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https://www.readbyqxmd.com/read/28942776/clinician-perspectives-on-the-management-of-abnormal-subcritical-tests-in-an-urban-academic-safety-net-health-care-system
#1
Cassidy Clarity, Urmimala Sarkar, Jonathan Lee, Margaret A Handley, L Elizabeth Goldman
BACKGROUND: Missed or delayed follow-up of abnormal subcritical tests (tests that do not require immediate medical attention) can lead to poor patient outcomes. Safety-net health systems with limited resources and socially complex patients are vulnerable to safety gaps resulting from delayed management. Clinician perspectives to identify system challenges, vulnerable situations, and potential solutions were sought in focus groups. METHODS: Five semistructured focus groups were conducted in 2015 with purposefully sampled clinicians from radiology, hospital medicine, emergency medicine, risk management, and ambulatory care from an urban, academic, integrated, safety-net health system...
October 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28941558/emergency-medicine-evaluation-of-community-acquired-pneumonia-history-examination-imaging-and-laboratory-assessment-and-risk-scores
#2
Brit Long, Drew Long, Alex Koyfman
BACKGROUND: Pneumonia is a common infection, accounting for approximately one million hospitalizations in the United States annually. This potentially life-threatening disease is commonly diagnosed based on history, physical examination, and chest radiograph. OBJECTIVE: To investigate emergency medicine evaluation of community-acquired pneumonia including history, physical examination, imaging, and the use of risk scores in patient assessment. DISCUSSION: Pneumonia is the number one cause of death from infectious disease...
September 20, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28941075/patient-perspectives-on-priorities-for-emergency-medicine-research-the-perspex-study
#3
Stuart Vb McLay, David McCutcheon, Glenn Arendts, Stephen Pj Macdonald, Daniel M Fatovich
OBJECTIVES: To determine the priorities for emergency medicine research of patients currently in an ED and to compare their priorities with those of ACEM researchers. METHODS: A survey of current patients in the EDs of Royal Perth Hospital and Armadale Health Service. Patients gave their reason for presentation, suggested three important research priorities for emergency medicine and ranked their top 5 choices from a pre-specified list published by the ACEM researchers...
September 21, 2017: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/28940436/in-reply
#4
Erin Dehon, Nicole Weiss, Sarah A Sterling
We appreciate the comments and concerns raised by members of SAEM's Academy of Diversity and Inclusion in Emergency Medicine(1) regarding the findings of our article, "A Systematic Review of the Impact of Physician Implicit Racial Bias on Clinical Decision Making."(2) We agree with Samuels et al.(1) that there are notable methodological limitations of earlier studies examining the influence of physician implicit bias on clinical decision making that must be considered when interpreting the findings of our systematic review...
September 20, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28939398/the-emergency-medicine-focused-review-of-cholangitis
#5
Rachel Ely, Brit Long, Alex Koyfman
BACKGROUND: Cholangitis is a life-threatening infection of the biliary tract. Historically, the mortality secondary to cholangitis approached 100%. However, with early recognition, antibiotics, resuscitation, and surgical or endoscopic intervention, patient outcomes have significantly improved, although there is still progress to be made. OBJECTIVE OF REVIEW: The objective of this review is to provide an emergency medicine-centered approach to the risk factors, presentations, and various diagnostic and treatment modalities in cholangitis...
September 19, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28934995/quality-improvement-primer-part-2-executing-a-quality-improvement-project-in-the-emergency-department
#6
Lucas B Chartier, Antonia S Stang, Samuel Vaillancourt, Amy H Y Cheng
The topics of quality improvement (QI) and patient safety have become important themes in health care in recent years, particularly in the emergency department setting, which is a frequent point of contact with the health care system for patients. In the first of three articles in this series meant as a QI primer for emergency medicine clinicians, we introduced the strategic planning required to develop an effective QI project using a fictional case study as an example. In this second article we continue with our example of improving time to antibiotics for patients with sepsis, and introduce the Model for Improvement...
September 22, 2017: CJEM
https://www.readbyqxmd.com/read/28933808/pediatric-orthopedic-injuries-evidence-based-management-in-the-emergency-department-digest
#7
Jamie Lien, Kathryn H Pade
Upper and lower extremity injuries are common in children, with an overall risk of fracture estimated at just under 1 in 5 children. Pediatric bone anatomy and physiology produce age specific injury patterns and conditions that are unique to children, which can make accurate diagnosis difficult for emergency clinicians. This issue reviews the etiology and pathophysiology of child-specific fractures, as well as common injuries of the upper and lower extremities. Evidence-based recommendations for management of pediatric fractures, including appropriate diagnostic studies and treatment, are also discussed...
