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Sample records for emergency medicine clinical

  1. Promoting interventional radiology in clinical practice of emergency medicine

    International Nuclear Information System (INIS)

    Zhou Bing; Yuan Jianhua

    2009-01-01

    Interventional radiology has lot of advantages in dealing with various emergencies. The technique is minimally-invasive, highly-effective and immediately-efficient, moreover, it integrates the diagnosis with the therapy perfectly. Besides, the interventional techniques applied in emergency medicine include not only the vascular interventions,such as embolization, embolectomy, etc, but also the nonvascular interventions, such as tracheal s tent implantation, percutaneous vertebroplasty and so forth. However, importance has not been attached to the clinical use of interventional therapy in emergency medicine so far. It is imperative for us to promote the acceptance of interventional therapy in emergency medicine as well as to popularize the technique in clinical practice. (authors)

  2. Can emergency medicine research benefit from adaptive design clinical trials?

    Science.gov (United States)

    Flight, Laura; Julious, Steven A; Goodacre, Steve

    2017-04-01

    Adaptive design clinical trials use preplanned interim analyses to determine whether studies should be stopped or modified before recruitment is complete. Emergency medicine trials are well suited to these designs as many have a short time to primary outcome relative to the length of recruitment. We hypothesised that the majority of published emergency medicine trials have the potential to use a simple adaptive trial design. We reviewed clinical trials published in three emergency medicine journals between January 2003 and December 2013. We determined the proportion that used an adaptive design as well as the proportion that could have used a simple adaptive design based on the time to primary outcome and length of recruitment. Only 19 of 188 trials included in the review were considered to have used an adaptive trial design. A total of 154/165 trials that were fixed in design had the potential to use an adaptive design. Currently, there seems to be limited uptake in the use of adaptive trial designs in emergency medicine despite their potential benefits to save time and resources. Failing to take advantage of adaptive designs could be costly to patients and research. It is recommended that where practical and logistical considerations allow, adaptive designs should be used for all emergency medicine clinical trials. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  3. An eMERGE Clinical Center at Partners Personalized Medicine

    Directory of Open Access Journals (Sweden)

    Jordan W. Smoller

    2016-01-01

    Full Text Available The integration of electronic medical records (EMRs and genomic research has become a major component of efforts to advance personalized and precision medicine. The Electronic Medical Records and Genomics (eMERGE network, initiated in 2007, is an NIH-funded consortium devoted to genomic discovery and implementation research by leveraging biorepositories linked to EMRs. In its most recent phase, eMERGE III, the network is focused on facilitating implementation of genomic medicine by detecting and disclosing rare pathogenic variants in clinically relevant genes. Partners Personalized Medicine (PPM is a center dedicated to translating personalized medicine into clinical practice within Partners HealthCare. One component of the PPM is the Partners Healthcare Biobank, a biorepository comprising broadly consented DNA samples linked to the Partners longitudinal EMR. In 2015, PPM joined the eMERGE Phase III network. Here we describe the elements of the eMERGE clinical center at PPM, including plans for genomic discovery using EMR phenotypes, evaluation of rare variant penetrance and pleiotropy, and a novel randomized trial of the impact of returning genetic results to patients and clinicians.

  4. The emergence of trust in clinics of alternative medicine

    DEFF Research Database (Denmark)

    Pedersen, Inge Kryger; Hansen, Vibeke Holm; Grünenberg, Kristina

    2016-01-01

    qualitative studies and informing the empirical findings with a sociological concept of trust, this article provides new empirical insights on how trust emerges in Danish clinics of acupuncture, reflexology and homeopathy. The analysis demonstrates how trust is situational and emerges through both clients...

  5. Development of a clinical forensic medicine curriculum for emergency physicians in the USA.

    Science.gov (United States)

