinson DR, et al. Implications of the failure to identify high-risk electrocardiogram findings for the quality of care of patients with acute myocardial infarction. Results of the ED Quality in Myocardial Infarction (EDQMI) Study. Circulation. 2006;114:1565-1571.  Full-text 

Presented at the 2005 Amer College of Cardiology Scientific Sessions, Orlando, FL

Featured on HeartWire, WebMD, Oct 6, 2006

 

• Magid DJ, Masoudi FA, Vinson DR, et al. Older emergency department patients with acute myocardial infarction receive lower quality of care than younger patients. Ann Emerg Med. 2005;46:14-21.  PubMed

Presented at the 2004 American College of Emergency Physicians’ Research Forum, San Francisco, CA. 

 

Ambulance Diversion 

• Patel PB, Vinson DR. The rise of regional "No Diversion" policies. Ann Emerg Med. 2012;59(2):157-158. Full-text

• Patel PB, Vinson DR. Ambulance diversion reduction and elimination: The 3-2-1 Plan. J Emerg Med. 2012;43(5):e363-371.  PubMed

• Patel PB, Derlet RW, Vinson DR, Williams M, Wills J. Ambulance diversion reduction: the Sacramento solution. Am J Emerg Med. 2006;24:206-13.  PubMed

        Presented at the 2004 American College of Emergency Physicians’ Research Forum, San Francisco, CA

• Ballard DW, Reed ME, Singh N, Rauchwerger AS, Hamity CA, Chettipally UK, Mark DG, Vinson DR. Emergency department follow-up quality of life assessment of patients presenting with atrial fibrillation/flutter. Acad Emerg Med. 2014;21(4):S132  [abstract 306].

Presented at the 2014 Society for Academic Emergency Medicine, Annual Meeting, Dallas, TX

• Singh N, Rauchwerger AS, Reed ME, Chettipally UK, Mark DG, Offerman SR, Vinson DR, Ballard DW. Adaptation of a disease-specific research instrument for quality of life assessments in ED patients with atrial fibrillation/flutter. Acad Emerg Med. 2013;20(5) Suppl:S138 (abstract 332). Link

Presented at the 2013 Society for Academic Emergency Medicine, Annual Meeting, Atlanta, GA

• Vinson DR. The safety of cardioversion of recent-onset atrial fibrillation in emergency department patients. Ann Emerg Med. 2012;60(1):134-135. Full-text    Reply 

• Vinson DR, Hoehn T, Graber D, Williams T. Managing emergency department patients with recent-onset atrial fibrillation. J Emerg Med. 2012;42(2):139-148. PubMed  Featured in Physician's Weekly, July 11, 2012

Burton JH, Vinson DR, Drummond K, Strout TD, Thode HC, McInturff JJ. Electrical cardioversion of emergency department patients with atrial fibrillation. Ann Emerg Med. 2004;44:20-30.  PubMed

Presented at the 2003 Society of Academic Emergency Medicine, Annual Meeting, Boston, MA.

Featured in Von Besser K, Mills AM. Is discharge to home after emergency department cardioversion safe for the treatment of recent-onset atrial fibrillation? Ann Emerg Med. 2011;58:517-20.

 

 
• Vinson DR. Expediting emergency throughput: Kiosk-assisted care and telephone treatment protocols. Acad Emerg Med. 2012;19:365. PubMed

   

• Vinson DR, Quesenberry CP Jr. Telephone management of presumed cystitis in women: Factors associated with recurrence. J Clin Outcomes Manage. 2007;14:41-46.  Abstract

Winner of the 2008 Morris F. Collen Research Award for best paper by a clinician in Kaiser Northern California 

Study summary       Award Intro Video (3 min)    Our Project Video (3 min)

 

Presented at the 2003 Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, IL

Presented at the 2002 International Meeting on the Therapies of Infections, Florence, IT.

