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https://www.readbyqxmd.com/read/29768634/perceived-burden-of-ehrs-on-physicians-at-different-stages-of-their-career
#1
Saif Khairat, Gary Burke, Heather Archambault, Todd Schwartz, James Larson, Raj M Ratwani
OBJECTIVE:  The purpose of this study was to further explore the effect of EHRs on emergency department (ED) attending and resident physicians' perceived workload, satisfaction, and productivity through the completion of six EHR patient scenarios combined with workload, productivity, and satisfaction surveys. METHODS:  To examine EHR usability, we used a live observational design combined with post observation surveys conducted over 3 days, observing emergency physicians' interactions with the EHR during a 1-hour period...
April 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/29765259/shadowing-emergency-medicine-residents-by-medical-education-specialists-to-provide-feedback-on-non-medical-knowledge-based-acgme-sub-competencies
#2
Anna L Waterbrook, Karen C Spear Ellinwood, T Gail Pritchard, Karen Bertels, Ariel C Johnson, Alice Min, Lisa R Stoneking
Objective: Non-medical knowledge-based sub-competencies (multitasking, professionalism, accountability, patient-centered communication, and team management) are challenging for a supervising emergency medicine (EM) physician to evaluate in real-time on shift while also managing a busy emergency department (ED). This study examines residents' perceptions of having a medical education specialist shadow and evaluate their nonmedical knowledge skills. Methods: Medical education specialists shadowed postgraduate year 1 and postgraduate year 2 EM residents during an ED shift once per academic year...
2018: Advances in Medical Education and Practice
https://www.readbyqxmd.com/read/29762793/a-qualitative-study-of-the-communication-process-for-medical-acupuncture-in-family-medicine
#3
Christy J W Ledford, Carla L Fisher, Paul Crawford
BACKGROUND AND OBJECTIVES: As evidence establishes the efficacy of medical acupuncture, more family physicians and family medicine residents may receive medical acupuncture training and need to know how to effectively communicate about the treatment option with patients. By identifying how physicians talk about acupuncture treatment with their patients, we aimed to develop a model for physician training that could enhance their ability to integrate and practice medical acupuncture in conventional clinical settings...
May 2018: Family Medicine
https://www.readbyqxmd.com/read/29759656/well-being-among-emergency-medicine-resident-physicians-results-from-the-abem-longitudinal-study-of-emergency-medicine-residents
#4
Debra G Perina, Catherine A Marco, Rebecca Smith-Coggins, Terry Kowalenko, Mary M Johnston, Anne Harvey
BACKGROUND: The Longitudinal Study of Emergency Medicine Residents (LSEMR) conducted by the American Board of Emergency Medicine queries a randomized cohort of emergency medicine (EM) residents. It is designed to identify residents' perceptions of their training, sources of stress, well-being level, and career choice satisfaction over time. OBJECTIVES: This study utilizes LSEMR to identify resident well-being levels, career satisfaction, factors producing stress, and whether a specific cohort is more stressed than the overall respondent group...
May 11, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29759261/deriving-a-framework-for-a-systems-approach-to-agitated-patient-care-in-the-emergency-department
#5
Ambrose H Wong, Halley Ruppel, Lauren J Crispino, Alana Rosenberg, Joanne D Iennaco, Federico E Vaca
BACKGROUND: The rising agitated patient population presenting to the emergency department (ED) has caused increasing safety threats for health care workers and patients. Development of evidence-based strategies has been limited by the lack of a structured framework to examine agitated patient care in the ED. In this study, a systems approach from the patient safety literature was used to derive a comprehensive theoretical framework for addressing ED patient agitation. METHODS: A mixed-methods approach was used with ED staff members at an academic site and a community site of a regional health care network...
May 2018: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/29753518/application-of-the-canadian-computed-tomography-head-rule-to-patients-with-minimal-head-injury
#6
Kevin Davey, Turandot Saul, Geoffrey Russel, Jonathan Wassermann, Joshua Quaas
STUDY OBJECTIVE: Two clinical decision rules, the Canadian CT Head Rule and the New Orleans Criteria, set the standard to guide clinicians in determining which patients with minor head trauma need computed tomography (CT) imaging. Both rules were derived with patients with minor head injury who had had a loss of consciousness or witnessed disorientation. No evidence exists for evaluating patients and need for CT imaging with minimal head injury; that is, patients who had a head injury but no loss of consciousness or disorientation and therefore would have been excluded from the Canadian CT Head Rule and New Orleans Criteria trials...