    Smock, W S

    1994-06-01

    To address the forensic needs of living patients, the Department of Emergency Medicine at the University of Louisville School of Medicine in Louisville, Kentucky, USA initiated the first clinical forensic medicine training programme in the USA. In July 1991, formal training in clinical forensic medicine was incorporated into the core curriculum of the USA's second oldest academic emergency medicine training programme. The University of Louisville, in cooperation with the Kentucky Medical Examiner's Office, developed the curriculum to provide the emergency physician with the knowledge base and technical skills to perform forensic evaluations of living patients. Forensic lectures are given monthly by local and regional forensic experts including: forensic pathologists, prosecuting attorneys, firearm and ballistics examiners, law enforcement officers, forensic chemists and forensic odontologists. Topics which are presented include: forensic pathology, forensic photography, ballistics and firearms analysis, paediatric physical and sexual assault, crime scene investigation, forensic odontology, courtroom and expert testimony and the forensic evaluation of penetrating trauma. As a result of the introduction of clinical forensic medicine into the core curriculum of an emergency medicine training programme the residents are now actively addressing the forensic issues encountered in the Emergency department. Key, often short-lived forensic evidence, which was frequently overlooked or discarded while delivering patient care is now recognized, documented and preserved. The development and introduction of a clinical forensic medicine curriculum into emergency medicine training has greatly enhanced the emergency physician's ability to recognize, document and address the forensic needs of their patients who are victims of violent and non-fatal trauma.

  6. Emergency medicine and internal medicine trainees’ smartphone use in clinical settings in the United States

    Directory of Open Access Journals (Sweden)

    Sonja E. Raaum

    2015-10-01

    Full Text Available Purpose: Smartphone technology offers a multitude of applications (apps that provide a wide range of functions for healthcare professionals. Medical trainees are early adopters of this technology, but how they use smartphones in clinical care remains unclear. Our objective was to further characterize smartphone use by medical trainees at two United States academic institutions, as well as their prior training in the clinical use of smartphones. Methods: In 2014, we surveyed 347 internal medicine and emergency medicine resident physicians at the University of Utah and Brigham and Women’s Hospital about their smartphone use and prior training experiences. Scores (0%–100% were calculated to assess the frequency of their use of general features (email, text and patient-specific apps, and the results were compared according to resident level and program using the Mann-Whitney U-test. Results: A total of 184 residents responded (response rate, 53.0%. The average score for using general features, 14.4/20 (72.2% was significantly higher than the average score for using patient-specific features and apps, 14.1/44 (33.0%, P<0.001. The average scores for the use of general features, were significantly higher for year 3–4 residents, 15.0/20 (75.1% than year 1–2 residents, 14.1/20 (70.5%, P=0.035, and for internal medicine residents, 14.9/20 (74.6% in comparison to emergency medicine residents, 12.9/20 (64.3%, P= 0.001. The average score reflecting the use of patient-specific apps was significantly higher for year 3–4 residents, 16.1/44 (36.5% than for year 1–2 residents, 13.7/44 (31.1%; P=0.044. Only 21.7% of respondents had received prior training in clinical smartphone use. Conclusion: Residents used smartphones for general features more frequently than for patient-specific features, but patient-specific use increased with training. Few residents have received prior training in the clinical use of smartphones.

  7. Emergency medicine: Concepts and clinical practice. Second edition. Volume 2

    International Nuclear Information System (INIS)

    Rosen, P.

    1988-01-01

    This book contains over 50 selections. Some of the titles are: Radiation Injuries; Hydrocarbons; Pain control: anesthesia and analgesia; Techniques of endotracheal intubation and muscle relaxation; Neck injuries; Vascular and cardiac injuries; Foreign bodies; Dental emergencies; Knee and lower leg; and Orthopedic injuries

  8. Development of emergency medicine as academic and distinct clinical discipline in Bosnia & Herzegovina.

    Science.gov (United States)

    Salihefendic, Nizama; Zildzic, Muharem; Masic, Izet; Hadziahmetovic, Zoran; Vasic, Dusko

    2011-01-01

    Emergency medicine is a new academic discipline, as well as a recent independent clinical specialization with the specific principles of practice, education and research. It is also a very important segment of the overall health care and health system. Emergency medicine as a distinct specialty was introduced in the U.S. in 1970. Ten years later and relatively quickly emergency medicine was introduced in the health system in Bosnia and Herzegovina as a specialty with a special education program for specialist and a final exam. Compare the development of emergency medicine in Bosnia and Herzegovina with the trends of development of this discipline in the world as a specialization and an academic discipline. Identify specific problems and possible solutions and learn lessons from other countries. Reviewed are the literature data on the development of emergency medicine in the world, programs of undergraduate and postgraduate teaching, the organizational scheme of emergency centers and residency. This is then compared with data of the current status of emergency medicine as an academic discipline and a recognized specialization, in Bosnia and Herzegovina. There are substantial differences in the development of emergency medicine in the United States, European Union and Bosnia and Herzegovina. Although Bosnia and Herzegovina relatively early recognized specialty of emergency medicine in academia, it failed to mach the academic progress with the practical implementation. A&E departments in the Community Health Centers failed to meet the desired objectives even though they were led by specialists in emergency medicine. The main reason being the lack of space and equipment as well as staff needed to meet set standards of good clinical practice, education and research. Furthermore the Curriculum of undergraduate education and specialization does not match modern concept of educational programs that meet the principles set out in emergency medicine and learning through