Media coverage: Newsweek, Sept 22, 2003; Chicago Sun-Times, Good Housekeeping, Shape, First for Women, Health, Urology Times--Oct 9, 2003; Family Practice News 2003;33:41, Cosmopolitan (Cosmo. Ring Up UTI Relief, attached below)

 

• Mark DG, Vinson DR, Hung YY, Anderson ES, Escobar GJ, Carr BG, Abella BS, Ballard DW. Lack of improved outcomes with increased use of targeted temperature management following out-of-hospital cardiac arrest: A multicenter retrospective cohort study. Resuscitation. 2014;85(11):1549-56. PubMed

  
  

  
  

• Mark DG, Vinson DR, Anderson E, Ballard DW. Treatment of out-of-hospital cardiac arrest patients with electrocardiographic ST segment elevation myocardial infarction: differences in rates of emergent cardiac catheterization between receiving hospitals with and without on-site cardiac catheterization capacity. Crit Care Med. 2012;43(12 Suppl.):295 [abstract]. Link

  Presented at the Society of Critical Care Medicine's 42nd Critical Care Congress in San Juan, Puerto Rico, January 2013.

   

• Anderson E, Ballard DW, Vinson DR, Mark DG. Does the annual volume of patients admitted following out-of-hospital cardiac arrest predict use of therapeutic hypothermia? Crit Care Med. 2012;43(12 Suppl.):555 [abstract].

   

  Presented at the Society of Critical Care Medicine's 42nd Critical Care Congress in San Juan, Puerto Rico, January 2013.

   

• Mark DG, Vinson DR, Ballard DW. Letter by Mark et al Regarding Article "Implementation of the fifth link of the chain of survival concept for out-of-hospital cardiac arrest. Circulation. 2013;127:e566. Extract 

• Vinson DR, Ballard DW, Mark DG. The indications for screening chest radiography after failed thoracic central venous catheterization. Am J Emerg Med. 2015; publication pending

• Vinson DR, Ballard DW, Hance LG, Stevenson DW, Clague VA, Rauchwerger AS, Reed ME, Mark DG, for the CREST Network Investigators. Pneumothorax is a rare complication of thoracic central venous catheterization in community Emergency Departments. Amer J Emerg Med. 2015;33(1):60-66. PubMed

• * Vinson DR, Ballard DW, Hance LG, Hung YY, Rauchwerger AS, Reed ME, Kene MV, Chettipally UK, Elms AR, Mark DG, for the Kaiser Permanente CREST Network Investigators. Bleeding complications of central venous catheterization in septic patients with abnormal hemostasis. Amer J Emerg Med. 2014;32(7):737-42.  PubMed

Presented at the 2013 Research Forum, American College of Emergency Physicians, Seattle, WA. iPoster 

• Ballard DW, Reed ME, Rauchwerger AS, Chettipally UK, Offerman SR, Vinson DR. Emergency physician perspectives on central venous catheterization in septic patients: a survey-based study. Acad Emerg Med. 2014;21(6):623-30. PubMed

• Vinson DR, Ballard DW, Stevenson MD, Mark DG, Reed ME, Rauchwerger AS, Chettipally UK, Offerman SR, for the Kaiser Permanente CREST Network Investigators. Predictors of unattempted central venous catheterization in septic patients eligible for early goal-directed therapy. West J Emerg Med. 2014;15(1):67-75.   Full-text

Presented at the 2011 Research Forum, American College of Emergency Physicians, San Francisco, CA. Abstract

• Vinson DR, Mark DG, Huang J, Iskin HR, Rauchwerger AS, Reed ME, Pleshakov T, Wang DH, Ballard DW, for the KP CREST Network. The characteristics and outcomes of ED patients with acute pulmonary embolism discharged home within 24 hours. Acad Emerg Med. 2015; publication pending

• Vinson DR, Morley JE, Huang J, Liu V, Anderson ML, Drenten CE, Radecki RP, Nishijima DK, Reed ME. The accuracy of an electronic Pulmonary Embolism Severity Index auto-populated from the electronic health record: setting the stage for computerized clinical decision support. Appl Clin Inform. 2015; publication pending

• Vinson DR, Ballard DW, Huang J, Rauchwerger AS, Reed ME, Mark DG, for the KP CREST Network. Timing of discharge follow-up for acute pulmonary embolism: retrospective cohort study. West J Emerg Med. 2015;16(1):55-61. Full-text

• Vinson DR, Drenten CE, Huang J, Morley JE, Anderson ML, Reed ME, Nishijima DK, Liu V, on behalf of the KP CREST Network. Impact of relative contraindications to home management in emergency department patients with low-risk pulmonary embolism. Ann Am Thoracic Soc. 2015 Feb 19 [Epub ahead of print]. Abstract

Presented at the 2014 Society for Academic Emergency Medicine annual meeting, Dallas, TX.