May 9, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29737962/perceived-barriers-and-facilitators-to-goals-of-care-discussions-in-the-emergency-department-a-descriptive-analysis-of-the-views-of-emergency-medicine-physicians-and-residents
#7
Niran Argintaru, Kieran L Quinn, Lucas B Chartier, Jacques Lee, Paul Hannam, Erin O'Connor, Leah Steinberg, Howard Ovens, Melissa McGowan, Samuel Vaillancourt
CLINICIAN'S CAPSULE What is known about the topic? Goals of care discussions (GOC) are critical to reflecting patients' preferences in the provision of acute care, yet these discussions can be challenging to have in the emergency department (ED) setting. What did this study ask? What are emergency physicians' perspectives on barriers and facilitators to GOC discussions? What did this study find? In this survey of emergency medicine attending and resident physicians, the majority reported feeling comfortable and adequately trained to conduct GOC discussions...
May 8, 2018: CJEM
https://www.readbyqxmd.com/read/29735771/opinion-and-special-articles-amateur-fundus-photography-with-various-new-devices-our-experience-as-neurology-residents
#8
Saman Zafar, Ylec Mariana Cardenas, Lakshmi Leishangthem, Sridhara Yaddanapudi
Times are changing in the way we secure and share patient fundus photographs to enhance our diagnostic skills in neurology. At the recent American Academy of Neurology meeting, the use of a fundus camera and smartphones to secure good-quality fundus photographs of patients presenting with headache to the emergency department (ED) was presented. We were enthusiastic to replicate the success of the Fundus Photography vs Ophthalmoscopy Trial Outcomes in the Emergency Department (FOTO-ED) study in our neurology department, but encountered problems in terms of cost, setup, feasibility, and portability of the device...
May 8, 2018: Neurology
https://www.readbyqxmd.com/read/29730649/diagnostic-accuracy-in-family-medicine-residents-using-a-clinical-decision-support-system-dxplain-a-randomized-controlled-trial
#9
Adrian Israel Martinez-Franco, Melchor Sanchez-Mendiola, Juan Jose Mazon-Ramirez, Isaias Hernandez-Torres, Carlos Rivero-Lopez, Troy Spicer, Adrian Martinez-Gonzalez
BACKGROUND: Clinical reasoning is an essential skill in physicians, required to address the challenges of accurate patient diagnoses. The goal of the study was to compare the diagnostic accuracy in Family Medicine residents, with and without the use of a clinical decision support tool (DXplain http://www.mghlcs.org/projects/dxplain). METHODS: A total of 87 first-year Family Medicine residents, training at the National Autonomous University of Mexico (UNAM) Postgraduate Studies Division in Mexico City, participated voluntarily in the study...
May 7, 2018: Diagnosis
https://www.readbyqxmd.com/read/29713649/treatment-discontinuation-and-clinical-events-in-type-2-diabetes-patients-treated-with-dipeptidyl-peptidase-4-inhibitors-or-nph-insulin-as-third-line-therapy
#10
Cristiano S Moura, Zale B Rosenberg, Michal Abrahamowicz, Sasha Bernatsky, Hassan Behlouli, Louise Pilote
Objective: To compare dipeptidyl peptidase-4 (DPP-4) inhibitors with neutral protamine Hagedorn (NPH) insulin, in terms of effectiveness and safety for the management of patients with type 2 diabetes mellitus (DM2) not controlled on metformin and sulfonylureas. Methods: A retrospective cohort study of individuals with DM2 newly dispensed with either DPP-4 inhibitors or NPH as third-line therapy, after metformin and sulfonylurea. Treatment discontinuation, macrovascular outcomes, and hypoglycemia were compared using multivariable Cox regression models, adjusted for sex, age, year of cohort entry, place of residence, hypertension, past history of hypoglycemia, diabetic ketoacidosis, comorbidities, and number of visits to emergency departments, outpatient physician, and hospitalizations...