  9. Quality of registration for clinical trials published in emergency medicine journals.

    Science.gov (United States)

    Jones, Christopher W; Platts-Mills, Timothy F

    2012-10-01

    In 2005, the International Committee of Medical Journal Editors established clinical trial registration as a requirement for articles submitted to member journals, with the goal of improving the transparency of clinical research. The objective of this study is to characterize the registration of clinical trials published in emergency medicine journals. Randomized trials involving human subjects and published between June 1, 2008, and May 31, 2011 in the 5 emergency medicine journals with the highest impact factors were included. We assessed the clarity of registered primary outcomes, timing of registration relative to patient enrollment, and consistency between registered and published outcomes. Of the 123 trials included, registry entries were identified for 57 (46%). Of the 57 registered studies, 45 (79%) were registered after the initiation of subject enrollment, 9 (16%) had registered outcomes that were unclear, and 26 (46%) had discrepancies between registered and published outcomes. Only 5 studies were registered before patient enrollment with a clear primary outcome that was consistent with the published primary outcome. Annals of Emergency Medicine was the only journal in which the majority of trials were registered. Current compliance with clinical trial registration guidelines is poor among trials published in emergency medicine journals. Copyright © 2012. Published by Mosby, Inc.

  10. Clinical audit of emergency unit before and after establishment of the emergency medicine department.

    Science.gov (United States)

    Amini, Afshin; Dindoost, Payam; Moghimi, Mehrdad; Kariman, Hamid; Shahrami, Ali; Dolatabadi, Ali Arhami; Ali-Mohammadi, Hossein; Alavai-Moghaddam, Mostafa; Derakhshanfar, Hojjat; Hatamabadi, HamidReza; Heidari, Kamran; Alamdari, Shahram; Meibodi, Mohammad Kalantar; Shojaee, Majid; Foroozanfar, Mohammad Mehdi; Hashemi, Behrooz; Sabzeghaba, Anita; Kabir, Ali

    2012-02-01

    To assess the deficiencies and potential areas through a medical audit of the emergency departments, in six general hospitals affiliated to Shahid Beheshti University of Medical Sciences at Tehran, Iran, after preparing specific wards-based international standards. A checklist was completed for all hospitals which met our eligibility criteria mainly observation and interviews with head nurses and managers of the emergency medicine unit of the hospitals before (2003) and after (2008) the establishment of emergency departments there. Domains studied included staffing, education and continuing professional development (CPD), facility (design), equipment, ancillary services, medical records, manuals and references, research, administration, pre-hospital care, information systems, disaster planning, bench-marking and hospital accreditation. Education and CPD (p = 0.042), design and facility (p = 0.027), equipment (p = 0.028), and disaster (p = 0.026) had significantly improved after the establishment of emergency departments. Nearly all domains showed a positive change though it was non-significant in a few. In terms of observation, better improvement was seen in disaster, security, design, and research. According to the score for each domain compared to what it was in the earlier phase, better improvement was observed in hospital accreditation, information systems, security, disaster planning, and research. Security, disaster planning, research, design and facility had improved in hospitals that wave studied, while equipment, records, ancillary services, administration and bench-marking had the lowest improvement even after the establishment of emergency department, and, hence, needed specific attention.

  11. A framework for implementation, education, research and clinical use of ultrasound in emergency departments by the Danish Society for Emergency Medicine

    DEFF Research Database (Denmark)

    Laursen, Christian B; Nielsen, Klaus; Riishede, Minna

    2014-01-01

    The first Danish Society for Emergency Medicine (DASEM) recommendations for the use of clinical ultrasound in emergency departments has been made. The recommendations describes what DASEM believes as being current best practice for training, certification, maintenance of acquired competencies...