• Vinson DR, Zehtabchi S, Yealy DM. Can selected patients with newly diagnosed pulmonary embolism be safely treated without hospitalization? A systematic review. Ann Emerg Med. 2012;60(5):651-662.e4.  Full-text   

Reuters Health interview    Featured in Journal Watch 

• *Vinson DR, Patel JP, Irving CS. Pretest probability estimation in the evaluation of patients with possible deep vein thrombosis. Amer J Emerg Med. 2011;29:594-600. PubMed 

• *Vinson DR, Berman DA, Patel PB, Hickey DO. Outpatient management of deep venous thrombosis: Two models of integrated care. Amer J Manag Care. 2006;12:405-410.  Full-text 

• Vinson DR. Eligibility criteria for home treatment of DVT vary. BMJ. 2001;323:866.  PubMed 

• Vinson DR. Outpatient treatment of deep venous thrombosis: effective management by emergency physicians. Thrombosis in Oncology. 2001;4:2-7. 

• Vinson DR, Berman DA. Outpatient treatment of deep venous thrombosis: a clinical care pathway managed by the emergency department. Ann Emerg Med. 2001;37(3):251-258.  Full-text

Reviewed by Journal Watch Emergency Medicine 2001 May 2.

Presented at the 2000 American College of Emergency Physicians’ Research Forum, Philadelphia, PA.

 

• Darracq MA, Vinson DR, Panacek EA. Preservation of active range of motion following acute elbow trauma predicts absence of elbow fracture. Amer J  Emerg Med. 2008;26:779-782. PubMed

 

• Patel PB, Vinson DR, Combs MA. Reduction of admit wait times: The effect of a leadership-based program. Acad Emerg Med. 2014;21(3):266-273. PubMed 

   

• Vinson DR. Expediting emergency management: Kiosk-assisted care and telephone treatment protocols. Acad Emerg Med. 2012;19(3):365. PubMed 

• Vinson DR, Patel PB. Facilitating follow-up after emergency care using an appointment assignment system. J Healthcare Quality. 2009; 31:18-24. Abstract 

• Patel PB, Vinson DR. Team Assignment System: Expediting emergency department care. Ann Emerg Med. 2005;46:499-506.  PubMed

Presented at the 2004 American College of Emergency Physicians’ Research Forum, San Francisco, CA

Reviewed by Emergency Medical Abstracts, October, 2006

 

• Nishijima DK, Offerman SR, Ballard DW, Vinson DR, Chettipally UK, Rauchwerger AS, Reed ME, Holmes JF, for the Clinical Research in Emergency Services and Treatment (CREST) Network. Risk of traumatic intracranial hemorrhage in patients with head injury and pre-injury warfarin or clopidogrel use. Acad Emerg Med. 2013;20(2):140-5.  PubMed

• Nishijima DK, Offerman SR, Ballard DW, Vinson DR, Chettipally UK, Rauchwerger AS, Reed ME, Holmes JF, for the Clinical Research in Emergency Services and Treatment (CREST) Network. Immediate and delayed traumatic intracranial hemorrhage in patients with head trauma and pre-injury warfarin or clopidogrel use. Ann Emerg Med. 2012;59(6):460-468.e7. PubMed

• Nishijima DK, Holmes JF,  Offerman SR, Ballard DW, Vinson DR, Chettipally UK, Rauchwerger AS, Reed ME. In reply (response to Rasler F, Delayed intracranial hemorrhage from mild head injury and warfarin use). Ann Emerg Med. 2013;61:126-127. Full text   

