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Jason Mackey, Jane C Khoury, Kathleen Alwell, Charles J Moomaw, Brett M Kissela, Matthew L Flaherty, Opeolu Adeoye, Daniel Woo, Simona Ferioli, Felipe De Los Rios La Rosa, Sharyl Martini, Pooja Khatri, Joseph P Broderick, Mario Zuccarello, Dawn Kleindorfer
OBJECTIVE: To characterize temporal trends in subarachnoid hemorrhage (SAH) incidence and outcomes over 5 time periods in a large population-based stroke study in the United States. METHODS: All SAHs among residents of the Greater Cincinnati/Northern Kentucky region at least 20 years of age were identified and verified via study physician review in 5 distinct year-long study periods between 1988 and 2010. We abstracted demographics, care patterns, and outcomes, and we compared incidence and case-fatality rates across the study periods...
October 21, 2016: Neurology
Gerrit I van Schalkwyk, Rachel B Katz, Joseph Resignato, Susan C van Schalkwyk, Robert M Rohrbaugh
OBJECTIVE: Challenges in pursuing research during residency may contribute to the shortage of clinician-scientists. Although the importance of mentorship in facilitating academic research careers has been described, little is understood about early career research mentorship for residents. The aim of this study was to better understand the mentorship process in the context of psychiatry residency. METHOD: Semi-structured interviews were conducted with experienced faculty mentors in a psychiatry department at a large academic medical center...
October 20, 2016: Academic Psychiatry
Daniel Hausmann, Cristina Zulian, Edouard Battegay, Lukas Zimmerli
BACKGROUND: Decision-making processes in a medical setting are complex, dynamic and under time pressure, often with serious consequences for a patient's condition. OBJECTIVE: The principal aim of the present study was to trace and map the individual diagnostic process of real medical cases using a Decision Process Matrix [DPM]). METHODS: The naturalistic decision-making process of 11 residents and a total of 55 medical cases were recorded in an emergency department, and a DPM was drawn up according to a semi-structured technique following four steps: 1) observing and recording relevant information throughout the entire diagnostic process, 2) assessing options in terms of suspected diagnoses, 3) drawing up an initial version of the DPM, and 4) verifying the DPM, while adding the confidence ratings...
October 18, 2016: BMC Medical Informatics and Decision Making
Austin F Mount-Campbell, Michael F Rayo, James J OʼBrien, Theodore T Allen, Emily S Patterson
Handover communication improvement initiatives typically employ a "one size fits all" approach. A human factors perspective has the potential to guide how to tailor interventions to roles, levels of experience, settings, and types of patients. We conducted ethnographic observations of sign-outs by attending and resident physicians in 2 medical intensive care units at one institution. Digitally audiotaped data were manually analyzed for content using codes and time spent using box plots for emergent categories...
October 2016: Quality Management in Health Care
Suliman Alghnam, Glen H Tinkoff, Renan Castillo
BACKGROUND: Repeated injuries, as known as injury recidivism, pose a significant burden on population health and healthcare settings. Therefore, identifying those at risk of recidivism can highlight targeted populations for primary prevention in order to improve health and reduce healthcare expenditures. There has been limited research on factors associated with recidivism in the U.S. Using a population-based sample, we aim to: 1) identify the prevalence and risk factors for injury recidivism among non-institutionalized adults; 2) investigate the trend in nationwide recidivism rates over time...
December 2016: Injury Epidemiology
Kevin Kalisz, Vasant Garg, Kyle Basques, Robert Gilkeson, Peter Young
RATIONALE AND OBJECTIVES: This study aimed to assess the quality of and analyze trends among clinical indications received for emergency room radiograph studies. MATERIALS AND METHODS: Clinical indications provided by the emergency room and rapid care for consecutive chest, abdominal, and musculoskeletal radiographs were reviewed. Chart review was performed to analyze the provided indications compared to clinical information known to the ordering providers. Chest and abdominal radiograph indications were graded according to symptoms and physical examination signs and relevant past medical history...