  12. Can Emergency Medicine Residents Reliably Use the Internet to Answer Clinical Questions?

    Directory of Open Access Journals (Sweden)

    June Abbas

    2011-05-01

    Full Text Available Introduction: The study objective was to determine the accuracy of answers to clinical questions by emergency medicine (EM residents conducting Internet searches by using Google. Emergency physicians commonly turn to outside resources to answer clinical questions that arise in the emergency department (ED. Internet access in the ED has supplanted textbooks for references because it is perceived as being more up to date. Although Google is the most widely used general Internet search engine, it is not medically oriented and merely provides links to other sources. Users must judge the reliability of the information obtained on the links. We frequently observed EM faculty and residents using Google rather than medicine-specific databases to seek answers to clinical questions. Methods: Two EM faculties developed a clinically oriented test for residents to take without the use of any outside aid. They were instructed to answer each question only if they were confident enough of their answer to implement it in a patient-care situation. Questions marked as unsure or answered incorrectly were used to construct a second test for each subject. On the second test, they were instructed to use Google as a resource to find links that contained answers. Results: Thirty-three residents participated. The means for the initial test were 32% correct, 28% incorrect, and 40% unsure. On the Google test, the mean for correct answers was 59%; 33% of answers were incorrect and 8% were unsure. Conclusion: EM residents’ ability to answer clinical questions correctly by using Web sites from Google searches was poor. More concerning was that unsure answers decreased, whereas incorrect answers increased. The Internet appears to have given the residents a false sense of security in their answers. Innovations, such as Internet access in the ED, should be studied carefully before being accepted as reliable tools for teaching clinical decision making. [West J Emerg Med. 2011

  13. Autopsy interrogation of emergency medicine dispute cases: how often are clinical diagnoses incorrect?

    Science.gov (United States)

    Liu, Danyang; Gan, Rongchang; Zhang, Weidi; Wang, Wei; Saiyin, Hexige; Zeng, Wenjiao; Liu, Guoyuan

    2018-01-01

    Emergency medicine is a 'high risk' specialty. Some diseases develop suddenly and progress rapidly, and sudden unexpected deaths in the emergency department (ED) may cause medical disputes. We aimed to assess discrepancies between antemortem clinical diagnoses and postmortem autopsy findings concerning emergency medicine dispute cases and to figure out the most common major missed diagnoses. Clinical files and autopsy reports were retrospectively analysed and interpreted. Discrepancies between clinical diagnoses and autopsy diagnoses were evaluated using modified Goldman classification as major and minor discrepancy. The difference between diagnosis groups was compared with Pearson χ 2 test. Of the 117 cases included in this study, 71 of cases (58 class I and 13 class II diagnostic errors) were revealed as major discrepancies (60.7%). The most common major diagnoses were cardiovascular diseases (54 cases), followed by pulmonary diseases, infectious diseases and so on. The difference of major discrepancy between the diagnoses groups was significant (ppay special attention to in practice. This study reaffirmed the necessity and usefulness of autopsy in auditing death in EDs. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  14. Science, humanism, judgement, ethics: person-centered medicine as an emergent model of modern clinical practice.

    Science.gov (United States)

    Miles, Andrew

    2013-01-01

    The Medical University of Plovdiv (MUP) has as its motto 'Committed to humanity". But what does humanity in modern medicine mean? Is it possible to practise a form of medicine that is without humanity? In the current article, it is argued that modern medicine is increasingly being practised in a de-personalised fashion, where the patient is understood not as a unique human individual, a person, but rather as a subject or an object and more in the manner of a complex biological machine. Medicine has, it is contended, become distracted from its duty to care, comfort and console as well as to ameliorate, attenuate and cure and that the rapid development of medicine's scientific knowledge is, paradoxically, principally causative. Signal occurrences in the 'patient as a person' movement are reviewed, together with the emergence of the evidence-based medicine (EBM) and patient-centered care (PCC) movements. The characteristics of a model of medicine evolving in response to medicine's current deficiencies--person-centered healthcare (PCH)--are noted and described. In seeking to apply science with humanism, via clinical judgement, within an ethical framework, it is contended that PCH will prove to be far more responsive to the needs of the individual patient and his/her personal circumstances than current models of practice, so that neither a reductive anatomico-pathological, disease-centric model of illness (EBM), nor an aggressive patient-directed, consumerist form of care (PCC) is allowed continued dominance within modern healthcare systems. In conclusion, it is argued that PCH will enable affordable advances in biomedicine and technology to be delivered to patients within a humanistic framework of clinical practice that recognises the patient as a person and which takes full account of his/her stories, values, preferences, goals, aspirations, fears, worries, hopes, cultural context and which responds to his/her psychological, emotional, spiritual and social necessities