• Sheehan B, Nigrovic LE, Dayan PS, Kuppermann N, Ballard DW, Alessandrini E, Bajaj L, Goldberg H, Hoffman J, Offerman SR, Mark DG, Swietlik M, Tham E, Tzimenatos L, Vinson DR, Jones GS, Bakken S; for the Pediatric Emergency Care Applied Research Network (PECARN).Informing the design of clinical decision support services for evaluation of children with minor blunt head trauma in the emergency department: A sociotechnical analysis. J Biomed Inform. 2013;46(5):905-13. PubMed

Presented at the 2011 American Medical Informatics Association’s Annual Symposium, Washington, DC

• Ballard DW, Reed ME, Rauchwerger AS, Vinson DR, Mark DG, Offerman SR, Chettipally UK, Graetz I, Dayan P, Kuppermann N, for the Clinical Research in Emergency Services and Treatment (CREST) Network. Emergency physicians’ knowledge and attitudes of clinical decision support in the electronic health record: a survey-based study. Acad Emerg Med. 2013;20(4):352-360. PubMed  

• Friedman BW, Vinson DR. Convincing the skeptic. How to fix emergency department headache management. Cephalalgia. 2014 Nov 3 [Epub ahead of print]. Full-text

• Friedman BW, West J, Vinson DR, Minen MT, Restivo A, Gallagher EJ. Current management of migraine in U.S. emergency departments: an analysis of NHAMCS. Cephalalgia. 2014 June 19 [Epub ahead of print]  PubMed

• Hurtado T, Vinson DR, Vandenberg JT. ED treatment of migraine headache: factors influencing pharmacotherapeutic choices. Headache. 2007;47:1134-1143.  PubMed  

• Vinson DR. Reply to Gupta R, Gernsheimer J. Treating headache in the emergency department: Avoiding the migraine-meperidine trap. Ann Emerg Med. 2003;42:161-2.  

• Vinson DR, Hurtado TR, Banwert L, Vandenberg JT: Variations among emergency departments in the treatment of benign headache. Ann Emerg Med. 2003;41:90-97.  PubMed

Reported in The Year Book of Emergency Medicine 2004, WP Burdick, ed. (St. Louis: Mosby, 2004), 121-122.

Presented at the 2002 American College of Emergency Physicians’ Research Forum, Seattle, WA.

 

• Vinson DR. Emergency department treatment of migraine headaches. Arch Intern Med. 2002; 162:845-846. 
• Vinson DR. Treatment patterns of isolated benign headache in US emergency departments. Ann Emerg Med. 2002;39:215-22.  PubMed 

Reviewed by Journal Watch Emergency Medicine 2002 May 15, and AnalgesiaFile. 

 

• Vinson DR. Development of a simplified instrument for the diagnosis and grading of akathisia in a cohort of patients receiving prochlorperazine. J Emerg Med. 2006;31:139-145.  PubMed 

Featured in “You can’t assume headaches are benign”  ED Nursing. 2008;11:65-66.

 

• Vinson DR. Diphenhydramine in the treatment of akathisia induced by prochlorperazine. J Emerg Med. 2005;28:348-349 [letter]. In response to Baden EY et al. Diphenhydramine in the treatment of akathesia [sic] induced by prochlorperazine. J Emerg Med. 2005;28:347-348. 

• Vinson DR. Diphenhydramine in the treatment of akathisia induced by prochlorperazine. J Emerg Med.  2004;26:265-270.  Full-text

Presented at the 2002 American College of Emergency Physicians’ Research Forum, Seattle, WA.

 

• Gupta R, Vinson DR. Akathisia can be reduced by lowering the dose of D2 receptor antagonists. Ann Emerg Med. 2003;41:280.  

• Vinson DR. Akathisia: Problematic but preventable. Ann Emerg Med. 2002; 39:575-576. 

• Vinson DR. Drug-induced akathisia: In Need of Detection and Prevention. Rapid Response to “Akathisia: overlooked at a cost.” BMJ. 2002; 324: 1506-1507.  BMJ Online 

• Vinson DR. Frequency of adverse reactions to prochlorperazine in the ED: a response. Amer J Emerg Med. 2001; 19:175. 

