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Emergency medicine practice

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https://www.readbyqxmd.com/read/28449293/a-novel-approach-to-study-medical-decision-making-in-the-clinical-setting-the-own-point-of-view-perspective
#1
Thierry Pelaccia, Jacques Tardif, Emmanuel Triby, Bernard Charlin
BACKGROUND: Making diagnostic and therapeutic decisions is a critical activity among physicians. It relies on the ability of physicians to use cognitive processes and specific knowledge in the context of a clinical reasoning. This ability is a core competency in physicians, especially in the field of emergency medicine where the rate of diagnostic errors is high. Studies that explore medical decision-making in an authentic setting are increasing significantly. They are based on the use of qualitative methods which are applied at two separate times: 1) a video recording of the subject's actual activity in an authentic setting and 2) an interview with the subject, supported by the video recording...
April 27, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28447542/assessing-outcomes-of-educational-videos-in-group-visits-for-patients-with-chronic-pain-at-an-academic-primary-care-clinic
#2
Carrie Vogler, Stacy Sattovia, Laura Y Salazar, Tiffany I Leung, Albert Botchway
OBJECTIVES: This study evaluates the impact of pain education group visits on patients with chronic non-cancer pain (CNCP). The primary outcome of the study was to evaluate patients' functional status and secondary outcomes included knowledge, behavior, and satisfaction, before and after participation in the pain education group visits. METHODS: Locally produced patient educational videos on chronic non-cancer pain were delivered during patient group visits led by a healthcare provider...
April 27, 2017: Postgraduate Medicine
https://www.readbyqxmd.com/read/28441672/how-to-lead-the-way-through-complexity-constraint-and-uncertainty-in-academic-health-science-centers
#3
Susan J Lieff, Francis J Yammarino
Academic medicine is in an era of unprecedented and constant change due to fluctuating economies, globalization, emerging technologies, research, and professional and educational mandates. Consequently, academic health science centers (AHSCs) are facing new levels of complexity, constraint, and uncertainty. Currently, AHSC leaders work with competing academic and health service demands and are required to work with and are accountable to a diversity of stakeholders. Given the new challenges and emerging needs, the authors believe the leadership methods and approaches AHSCs have used in the past that led to successes will be insufficient...
May 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28441671/swimming-upstream-creating-a-culture-of-high-value-care
#4
Reshma Gupta, Christopher Moriates
As health system leaders strategize the best ways to encourage the transition toward value-based health care, the underlying culture-defined as a system of shared assumptions, values, beliefs, and norms existing within an environment-continues to shape clinician practice patterns. The current prevailing medical culture contributes to overtesting, overtreatment, and health care waste. Choosing Wisely lists, appropriateness criteria, and guidelines codify best practices, but academic medicine as a whole must recognize that faculty and trainees are all largely still operating within the same cultural climate...
May 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28438783/mistakes-and-missed-opportunities-regarding-cosmetic-surgery-and-conscientious-objection
#5
Toni C Saad
In her paper 'Cosmetic surgery and conscientious objection', Minerva rightly identifies cosmetic surgery as an interesting test case for the question of conscientious objection in medicine. Her treatment of this important subject, however, seems problematic. It is argued that Minerva's suggestion that a doctor has a prima facie duty to satisfy patient preferences even against his better clinical judgment, which we call Patient Preference Absolutism, must be regarded with scepticism. This is because (1) it overlooks an important distinction regarding autonomy's meaning and place in clinical practice, and (2) it makes obsolete the important concepts of expert clinical judgment and beneficence...
April 24, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28437370/ethics-guide-recommendations-for-organ-donation-focused-physicians-endorsed-by-the-canadian-medical-association
#6
Sam D Shemie, Christy Simpson, Jeff Blackmer, Shavaun MacDonald, Sonny Dhanani, Sylvia Torrance, Paul Byrne
Donation physicians are specialists with expertise in organ and tissue donation and have been recognized internationally as a key contributor to improving organ and tissue donation services. Subsequent to a 2011 Canadian Critical Care Society-Canadian Blood Services consultation, the donation physician role has been gradually implemented in Canada. These professionals are generally intensive care unit physicians with an enhanced focus and expertise in organ/tissue donation. They must manage the dual obligation of caring for dying patients and their families while providing and/or improving organ donation services...
May 2017: Transplantation
https://www.readbyqxmd.com/read/28435508/a-novel-collaboration-to-reduce-the-travel-related-cost-of-residency-interviewing
#7
Eric Shappell, Abra Fant, Benjamin Schnapp, Jill P Craig, James Ahn, Christine Babcock, Michael A Gisondi
INTRODUCTION: Interviewing for residency is a complicated and often expensive endeavor. Literature has estimated interview costs of $4,000 to $15,000 per applicant, mostly attributable to travel and lodging. The authors sought to reduce these costs and improve the applicant interview experience by coordinating interview dates between two residency programs in Chicago, Illinois. METHODS: Two emergency medicine residency programs scheduled contiguous interview dates for the 2015-2016 interview season...