  15. Sex as a Biological Variable in Emergency Medicine Research and Clinical Practice: A Brief Narrative Review

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    Alyson J. McGregor

    2017-10-01

    Full Text Available The National Institutes of Health recently highlighted the significant role of sex as a biological variable (SABV in research design, outcome and reproducibility, mandating that this variable be accounted for in all its funded research studies. This move has resulted in a rapidly increasing body of literature on SABV with important implications for changing the clinical practice of emergency medicine (EM. Translation of this new knowledge to the bedside requires an understanding of how sex-based research will ultimately impact patient care. We use three case-based scenarios in acute myocardial infarction, acute ischemic stroke and important considerations in pharmacologic therapy administration to highlight available data on SABV in evidence-based research to provide the EM community with an important foundation for future integration of patient sex in the delivery of emergency care as gaps in research are filled.

  16. Emergency medicine in Dubai, UAE.

    Science.gov (United States)

    Partridge, Robert; Abbo, Michael; Virk, Alamjit

    2009-08-18

    Dubai has rapidly risen to prominence in the Persian Gulf region as a center of global commerce and tourism and as a cultural crossroad between East and West. The health-care infrastructure has undergone rapid development. Collaborations with academic medical centers now exist to advance clinical care, teaching and research. Emergency medicine has also advanced and is undergoing dynamic change. Dubai may soon emerge as a regional leader in emergency medicine training and practice.

  17. Emergency medicine in Dubai, UAE

    OpenAIRE

    Partridge, Robert; Abbo, Michael; Virk, Alamjit

    2009-01-01

    Dubai has rapidly risen to prominence in the Persian Gulf region as a center of global commerce and tourism and as a cultural crossroad between East and West. The health-care infrastructure has undergone rapid development. Collaborations with academic medical centers now exist to advance clinical care, teaching and research. Emergency medicine has also advanced and is undergoing dynamic change. Dubai may soon emerge as a regional leader in emergency medicine training and practice.

  18. Clinical reasoning of junior doctors in emergency medicine: a grounded theory study.

    Science.gov (United States)

    Adams, E; Goyder, C; Heneghan, C; Brand, L; Ajjawi, R

    2017-02-01

    Emergency medicine (EM) has a high case turnover and acuity making it a demanding clinical reasoning domain especially for junior doctors who lack experience. We aimed to better understand their clinical reasoning using dual cognition as a guiding theory. EM junior doctors were recruited from six hospitals in the south of England to participate in semi-structured interviews (n=20) and focus groups (n=17) based on recall of two recent cases. Transcripts were analysed using a grounded theory approach to identify themes and to develop a model of junior doctors' clinical reasoning in EM. Within cases, clinical reasoning occurred in three phases. In phase 1 (case framing), initial case cues and first impressions were predominantly intuitive, but checked by analytical thought and determined the urgency of clinical assessment. In phase 2 (evolving reasoning), non-analytical single cue and pattern recognitions were common which were subsequently validated by specific analytical strategies such as use of red flags. In phase 3 (ongoing uncertainty) analytical self-monitoring and reassurance strategies were used to precipitate a decision regarding discharge. We found a constant dialectic between intuitive and analytical cognition throughout the reasoning process. Our model of clinical reasoning by EM junior doctors illustrates the specific contextual manifestations of the dual cognition theory. Distinct diagnostic strategies are identified and together these give EM learners and educators a framework and vocabulary for discussion and learning about clinical reasoning. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  19. Nuclear medicine in emergency

    International Nuclear Information System (INIS)

    Mansi, L.; Rambaldi, P.F.; Cuccurullo, V.; Varetto, T.