• Vinson DR, Drotts DL. Diphenhydramine for the prevention of akathisia induced by prochlorperazine: a randomized, controlled trial. Ann Emerg Med. 2001:37:125-131.  Full-text

Discussed in Side Effects of Drugs—Annual 26, ed. Aronson JK (Boston/London: Elsevier, 2003), 66.

Presented at the 1999 Society for Academic Emergency Medicine, Annual Meeting, Boston, MA.

 

• Vinson DR, Migala AF, Quesenberry CP, Jr. Slow infusion for the reduction of akathisia induced by prochlorperazine: a randomized controlled trial. J Emerg Med. 2001;20:113-119.  PubMed 

Discussed in Side Effects of Drugs—Annual 26, ed. Aronson JK (Boston/London: Elsevier, 2003), 66.

Presented at the 2000 Society for Academic Emergency Medicine, Annual Meeting, San Francisco, CA.

 

• Vinson DR, Drotts DL: Akathisia and prochlorperazine. Ann Emerg Med. 2000;36:170-1. 

• Drotts DL, Vinson DR. Prochlorperazine induces akathisia in emergency patients. Ann Emerg Med. 1999;34:469-475.  PubMed

Reviewed by Journal Watch Emergency Medicine, 1999 Dec 1.

Presented at the 1998 Society for Academic Emergency Medicine, Annual Meeting, Chicago, IL  

• Patel PB, Keenly LD, Anderson HE, Vinson DR. Informed consent for lumbar puncture in the Emergency Department. West J Emerg Med. 2014;21:266-73. Full-text

• We at Kaiser Sacramento served as one of eighty-plus study sites who abstracted medical records for the following studies:
• Sullivan AF, Camargo CA Jr, Cleary PD, et al. The National Emergency Department Safety Study: study rationale and design. Acad Emerg Med. 2007;14:1182-9.
• Magid DJ, Sullivan AF, Cleary PD, et al. The safety of emergency care systems: Results of a survey of clinicians in 65 US emergency departments. Ann Emerg Med. 2009;53:715-23.e1.
• Tsai CL, Sullivan AF, Gordon JA, et al. Quality of care for acute asthma in 63 US emergency departments. J Allergy Clin Immunol. 2009;123:354-61.
• Kansagra SM, Rao SR, Sullivan AF, et al. A survey of workplace violence across 65 U.S. emergency departments. Acad Emerg Med. 2008;15:1268-74.

Patient Satisfaction

• Patel PB, Vinson DR. Physician email and telephone follow-up after emergency department visit improves patient satisfaction: A cross-over trial. Ann Emerg Med. 2013;61(6):631-7.   PubMed  Full-text

Presented at the 2011 Research Forum, American College of Emergency Physicians, San Francisco.

Featured in PR Newswire   Featured in ED Management   

 

 

• Vinson DR, Bradbury DR. Etomidate for procedural sedation in emergency medicine. Ann Emerg Med. 2002;39:592-598. PubMed

Reviewed by Journal Watch Emergency Medicine 2002 August 28.

 

• Offerman SR, Nishijima D, Ballard D, Chettipally U, Vinson DR, Holmes JF. The use of delayed telephone informed consent for observational emergency medicine research is ethical and effective. Acad Emerg Med. 2013;20(4):403-407.  Abstract

    Presented at the 2010 Society for Academic Emergency Medicine, Annual Meeting, Las Vegas, NV.

• Offerman SR, Rauchwerger AS, Nishijima DK, Ballard DW, Chettipally UK, Vinson DR, Reed ME, Holmes JF Jr. Use of an electronic medical record ‘‘dotphrase’’ data template for a prospective head injury study. West J Emerg Med. 2013;14(2):109-113. Full-text

                    Presented at the 2012 Society for Academic Emergency Medicine, Annual Meeting, Chicago, IL

• Mark DG, Morehouse JW, Hung YY, Kene MV, Elms AR, Liu V, Ballard DW, Vinson DR, for the KP CREST Network Investigators. In-hospital mortality following treatment with red blood cell transfusion or inotropic therapy during early goal-directed therapy for septic shock: a retrospective propensity-adjusted analysis. Crit Care. 2014;18:496. Full-text pdf