April 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28435485/impact-of-health-policy-changes-on-emergency-medicine-in-maryland-stratified-by-socioeconomic-status
#8
Laura Pimentel, David Anderson, Bruce Golden, Edward Wasil, Fermin Barrueto, Jon M Hirshon
INTRODUCTION: On January 1, 2014, the financing and delivery of healthcare in the state of Maryland (MD) profoundly changed. The insurance provisions of the Patient Protection and Affordable Care Act (ACA) began implementation and a major revision of MD's Medicare waiver ushered in a Global Budget Revenue (GBR) structure for hospital reimbursement. Our objective was to analyze the impact of these policy changes on emergency department (ED) utilization, hospitalization practices, insurance profiles, and professional revenue...
April 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28435482/state-emergency-department-opioid-guidelines-current-status
#9
Robert I Broida, Tanner Gronowski, Andrew F Kalnow, Andrew G Little, Christopher M Lloyd
INTRODUCTION: The purpose of this study was to evaluate and categorize current state-sponsored opioid guidelines for the practice of emergency medicine (EM). METHODS: We conducted a comprehensive search of EM-specific opioid prescribing guidelines and/or policies in each state to determine current state involvement in EM opioid prescribing, as well as to evaluate some of the specifics of each guideline or policy. The search was conducted using an online query and a follow-up email request to each state chapter of ACEP...
April 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28427766/evaluation-of-a-model-of-integrated-care-for-patients-with-chronic-medical-and-psychiatric-illness
#10
Aghaegbulam Uga, Shreedhar Kulkarni, Vineka Heeramun, Kathy Bottum
BACKGROUND: Chronic illnesses are prevalent in general medical and psychiatric practices, causing significant disease burden to care givers and providers. Systems of care that treat individuals with mental illness are often separate from general medical systems of care. OBJECTIVE: This study sought to compare the quality of life, satisfaction with care, and utilization of care in patients with comorbid chronic medical and mental illnesses. METHODS: A total of 64 participants from an integrated medicine and psychiatry clinic (med/psych), were compared with 52 patients from separate internal medicine and psychiatry clinics (within the same institution) for quality of life, satisfaction with care, and utilization of care...
February 20, 2017: Psychosomatics
https://www.readbyqxmd.com/read/28426110/closing-the-gap-in-travel-medicine-reframing-research-questions-for-a-new-era
#11
Lin H Chen, Karin Leder, Mary E Wilson
Background: Travel medicine needs are changing. New patterns of travel, including greater travel by individuals from emerging economies with different values in costs, risks and benefits, must be considered. This review aims to (1) highlight selected studies that have been published that address previously identified gaps in knowledge; (2) propose possible ways to consider questions regarding travel medicine practice for travelers from emerging economies, underscoring priorities for research focusing on these important populations; (3) highlight potential deficiencies in relevance of current international guidelines as they pertain to travelers from emerging economies; (4) frame research questions for travelers from emerging economies and (5) consider roles for ISTM in closing the gap...
July 1, 2017: Journal of Travel Medicine
https://www.readbyqxmd.com/read/28425004/on-the-inner-life-of-physicians-analysis-of-family-medicine-residents-written-reflections
#12
Andrea Vicini, Allen F Shaughnessy, Ashley Duggan
This qualitative study introduces the broad and inclusive concept of the "inner life of physicians" and analyzes the written reflections (N = 756) of family medicine residents (N = 33) during their residency as indicative of the physicians' inner lives. Residents completed reflective entries without specific prompts. Researchers describe unsolicited emergent categorical themes indicative of a robust inner life of the physician. Nurturing physicians' inner life through reflection allows physicians to recognize, identify, and respond to daily emotional events...
April 19, 2017: Journal of Religion and Health
https://www.readbyqxmd.com/read/28422296/keeping-out-and-getting-in-reframing-emergency-department-gatekeeping-as-structural-competence
#13
Mara Buchbinder
Sociologists have tended to frame medical gatekeeping as an exclusionary social practice, delineating how practitioners and clerical staff police the moral boundaries of medicine by keeping out patients who are categorised as 'bad', 'deviant', or otherwise problematic. Yet medical gatekeeping, understood more broadly, can include not only keeping patients out of particular clinical settings, but also redirecting them to alternative sources of care. In this article, I draw on qualitative analysis of audio-recorded patient-provider interactions in a United States emergency department (ED) to illustrate medical gatekeeping as a two-step process of, first, categorising certain patient complaints as unsuitable for treatment within a particular setting, and second, diverting patients to alternative sites for care...
April 19, 2017: Sociology of Health & Illness
https://www.readbyqxmd.com/read/28421650/keeping-up-with-the-kids-diffusion-of-innovation-in-pediatric-emergency-medicine-among-emergency-physicians
#14
Robert L Cloutier, Rakesh D Mistry, Stephen Cico, Chris Merritt, Samuel H F Lam, Marc Auerbach, L Melissa Skaugset, Jean Klig, Meg Wolff, Myto Duong, Jennifer Walthall
With 30,000,000 emergency department (ED) visits annually, children account for nearly one fourth of all ED visits in the United States. Despite these statistics, EDs across the country remain underprepared to care for pediatric patients [1, 2]. Based on published data, only 45% of EDs report having a pediatric quality improvement plan in place, one third of hospitals do not weigh children in kilograms, less than half have disaster plans in place for pediatric patients and more than 15% are missing critical pediatric emergency equipment [1]...