    2005-01-01

    The role of a procedure depends not only on its own capabilities but also on a cost/effective comparison with alternative technique giving similar information. Starting from the definition of emergency as a sudden unexpected occurrence demanding immediate action, the role of nuclear medicine (NM) is difficult to identify if it is not possible to respond 24h a day, 365 days a year, to clinical demands. To justify a 24 h NM service it is necessary to reaffirm the role in diagnosis of pulmonary embolism in the spiral CT era, to spread knowledge of the capabilities of nuclear cardiology in reliability diagnosis myocardial infraction (better defining admission and discharge to/from the emergency department), to increase the number of indications. Radionuclide technique could be used as first line, alternative, complementary procedures in a diagnostic tree taking into account not only the diagnosis but also the connections with prognosis and therapy in evaluating cerebral pathologies, acute inflammation/infection, transplants, bleeding, trauma, skeletal, hepatobiliary, renal and endocrine emergencies, acute scrotal pain

  20. An assessment of the faculty development needs of junior clinical faculty in emergency medicine.

    Science.gov (United States)

    Farley, Heather; Casaletto, Jennifer; Ankel, Felix; Young, Kelly D; Hockberger, Robert

    2008-07-01

    Academic physicians must be able to access the resources necessary to support their ongoing professional development and meet requirements for continued academic advancement. The authors sought to determine the self-perceived career development needs of junior clinical faculty in emergency medicine (EM) and the availability of educational resources to meet those needs. An educational "needs assessment" survey was distributed to 954 American College of Emergency Physicians (ACEP) members listed in the ACEP database as being faculty at EM residency programs in the United States and having graduated from an EM residency within the past 7 years. Respondents were asked to rank the importance of 22 areas of faculty development to their own professional growth and then to indicate whether educational resources in each area were available to them. Respondents were also asked to note the educational formats they prefer. A search for currently available resources in each topic area was undertaken and compared to the survey results. A total of 240 responses were received. Self-perceived career development needs were identified in the following areas: bedside teaching, lecture development, business skills, managerial skills, educational research, mentorship and career counseling, interpersonal skills, leadership skills, scholarly writing skills, physician wellness, and knowledge of the faculty development process. While a review of currently available educational resources revealed lectures, conferences, and online materials pertinent to most of these topics, a relative lack of resources in the areas of mentorship and physician wellness was identified. Junior clinical faculty in EM perceive a lack of educational resources in a number of areas of faculty development. The academic community of EM should strive to improve awareness of and access to currently existing resources and to develop additional resources to address the area of physician wellness. The lack of mentorship in

  1. An Assessment of an Oral Examination Format for Evaluating Clinical Competence in Emergency Medicine.

    Science.gov (United States)

    Solomon, David J.; And Others

    1990-01-01

    In July 1989 the American Board of Emergency Medicine conducted a field test of the oral recertification examination process. Sixteen examiners and 25 examinees participated in the field test. The examination included 3 chart-stimulated recall and 3 simulated-patient encounter cases. (MLW)

  2. LABORATORY OF CLINICAL IMMUNOLOGY N.V. SKLIFOSOVSKY RESEARCH INSTITUTE FOR EMERGENCY MEDICINE (HISTORY AND PRESENT

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    M. A. Godkov

    2013-01-01

    Full Text Available ABSTRACT. Assessment of the immune status of patients with urgent types of pathology in the Institute for Emergency Medicine is performed according to three main objects of research: humoral , phagocytic and lymphocytic components of immune system . This complex allows to fully and adequately evaluate the condition of the immune system of patients at different stages of traumatic disease and after transplantation of organs and tissues , to forecast the probability of septic complications developing, adjust the therapy . During 45 years of work of immunological service formed the algorithm of the adequate immunological screening was formed, number of innovative methods of diagnosis was developed, the ideology of post-test counseling of patients by immunologists was created, mathematical methods of storage, modeling and processing of research results was introduced. Laboratory staff identified a number of medical and social factors in the spread of blood-borne viral infections (HIV, hepatitis B and C. New organizational and economic methods of management team were introduced in the laboratory. The basis of the work is equal integration of scientific and clinical staff of the laboratory. 

  3. Does the Concept of the “Flipped Classroom” Extend to the Emergency Medicine Clinical Clerkship?

    Science.gov (United States)