September 22, 2017: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/28933807/recognizing-and-managing-adrenal-disorders-in-the-emergency-department-digest
#8
Amy Cutright, Stephen Ducey, Claudia L Barthold, Jeremy Kim
Primary and secondary adrenal insufficiency are underrecognized conditions among emergency department patients, affecting an estimated 10% to 20% of critically ill patients. The signs and symptoms of cortisol deficit can be nonspecific and wide-ranging, and identification and swift treatment with stress-dosing of hydrocortisone is vital to avoid life-threatening adrenal crisis. Laboratory evaluation focuses on identification of electrolyte abnormalities typical of adrenal insufficiency, and while additional testing may depend on the type and severity of symptoms, it should not delay corticosteroid replacement...
September 22, 2017: Emergency Medicine Practice
https://www.readbyqxmd.com/read/28932702/emergency-ct-of-blunt-abdominal-trauma-experience-from-a-large-urban-hospital-in-southern-china
#9
REVIEW
Jingshan Gong, Dongdong Mei, Minjie Yang, Jianmin Xu, Yangyang Zhou
Trauma is one of the leading causes of death for men and women under the age of 45 years old, and abdominal injuries contribute to a large number of these deaths. Prompt diagnosis is very important for treatment decision making and can be life-saving. CT has become an essential imaging modality in emergency medicine. In this pictorial review, we present our experience of CT in blunt abdominal trauma and describe CT findings of common injuries, including hemoperitoneum, solid viscera, hollow viscera, mesenteric and diaphragmatic injuries...
August 2017: Quantitative Imaging in Medicine and Surgery
https://www.readbyqxmd.com/read/28932396/research-associates-program-expanding-clinical-research-productivity-with-undergraduate-students
#10
Wirachin Hoonpongsimanont, Preet K Sahota, Nathan N Ng, Maryam J Farooqui, Bharath Chakravarthy, Bhakti Patel, Shahram Lotfipour
OBJECTIVES: Clinical research is often time-consuming and difficult to conduct in busy academic institutions. Previous studies have proposed methods to integrate undergraduate students as a means to increase research productivity. The authors aimed to describe the possibility to enhance emergency department research productivity at an academic emergency department in the United States, using undergraduate students in an Emergency Medicine Research Associates Program. METHODS: The authors described the Emergency Medicine Research Associates Program curriculum and its implementation...
2017: SAGE Open Medicine
https://www.readbyqxmd.com/read/28932302/predictive-value-of-tracheal-rapid-ultrasound-exam-performed-in-the-emergency-department-for-verification-of-tracheal-intubation
#11
Babak Masoumi, Reza Azizkhani, Gilava Hedayati Emam, Morteza Asgarzadeh, Behrouz Zargar Kharazi
BACKGROUND: Verification of the correct placement of the endotracheal tube (ETT) has been one of the most challenging issues of airway management in the field of emergency medicine. Early detection of oesophagal intubation through a reliable method is important for emergency physicians. AIM: The aim of this study was to assess the diagnostic accuracy of tracheal rapid ultrasound exam (TRUE) to assess endotracheal tube misplacement during emergency intubation. METHODS: This was an observational prospective study performed in the emergency department of the major tertiary referral hospital in the city...
August 15, 2017: Open Access Macedonian Journal of Medical Sciences
https://www.readbyqxmd.com/read/28927998/the-neurology-literature-2016
#12
REVIEW
Danya Khoujah, Wan-Tsu W Chang, Michael K Abraham
Emergency neurology is a complex and rapidly changing field. Its evolution can be attributed in part to increased imaging options, debates about optimal treatment, and simply the growth of emergency medicine as a specialty. Every year, a number of articles published in emergency medicine or other specialty journals should become familiar to the emergency physician. This review summarizes neurology articles published in 2016, which the authors consider crucial to the practice of emergency medicine. The articles are categorized according to disease process, with the understanding that there can be significant overlap among articles...
September 6, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28927978/approaching-zero-implications-of-a-computed-tomography-reduction-program-for-pediatric-appendicitis-evaluation
#13
K Tinsley Anderson, Marisa Bartz-Kurycki, Mary T Austin, Akemi Kawaguchi, Susan D John, Lillian S Kao, KuoJen Tsao
PURPOSE: Because of awareness of iatrogenic radiation exposure, there is a national trend of diminishing computed tomography (CT) use for pediatric suspected appendicitis. The purpose of this study was to evaluate the effects of a CT reduction program for evaluation of appendicitis. METHODS: A multidisciplinary group (emergency medicine, radiology, and surgery) at a children's hospital developed a reduction program which included: ultrasound (U/S) first (2012), magnetic resonance imaging (MRI) second (2014), and standardized U/S reports (2016)...
September 5, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28925587/lessons-learned-from-the-development-and-parameterization-of-a-computer-simulation-model-to-evaluate-task-modification-for-healthcare-providers
#14
Parastu Kasaie, W David Kelton, Rachel M Ancona, Michael J Ward, Craig M Froehle, Michael S Lyons
Computer simulation is a highly advantageous method for understanding and improving healthcare operations with a wide variety of possible applications. Most computer-simulation studies in emergency medicine have sought to improve allocation of resources to meet demand, or to assess the impact of hospital and other system policies on emergency department (ED) throughput. These models have enabled essential discoveries that can be used to improve the general structure and functioning of EDs. Theoretically, computer simulation could also be used to examine the impact of adding or modifying specific provider tasks...