April 19, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28421563/the-current-utilization-and-perceptions-of-prescription-drug-monitoring-programs-among-emergency-medicine-providers-in-florida
#15
Henry W Young, Joseph A Tyndall, Linda B Cottler
BACKGROUND: Pain is among the most commonly treated symptoms in the emergency department, and opioids are commonly prescribed from the emergency department to treat moderate to severe pain. Prescription drug monitoring programs (PDMP) can be used to assist physicians identify individuals at increased risk to misuse or abuse opioids. While the use of the PDMP has been shown useful among clinicians, in the past, utilization of the PDMP has been less than optimal. The objective of this study was to assess the current utilization and perceptions of the prescription drug monitoring program among emergency medicine providers in Florida...
December 2017: International Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28420618/research-progress-on-liquid-biopsy-in-oncology-and-its-clinical-applications
#16
Wang Chen, Li Yanming, Fang Xiangdong
Liquid biopsy is an emerging and promising detection tool for cancer, with the benefit of being non-invasive and convenient. It analyzes tumor-derived information in the blood or other body fluids including circulating tumour cells (CTCs), circulating tumour DNA (ctDNA) and exosomes. Nowadays, with the expansion of liquid biopsy research contents and the development of capture and detection technologies, liquid biopsy is increasingly utilized in clinical applications, promoting the development of tumor precision medicine...
March 20, 2017: Yi Chuan, Hereditas
https://www.readbyqxmd.com/read/28420603/the-coags-uncomplicated-app-fulfilling-educational-gaps-around-diagnosis-and-laboratory-testing-of-coagulation-disorders
#17
Craig Kessler, Ellinor I Peerschke, Meera B Chitlur, Roshni Kulkarni, Natalia Holot, David L Cooper
BACKGROUND: Patients with coagulation disorders may present to a variety of physician specialties; however, accurate and efficient diagnosis can be challenging for physicians not specialized in hematology, due to identified gaps in knowledge around appropriate laboratory assays and interpretation of test results. Coags Uncomplicated was developed to fill this unmet educational need by increasing practical knowledge of coagulation disorders among nonexpert physicians and other health care professionals (HCPs) in a point-of-care (POC) setting...
April 18, 2017: JMIR Medical Education
https://www.readbyqxmd.com/read/28410792/accuracy-of-pecarn-catch-and-chalice-head-injury-decision-rules-in-children-a-prospective-cohort-study
#18
Franz E Babl, Meredith L Borland, Natalie Phillips, Amit Kochar, Sarah Dalton, Mary McCaskill, John A Cheek, Yuri Gilhotra, Jeremy Furyk, Jocelyn Neutze, Mark D Lyttle, Silvia Bressan, Susan Donath, Charlotte Molesworth, Kim Jachno, Brenton Ward, Amanda Williams, Amy Baylis, Louise Crowe, Ed Oakley, Stuart R Dalziel
BACKGROUND: Clinical decision rules can help to determine the need for CT imaging in children with head injuries. We aimed to validate three clinical decision rules (PECARN, CATCH, and CHALICE) in a large sample of children. METHODS: In this prospective observational study, we included children and adolescents (aged <18 years) with head injuries of any severity who presented to the emergency departments of ten Australian and New Zealand hospitals. We assessed the diagnostic accuracy of PECARN (stratified into children aged <2 years and ≥2 years), CATCH, and CHALICE in predicting each rule-specific outcome measure (clinically important traumatic brain injury [TBI], need for neurological intervention, and clinically significant intracranial injury, respectively)...
April 11, 2017: Lancet
https://www.readbyqxmd.com/read/28408071/error-contradiction-and-reversal-in-science-and-medicine
#19
Sergio Coccheri
Error and contradictions are not "per se" detrimental in science and medicine. Going back to the history of philosophy, Sir Francis Bacon stated that "truth emerges more readily from error than from confusion", and recently Popper introduced the concept of an approximate temporary truth that constitutes the engine of scientific progress. In biomedical research and in clinical practice we assisted during the last decades to many overturnings or reversals of concepts and practices. This phenomenon may discourage patients from accepting ordinary medical care and may favour the choice of alternative medicine...
April 10, 2017: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/28405953/angioedema-in-the-emergency-department-a-practical-guide-to-differential-diagnosis-and-management
#20
REVIEW
Jonathan A Bernstein, Paolo Cremonesi, Thomas K Hoffmann, John Hollingsworth
BACKGROUND: Angioedema is a common presentation in the emergency department (ED). Airway angioedema can be fatal; therefore, prompt diagnosis and correct treatment are vital. OBJECTIVE OF THE REVIEW: Based on the findings of two expert panels attended by international experts in angioedema and emergency medicine, this review aims to provide practical guidance on the diagnosis, differentiation, and management of histamine- and bradykinin-mediated angioedema in the ED...
December 2017: International Journal of Emergency Medicine
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