    Heitz, Corey; Prusakowski, Melanie; Willis, George; Franck, Christopher

    2015-01-01

    Introduction Linking educational objectives and clinical learning during clerkships can be difficult. Clinical shifts during emergency medicine (EM) clerkships provide a wide variety of experiences, some of which may not be relevant to recommended educational objectives. Students can be directed to standardize their clinical experiences, and this improves performance on examinations. We hypothesized that applying a “flipped classroom” model to the clinical clerkship would improve performance on multiple-choice testing when compared to standard learning. Methods Students at two institutions were randomized to complete two of four selected EM clerkship topics in a “flipped fashion,” and two others in a standard fashion. For flipped topics, students were directed to complete chief complaint-based asynchronous modules prior to a shift, during which they were directed to focus on the chief complaint. For the other two topics, modules were to be performed at the students’ discretion, and shifts would not have a theme. At the end of the four-week clerkship, a 40-question multiple-choice examination was administered with 10 questions per topic. We compared performance on flipped topics with those performed in standard fashion. Students were surveyed on perceived effectiveness, ability to follow the protocol, and willingness of preceptors to allow a chief-complaint focus. Results Sixty-nine students participated; examination scores for 56 were available for analysis. For the primary outcome, no difference was seen between the flipped method and standard (p=0.494.) A mixed model approach showed no effect of flipped status, protocol adherence, or site of rotation on the primary outcome of exam scores. Students rated the concept of the flipped clerkship highly (3.48/5). Almost one third (31.1%) of students stated that they were unable to adhere to the protocol. Conclusion Preparation for a clinical shift with pre-assigned, web-based learning modules followed by an

  4. Does the Concept of the "Flipped Classroom" Extend to the Emergency Medicine Clinical Clerkship?

    Science.gov (United States)

    Heitz, Corey; Prusakowski, Melanie; Willis, George; Franck, Christopher

    2015-11-01

    Linking educational objectives and clinical learning during clerkships can be difficult. Clinical shifts during emergency medicine (EM) clerkships provide a wide variety of experiences, some of which may not be relevant to recommended educational objectives. Students can be directed to standardize their clinical experiences, and this improves performance on examinations. We hypothesized that applying a "flipped classroom" model to the clinical clerkship would improve performance on multiple-choice testing when compared to standard learning. Students at two institutions were randomized to complete two of four selected EM clerkship topics in a "flipped fashion," and two others in a standard fashion. For flipped topics, students were directed to complete chief complaint-based asynchronous modules prior to a shift, during which they were directed to focus on the chief complaint. For the other two topics, modules were to be performed at the students' discretion, and shifts would not have a theme. At the end of the four-week clerkship, a 40-question multiple-choice examination was administered with 10 questions per topic. We compared performance on flipped topics with those performed in standard fashion. Students were surveyed on perceived effectiveness, ability to follow the protocol, and willingness of preceptors to allow a chief-complaint focus. Sixty-nine students participated; examination scores for 56 were available for analysis. For the primary outcome, no difference was seen between the flipped method and standard (p=0.494.) A mixed model approach showed no effect of flipped status, protocol adherence, or site of rotation on the primary outcome of exam scores. Students rated the concept of the flipped clerkship highly (3.48/5). Almost one third (31.1%) of students stated that they were unable to adhere to the protocol. Preparation for a clinical shift with pre-assigned, web-based learning modules followed by an attempt at chief-complaint-focused learning during a

  5. Does the Concept of the “Flipped Classroom” Extend to the Emergency Medicine Clinical Clerkship?

    Directory of Open Access Journals (Sweden)

    Corey Heitz

    2015-10-01

    Full Text Available Introduction: Linking educational objectives and clinical learning during clerkships can be difficult. Clinical shifts during emergency medicine (EM clerkships provide a wide variety of experiences, some of which may not be relevant to recommended educational objectives. Students can be directed to standardize their clinical experiences, and this improves performance on examinations. We hypothesized that applying a “flipped classroom” model to the clinical clerkship would improve performance on multiple-choice testing when compared to standard learning. Methods: Students at two institutions were randomized to complete two of four selected EM clerkship topics in a “flipped fashion,” and two others in a standard fashion. For flipped topics, students were directed to complete chief complaint-based asynchronous modules prior to a shift, during which they were directed to focus on the chief complaint. For the other two topics, modules were to be performed at the students’ discretion, and shifts would not have a theme. At the end of the four-week clerkship, a 40-question multiple-choice examination was administered with 10 questions per topic. We compared performance on flipped topics with those performed in standard fashion. Students were surveyed on perceived effectiveness, ability to follow the protocol, and willingness of preceptors to allow a chief-complaint focus. Results: Sixty-nine students participated; examination scores for 56 were available for analysis. For the primary outcome, no difference was seen between the flipped method and standard (p=0.494. A mixed model approach showed no effect of flipped status, protocol adherence, or site of rotation on the primary outcome of exam scores. Students rated the concept of the flipped clerkship highly (3.48/5. Almost one third (31.1% of students stated that they were unable to adhere to the protocol. Conclusion: Preparation for a clinical shift with pre-assigned, web-based learning