October 10, 2016: Academic Radiology
Ambrose Hon-Wai Wong, Joan Combellick, Beth Ann Wispelwey, Allison Squires, Maureen Gang
OBJECTIVES: The emergency department (ED) has been recognized as a high-risk environment for workplace violence. Acutely agitated patients who perpetrate violence against healthcare workers represent a complex care challenge in the ED. Recommendations to improve safety are often based on expert opinion rather than empirical data. In this study we aim to describe the lived experience of staff members caring for this population in order to provide a broad perspective of ED patient violence...
October 15, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Lori A Stolz, Uwe Stolz, J Matthew Fields, Turandot Saul, Michael Secko, Matthew J Flannigan, Johnathan M Sheele, Robert P Rifenburg, Anthony J Weekes, Elaine B Josephson, John Bedolla, Dana M Resop, Jonathan Dela Cruz, Megan Boysen-Osborn, Terrell Caffery, Charlotte Derr, Rimon Bengiamin, Gerardo Chiricolo, Brandon Backlund, Jagdipak Heer, Robert J Hyde, Srikar Adhikari
OBJECTIVES: Emergency ultrasound (EUS) has been recognized as integral to the training and practice of emergency medicine (EM). The Council of Emergency Medicine Residency-Academy of Emergency Ultrasound (CORD-AEUS) consensus document provides guidelines for resident assessment and progression. The Accredited Council for Graduate Medical Education (ACGME) has adopted the EM Milestones for assessment of residents' progress during their residency training which includes demonstration of procedural competency in bedside ultrasound...
October 14, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Stephen Alerhand
Barely had I received my PGY2 in-service exam score when an attorney wrote me offering to pay for my supposed "medical expertise." Having come across one of my FOAM blog write-ups, he asked if I would consult with him on that topic for his client's medico-legal case against the defendant emergency physician. My natural response was to inform the attorney that I was only a resident. However, it seems that is precisely why he sought my insight. This article is protected by copyright. All rights reserved.
September 22, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Eric Egnot, Kim Jordan, John O Elliott
BACKGROUND: Use of the electronic cigarette for nicotine delivery has increased dramatically in recent years. Information continues to emerge on its role as a smoking cessation aid, but little is known about resident physician use of the device in clinical practice. METHODS: In 2015, an electronic survey was administered to resident physicians in one healthcare system in Columbus, Ohio. The survey included questions about personal smoking exposure, knowledge, beliefs, attitudes about electronic cigarettes and early adoption of electronic cigarettes with patients...
October 3, 2016: Postgraduate Medical Journal
Sayed Masoom Shah, Shehla Zaidi, Jamil Ahmed, Shafiq Ur Rehman
BACKGROUND: Workforce motivation and retention is important for the functionality and quality of service delivery in health systems of developing countries. Despite huge primary healthcare (PHC) infrastructure, Pakistan's health indicators are not impressive; mainly because of under-utilization of facilities and low patient satisfaction. One of the major underlying issues is staff absenteeism. The study aimed to identify factors affecting retention and motivation of doctors working in PHC facilities of Pakistan...
April 9, 2016: International Journal of Health Policy and Management
Yuwei Zhou, Uygar Teomete, Ozgur Dandin, Onur Osman, Taner Dandinoglu, Ulas Bagci, Weizhao Zhao
Bowing fractures are incomplete fractures of tubular long bones, often observed in pediatric patients, where plain radiographic film is the non-invasive imaging modality of choice in routine radiological workflow. Due to weak association between bent bone and distinct cortex disruption, bowing fractures may not be diagnosed properly while reading plain radiography. Missed fractures and dislocations are common in accidents and emergency practice, particularly in children. These missed injuries can result in more complicated treatment or even long-term disability...
September 17, 2016: Computers in Biology and Medicine
Ming-Ta Tsai, Yung-Lin Yen, Chih-Min Su, Chih-Wei Hung, Chia-Te Kung, Kuan-Han Wu, Hsien-Hung Cheng
OBJECTIVE: To investigate the impact of emergency department (ED) crowding (number of ED patients) and number of ED staff on the efficiency of the ED care process for acute stroke patients. DESIGN: Retrospective cohort study conducted from 1 May 2008 to 31 December 2013. SETTING: Largest primary stroke center (3000-bed tertiary academic hospital) in southern Taiwan. PARTICIPANTS: Patients aged 18-80 years presenting to the ED with acute stroke symptoms ≤3 h from symptom onset (n = 1142)...
