To investigate the role of indoor allergens in adult patients with acute asthma, we conducted a case-controlled study on patients presenting to an emergency room. One hundred and fourteen patients and 114 control subjects were enrolled over a 1-yr period in Wilmington, Delaware. Sera were assayed for total IgE, and for IgE antibodies to dust mites, cat dander, cockroach, grass pollen, and ragweed pollen. Dust was obtained from 186 homes and assayed for dust mite, cat, and cockroach allergens. IgE antibodies to mite, cat, and cockroach were each significantly associated with asthma, and this association was very strong among participants without medical insurance and among African Americans. Among 99 uninsured participants, sensitization to one of the indoor allergens (> 200 RAST units) was present in 28 of 57 asthmatics and in one of 42 control subjects (odds ratio, 39; confidence interval, 9.4 to 166). For cat and cockroach the combination of sensitization and presence of allergen in the house was significantly associated with asthma. Furthermore, there was a strong inverse relationship between IgE antibodies to cat and to cockroach, and the risk of this sensitization was in large part restricted to homes or areas with high levels of allergen. Thirty-eight percent of the asthmatics, but only 8% of the control subjects, were allergic to one of the three indoor allergens, and had high levels of the relevant allergen in their houses (odds ratio, 7.4; confidence interval, 3.3 to 16.5).(ABSTRACT TRUNCATED AT 250 WORDS)

Objective: To determine whether the frequency of unintentional needlesticks can be reduced by replacing conventional IV catheters with self-capping ones. Methods:Retrospective cohort, historically controlled study, conducted in an emergency medical services advanced life support (ALS) service. The ALS service annually transports 12,000 patients, for whom IV therapy is attempted in about 65% of cases. The needlestick rate per 1,000 patients receiving attempts at IV access was examined during the 2 10-month periods, before and after introduction of a self-capping IV catheter.Results: For the 2 periods, the percentage of patients for whom IV access was attempted remained constant at 65%. The success rate for IV access was statistically unchanged from 88% to 90% (p > 0.5, power = 0.995). During the period prior to use of the new datheter, 44 injuries were reported overall. Of these, 15 were due to unintentional needlesticks, 1 1 associated with contaminated needles. Following the system-wide introduction of the new catheter, only 1 of 31 reported injuries was due to needlestick (uncontaminated). The extrapolated annual incidence of contaminated needlesticks decreased from 169 (95% CI; 85, 253) to 0 (95% CI; 0, 46) per 100,000 IV attempts. The extrapolated incidence for all needlesticks decreased from 231 (95% CI; 132, 330) to 15 (95% CI; 0, 40) per 100,000 IV attempts. The absolute number of needlesticks and the proportion of injuries due to needlesticks decreased significantly (p < 0.005). Conclusion:The use of IV catheters with self-capping needles was associated with a significant reduction in the absolute number of inadvertent needlesticks as well as the proportion of injuries due to needlesticks among ALS providers. The use of self-capping IV catheters was feasible and did not appear to be a deterrent to initiating IV therapy in the out-of-hospital environment.Key words: emergency medical services systems; EMS; infectious disease; hepatitis; HIV, needlestick; universal precautions.Acad. Emerg. Med. 1996; 3:668-674. cluding HIV, hepatitis B virus (HBV), hepatitis c virus (HCV), and cytomegalovirus, can be transmitted by in-

For the fixed doses used in this study, the adult ureteral colic patients receiving hydromorphone achieved more pain relief, required less rescue medication, underwent fewer IVPs, and avoided hospital admission more frequently than did those receiving meperidine.

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