2018: Journal of Diabetes Research
https://www.readbyqxmd.com/read/29708218/stroke-code-simulation-benefits-advanced-practice-providers-similar-to-neurology-residents
#11
Muhib Khan, Grayson L Baird, Theresa Price, Tricia Tubergen, Omran Kaskar, Michelle De Jesus, Joseph Zachariah, Adam Oostema, Raymond Scurek, Robert R Coleman, Wendy Sherman, Cynthia Hingtgen, Tamer Abdelhak, Brien Smith, Brian Silver
Background: Advanced practice providers (APPs) are important members of stroke teams. Stroke code simulations offer valuable experience in the evaluation and treatment of stroke patients without compromising patient care. We hypothesized that simulation training would increase APP confidence, comfort level, and preparedness in leading a stroke code similar to neurology residents. Methods: This is a prospective quasi-experimental, pretest/posttest study. Nine APPs and 9 neurology residents participated in 3 standardized simulated cases to determine need for IV thrombolysis, thrombectomy, and blood pressure management for intracerebral hemorrhage...
April 2018: Neurology. Clinical Practice
https://www.readbyqxmd.com/read/29706056/changes-in-medical-care-due-to-the-absence-of-internal-medicine-physicians-in-emergency-departments
#12
Kyoung Ho Kim, Jang Young Lee, Won Suk Lee, Won Young Sung, Sang Won Seo
Objective: Especially in emergency departments (EDs), a lack of internal medicine (IM) residents in charge causes difficulties in medical care and ED overcrowding. Thus, protocols without IM residents in EDs is needed. This study aimed to investigate changes in medical care when emergency medicine residents replaced the roles of IM residents. Methods: This study was conducted at a single-site ED of a university medical center. The study group contained patients admitted to the IM department between September and December 2015, during which IM residents were absent in the ED...
April 30, 2018: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/29704980/emergency-department-crowding-and-time-at-the-bedside-a-wearable-technology-feasibility-study
#13
Jessica Castner, Heidi Suffoletto
INTRODUCTION: ED crowding is a public health crisis, limiting quality and access to lifesaving care. The purpose of this study was to (1) evaluate the feasibility of radio-frequency identification tags to measure clinician-patient contact and (2) to test the relationship between ED occupancy and clinician-patient contact time. METHODS: In this 4-week observational study, radio-frequency identification tags were worn by emergency clinicians in a 21-bay urban teaching hospital emergency department...
April 25, 2018: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/29704167/context-and-clinical-reasoning-understanding-the-medical-student-perspective
#14
Elexis McBee, Temple Ratcliffe, Lambert Schuwirth, Daniel O'Neill, Holly Meyer, Shelby J Madden, Steven J Durning
INTRODUCTION: Studies have shown that a physician's clinical reasoning performance can be influenced by contextual factors. We explored how the clinical reasoning performance of medical students was impacted by contextual factors in order to expand upon previous findings in resident and board certified physicians. Using situated cognition as the theoretical framework, our aim was to evaluate the verbalized clinical reasoning processes of medical students in order to describe what impact the presence of contextual factors has on their reasoning performance...
April 27, 2018: Perspectives on Medical Education
https://www.readbyqxmd.com/read/29685372/emergency-physician-risk-estimates-and-admission-decisions-for-chest-pain-a-web-based-scenario-study
#15
David L Schriger, Michael Menchine, Warren Wiechmann, Guy Carmelli
STUDY OBJECTIVE: We conducted this study to better understand how emergency physicians estimate risk and make admission decisions for patients with low-risk chest pain. METHODS: We created a Web-based survey consisting of 5 chest pain scenarios that included history, physical examination, ECG findings, and basic laboratory studies, including a negative initial troponin-level result. We administered the scenarios in random order to emergency medicine residents and faculty at 11 US emergency medicine residency programs...