• Mark D, Morehouse J, Kene M, Elms A, Ballard D, Vinson D. Unbundling early goal-directed therapy: correction of low central venous oxygen saturation. Crit Care Med. 2013; 41(S12), A269 [abstract 1068]. Abstract

• Mark D, Hung Y-Y, Morehouse J, Kene M, Elms A, Vinson D, Ballard D, for the KP CREST Network Investigators. Predictors of dobutamine and red blood cell administration among patients treated with EGDT in the ED. Ann Emerg Med. 2013;62(4S):S134  [abstract 375]. iPoster  

• Chettipally UK, Reed ME, Huang J, Rauchwerger AS, Ballard DW, Offerman SR, Vinson DR, for the CREST Network. Life After Sepsis Therapy: A one-year follow-up study of Early Goal Directed Therapy. Ann Emerg Med. 2013;62(4S):S132-S133  [abstract 372].   iPoster

Subarachnoid Hemorrhage

• Mark DG, Hung YY, Offerman SR, Rauchwerger AS, Reed ME, Chettipally UK, Vinson DR, Ballard DW, for the Kaiser Permanente CREST Network Investigators. Non-traumatic subarachnoid hemorrhage in the setting of negative cranial computed tomography: External validation of a clinical and imaging prediction rule. Ann Emerg Med. 2013;62(1):1-10.e1    PubMed

Presented at the 2012 Society of Academic Emergency Medicine Annual Meeting, Chicago, IL. 

• Mark DG, Vinson DR, Ballard DW; Kaiser Permanente CREST Network investigators. Reply to Perry JJ, “Pragmatic interpretation of the study of nontraumatic subarachnoid hemorrhage in the setting of negative cranial computed tomography results: External validation of a clinical and imaging prediction rule.” Ann Emerg Med. 2013;62(4):436-437.

  The Letter      The Reply

• Mark DG, Sonne DC, Vinson DR, Ballard DW; Kaiser Permanente CREST Network investigators. Reply to Schwartz DT, “Sensitivity of computed tomography for subarachnoid hemorrhage.” Ann Emerg Med. 2013;62(4):438-439.

The Letter      The Reply

• Mark DG, Vinson DR, Ballard DW. Reply to Verrgouwen MD, et al, “Clinical suspicion of subarachnoid hemorrhage and negative head CT scan performed within 6 hours of headache onset - no need for lumbar puncture.” Ann Emerg Med. 2013;61(4):504-5.

The Letter     The Reply

 

Miscellany

 

• Vinson DR. NEXUS Cervical Spine Criteria. Ann Emerg Med. 2001;37:237-238.

Discussed by Fatovich DM. Recent developments: Emergency medicine. BMJ. 2002; 324:958-962. 

 

• Vinson DR. Tetanus not 100% preventable. J Emerg Med. 2000;19:74-5. 

Vinson DR: Immunisation does not rule out tetanus. BMJ. 2000; 320:383.  Full-text 

• Vandenberg JT, Lutz RH, Vinson DR. Large-diameter suction system reduces oropharyngeal evacuation time. J Emerg Med. 1999;17:941-944.  PubMed

 

• Vinson DR, Burke TF, Sung HM. Rapid reversal of life-threatening diltiazem-induced tetany with calcium chloride. Ann Emerg Med. 1999;34:676-678.  PubMed 

 

• Vandenberg JT, Vinson DR. The inadequacies of contemporary oropharyngeal suction. Am J Emerg Med. 1999;17:611-613.  PubMed 

• Vinson DR: Epiploic appendagitis. a new diagnosis for the emergency physician. Two cases and a review. J Emerg Med. 1999;17:827-832.  PubMed 

 

• Vinson DR. The Ellis fracture: An anachronistic eponym in dentistry. Ann Emerg Med. 1999; 33:599-600. 

 

• Roth BA, Vinson DR, Kim S. Carisoprodol-induced myoclonic encephalopathy. J Toxicol Clin Toxicol. 1998;36:609-612.  PubMed 

 

• Vinson DR. Superstitions in medicine: bad luck or bad logic? Ann Emerg Med. 1998;31:650-652.