September 19, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28925571/human-factors-and-simulation-in-emergency-medicine
#15
Emily M Hayden, Ambrose H Wong, Jeremy Ackerman, Margaret K Sande, Charles Lei, Leo Kobayashi, Michael Cassara, Dylan D Cooper, Kimberly Perry, William E Lewandowski, Mark W Scerbo
This consensus group from the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change through Health Care Simulation: Systems, Competency, and Outcomes" held in Orlando, Florida on May 16, 2017 focused on the use of human factors and simulation in the field of emergency medicine. The human factors discipline is often underutilized within emergency medicine but has significant potential in improving the interface between technologies and individuals in the field. The discussion explored the domain of human factors, its benefits in medicine, how simulation can be a catalyst for human factors work in emergency medicine, and how emergency medicine can collaborate with human factors professionals to affect change...
September 19, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28921727/hot-off-the-press-embedded-clinical-decision-support-in-electronic-health-record-decreases-use-of-high-cost-imaging-in-the-emergency-department-embed-study
#16
Corey Heitz, Justin Morgenstern, William K Milne
This longitudinal before/after study of embedded CDRs assessed the effects of clinical decision support on use of common imaging studies. Among high users, rates of CT-brain and CT c-spine were reduced after implementation of embedded clinical decision instruments, while in low users, rates increased. This article summarizes the manuscript and the Skeptics Guide to Emergency Medicine podcast, as well as the ensuing social media/online discussion. This article is protected by copyright. All rights reserved.
September 15, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28920825/cjem-debate-series-burnout-burnout-is-inevitable-in-clinical-emergency-medicine-practice
#17
Paul Atkinson, James Ducharme, Sam Campbell
No abstract text is available yet for this article.
September 2017: CJEM
https://www.readbyqxmd.com/read/28918414/a-protocol-of-a-cross-sectional-study-evaluating-an-online-tool-for-early-career-peer-reviewers-assessing-reports-of-randomised-controlled-trials
#18
Anthony Chauvin, David Moher, Doug Altman, David L Schriger, Sabina Alam, Sally Hopewell, Daniel R Shanahan, Alessandro Recchioni, Philippe Ravaud, Isabelle Boutron
INTRODUCTION: Systematic reviews evaluating the impact of interventions to improve the quality of peer review for biomedical publications highlighted that interventions were limited and have little impact. This study aims to compare the accuracy of early career peer reviewers who use an innovative online tool to the usual peer reviewer process in evaluating the completeness of reporting and switched primary outcomes in completed reports. METHODS AND ANALYSIS: This is a cross-sectional study of individual two-arm parallel-group randomised controlled trials (RCTs) published in the BioMed Central series medical journals, BMJ, BMJ Open and Annals of Emergency Medicine and indexed with the publication type 'Randomised Controlled Trial'...
September 15, 2017: BMJ Open
https://www.readbyqxmd.com/read/28917064/a-novel-method-for-improving-chest-tube-insertion-skills-among-medical-interns-using-biomaterial-covered-mannequin
#19
Ozgur Tatli, Suha Turkmen, Melih Imamoglu, Yunus Karaca, Mustafa Cicek, Metin Yadigaroglu, Selen T Bayrak, Olgun Asik, Murat Topbas, Suleyman Turedi
To develop a low-cost biomaterial-covered chest tube simulation model and assess its possible usefulness for developing the chest tube insertion skills among medical interns. Methods: This mannequin-based interventional study was performed in a University hospital setting. We included 63 physicians performing emergency medicine internship at the Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey, between January 2015 and March 2015. A dummy was prepared for training simulation using a display mannequin...
October 2017: Saudi Medical Journal
https://www.readbyqxmd.com/read/28915258/rapid-emergency-medicine-score-a-novel-prognostic-tool-for-predicting-the-outcomes-of-adult-patients-with-hepatic-portal-venous-gas-in-the-emergency-department
#20
Chen-June Seak, David Hung-Tsang Yen, Chip-Jin Ng, Yon-Cheong Wong, Kuang-Hung Hsu, Joanna Chen-Yeen Seak, Hsien-Yi Chen, Chen-Ken Seak
OBJECTIVE: This study aims to evaluate the performance of Rapid Emergency Medicine Score (REMS), Rapid Acute Physiology Score (RAPS), and Modified Early Warning Score (MEWS) in ascertaining the severity of illness and predicting the mortality of adult hepatic portal venous gas (HPVG) patients presenting to the emergency department (ED). This will assist emergency physicians (EPs) in risk stratification. METHODS: Data for 66 adult HPVG patients who visited the EDs of 2 research hospitals between October 1999 and April 2016 were analyzed...
2017: PloS One
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