September 27, 2016: International Journal for Quality in Health Care
Sejal H Patel, Sunju Park, Jamie B Rosenberg
PURPOSE: The purpose of this study was to compare pediatric and adult ophthalmology consultations in an urban academic center. METHODS: A retrospective chart review of patients evaluated by the ophthalmology consultation service from January through June 2014 was conducted. RESULTS: A total of 751 inpatients and emergency department patients were evaluated by the ophthalmology consultation service, of whom 152 (20.4%) were children and 598 (79...
September 26, 2016: Journal of Pediatric Ophthalmology and Strabismus
Martin Sievert, Igor Zwir, Kevin M Cloninger, Nigel Lester, Sandor Rozsa, C Robert Cloninger
BACKGROUND: Multiple factors influence the decision to enter a career in medicine and choose a specialty. Previous studies have looked at personality differences in medicine but often were unable to describe the heterogeneity that exists within each specialty. Our study used a person-centered approach to characterize the complex relations between the personality profiles of resident physicians and their choice of specialty. METHODS: 169 resident physicians at a large Midwestern US training hospital completed the Temperament and Character Inventory (TCI) and the Satisfaction with Life Scale (SWLS)...
2016: PeerJ
Simon Kotlyar
BACKGROUND: Tick-borne relapsing fever (TBRF) is a zoonosis caused by spirochetes of the genus Borrelia. The zoonosis is endemic in higher-elevation coniferous forests of the western United States. CASE REPORT: We discuss the case of a 44-year-old male residing in the San Juan Mountains of Western Colorado who presented with fever, myalgia, vomiting, and "violent chills" to an emergency department. Laboratory studies were notable for bandemia and thrombocytopenia with mild hyperbilirubinemia...
September 17, 2016: Journal of Emergency Medicine
Hanna Allemann, Märta Sund-Levander
AIMS: To describe what nurses do during episodes of suspected infection in elderly nursing home residents and if these actions are linked to who is initiating an episode and whether the episode is considered an infection or not. DESIGN: Prospective descriptive study. Data were collected in 2008-2010. METHODS: Summarized and categorized documentation by nursing assistants and nurses was used for summative content analysis. RESULTS: Nurses' actions seem to be related to who initiated the episode and if the episodes are categorized as 'non-infection', 'possible infection' or 'infection'...
November 2015: Nurs Open
Bhakti Hansoti, Dylan S Kellogg, Sara J Aberle, Morgan C Broccoli, Jeffrey Feden, Arthur French, Charles M Little, Brooks Moore, Joseph Sabato, Tara Sheets, R Weinberg, Pat Elmes, Christopher Kang
: Study Objective This study aimed to review available disaster training options for health care providers, and to provide specific recommendations for developing and delivering a disaster-response-training program for non-disaster-trained emergency physicians, residents, and trainees prior to acute deployment. METHODS: A comprehensive review of the peer-reviewed and grey literature of the existing training options for health care providers was conducted to provide specific recommendations...
September 19, 2016: Prehospital and Disaster Medicine
Tiffani J Johnson, Daniel G Winger, Robert W Hickey, Galen E Switzer, Elizabeth Miller, Margaret B Nguyen, Richard A Saladino, Leslie R M Hausmann
BACKGROUND AND OBJECTIVES: The general population and most physicians have implicit racial bias against black adults. Pediatricians also have implicit bias against black adults, albeit less than other specialties. There is no published research on the implicit racial attitudes of pediatricians or other physicians towards children. Our objectives were to compare implicit racial bias towards adults versus children among resident physicians working in a pediatric emergency department (ED), and to assess whether bias varied by specialty (pediatrics, emergency medicine, or other), gender, race, age, and year of training...
September 9, 2016: Academic Pediatrics
Jenifer Hashem, Maya Deza Culbertson, John Munyak, Jack Choueka, Nima P Patel
BACKGROUND: Complaints related to the hands, wrists, and fingers comprise approximately 3.7 million emergency department visits annually. The complexity of this subject can confound timely diagnosis and treatment, particularly if the treating physician has not received specialized training. We set out to determine whether emergency medicine training in the USA provides adequate preparation for dealing with the identification, management, and treatment of hand, wrist, and finger injuries...
September 2016: Bulletin of the Hospital for Joint Diseases
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