April 20, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29667890/novel-quality-indicators-for-radiologists-interpreting-abdominopelvic-ct-images-risk-adjusted-outcomes-among-emergency-department-patients-with-right-lower-quadrant-pain
#16
Matthew S Davenport, Shokoufeh Khalatbari, James H Ellis, Richard H Cohan, Suzanne T Chong, Keith E Kocher
OBJECTIVE: The purpose of this study was to determine whether individual radiologists are predictive of important relevant health outcomes among emergency department (ED) patients undergoing abdominopelvic CT for right lower quadrant pain. MATERIALS AND METHODS: This single-institution retrospective cohort study included 2169 patients undergoing abdominopelvic CT for right lower quadrant pain in the ED from February 1, 2012, through August 31, 2016. CT examinations were interpreted by 15 radiologists (four emergency, 11 abdominal) who each reported on more than 70 CT examinations in the cohort...
April 18, 2018: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/29667566/us-emergency-medical-services-fellows
#17
Brian Clemency, Christian Martin-Gill, Nicole Rall, Dipesh Patel, Jeffery Myers
IntroductionThe 2015-2016 academic year was the fourth year since the Accreditation Council for Graduate Medical Education (ACGME; Chicago, Illinois USA) accredited Emergency Medical Services (EMS) fellowships, and the first year an in-training examination was given. Soon, ACGME-accredited fellowship education will be the sole path to EMS board certification when the practice pathway closes after 2019. This project aimed to describe the current class of EMS fellows at ACGME-accredited programs and their current educational opportunities to better understand current and future needs in EMS fellowship education...
April 18, 2018: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/29665585/-outpatient-emergency-care-for-nursing-home-residents-a-status-quo-from-a-nursing-perspective
#18
Markus Bleckwenn, Linnea Bell, Rieke Schnakenberg, Klaus Weckbecker, Manuela Klaschik
AIM OF THE STUDY: At present about 2 million people need care in Germany, about one third of them live in old people's homes or nursing homes. Outpatient emergency care of nursing home residents is ensured by primary care physicians, the medical emergency service and the emergency services. Emergency care has rarely been examined from the perspective of nurses. Therefore, in our study, we investigated how the nurses perceive medical care in medical emergencies and what suggestions for improvements they have...
April 17, 2018: Das Gesundheitswesen
https://www.readbyqxmd.com/read/29665190/comparison-of-emergency-medicine-malpractice-cases-involving-residents-to-non-resident-cases
#19
Kiersten L Gurley, Shamai A Grossman, Margaret Janes, C Winnie Yu-Moe, Ellen Song, Carrie D Tibbles, Nathan I Shapiro, Carlo L Rosen
BACKGROUND: Data are lacking on how emergency medicine (EM) malpractice cases with resident involvement differs from cases that do not name a resident. OBJECTIVES: To compare malpractice case characteristics in cases where a resident is involved (resident case) to cases that do not involve a resident (non-resident case) and to determine factors that contribute to malpractice cases utilizing EM as a model for malpractice claims across other medical specialties. METHODS: We used data from the Controlled Risk Insurance Company (CRICO) Strategies' division Comparative Benchmarking System (CBS) to analyze open and closed EM cases asserted from 2009-2013...
April 17, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29650397/assessment-of-five-different-probes-for-lung-ultrasound-in-critically-ill-patients-a-pilot-study
#20
Xavier Bobbia, Margaux Chabannon, Thierry Chevallier, Jean Emmanuel de La Coussaye, Jean Yves Lefrant, Sarah Pujol, Pierre-Géraud Claret, Laurent Zieleskiewicz, Claire Roger, Laurent Muller
INTRODUCTION: The present study was aimed at comparing the diagnosis concordance of five echo probes of lung ultrasound (LUS) with CT scans in intensive care and emergency patients with acute respiratory failure. MATERIALS: This prospective, observational, pilot study involved 10 acute patients in whom a thoracic CT scan was performed. An expert performed an LUS reference exam using five different probes: three probes with a high-quality conventional echo machine (cardiac phased-array probe, abdominal convex probe, linear probe) and two probes (cardiac and linear) with a pocket ultrasound device (PUD)...
April 3, 2018: American Journal of Emergency Medicine
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