  6. How Do Emergency Medicine Residency Programs Structure Their Clinical Competency Committees? A Survey.

    Science.gov (United States)

    Doty, Christopher I; Roppolo, Lynn P; Asher, Shellie; Seamon, Jason P; Bhat, Rahul; Taft, Stephanie; Graham, Autumn; Willis, James

    2015-11-01

    The Accreditation Council for Graduate Medical Education (ACGME) recently has mandated the formation of a clinical competency committee (CCC) to evaluate residents across the newly defined milestone continuum. The ACGME has been nonproscriptive of how these CCCs are to be structured in order to provide flexibility to the programs. No best practices for the formation of CCCs currently exist. We seek to determine common structures of CCCs recently formed in the Council of Emergency Medicine Residency Directors (CORD) member programs and identify unique structures that have been developed. In this descriptive study, an 18-question survey was distributed via the CORD listserv in the late fall of 2013. Each member program was asked questions about the structure of its CCC. These responses were analyzed with simple descriptive statistics. A total of 116 of the 160 programs responded, giving a 73% response rate. Of responders, most (71.6%) CCCs are chaired by the associate or assistant program director, while a small number (14.7%) are chaired by a core faculty member. Program directors (PDs) chair 12.1% of CCCs. Most CCCs are attended by the PD (85.3%) and selected core faculty members (78.5%), leaving the remaining committees attended by any core faculty. Voting members of the CCC consist of the residency leadership either with the PD (53.9%) or without the PD (36.5%) as a voting member. CCCs have an average attendance of 7.4 members with a range of three to 15 members. Of respondents, 53.1% of CCCs meet quarterly while 37% meet monthly. The majority of programs (76.4%) report a system to match residents with a faculty mentor or advisor. Of respondents, 36% include the resident's faculty mentor or advisor to discuss a particular resident. Milestone summaries (determination of level for each milestone) are the primary focus of discussion (93.8%), utilizing multiple sources of information. The substantial variability and diversity found in our CORD survey of CCC structure

  7. Systematic Reviews Published in Emergency Medicine Journals Do Not Routinely Search Clinical Trials Registries: A Cross-Sectional Analysis.

    Science.gov (United States)

    Keil, Lukas G; Platts-Mills, Timothy F; Jones, Christopher W

    2015-10-01

    Publication bias compromises the validity of systematic reviews. This problem can be addressed in part through searching clinical trials registries to identify unpublished studies. This study aims to determine how often systematic reviews published in emergency medicine journals include clinical trials registry searches. We identified all systematic reviews published in the 6 highest-impact emergency medicine journals between January 1 and December 31, 2013. Systematic reviews that assessed the effects of an intervention were further examined to determine whether the authors described searching a clinical trials registry and whether this search identified relevant unpublished studies. Of 191 articles identified through PubMed search, 80 were confirmed to be systematic reviews. Our sample consisted of 41 systematic reviews that assessed a specific intervention. Eight of these 41 (20%) searched a clinical trials registry. For 4 of these 8 reviews, the registry search identified at least 1 relevant unpublished study. Systematic reviews published in emergency medicine journals do not routinely include searches of clinical trials registries. By helping authors identify unpublished trial data, the addition of registry searches may improve the validity of systematic reviews. Copyright © 2014 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  8. Evidence-based emergency medicine. Creating a system to facilitate translation of evidence into standardized clinical practice: a preliminary report.

    Science.gov (United States)

    Wright, Stewart W; Trott, Alexander; Lindsell, Christopher J; Smith, Carol; Gibler, W Brian

    2008-01-01

    The Institute of Medicine, through its landmark report concerning errors in medicine, suggests that standardization of practice through systematic development and implementation of evidence-based clinical pathways is an effective way of reducing errors in emergency systems. The specialty of emergency medicine is well positioned to develop a complete system of innovative quality improvement, incorporating best practice guidelines with performance measures and practitioner feedback mechanisms to reduce errors and therefore improve quality of care. This article reviews the construction, ongoing development, and initial impact of such a system at a large, urban, university teaching hospital and at 2 affiliated community hospitals. The Committee for Procedural Quality and Evidence-Based Practice was formed within the Department of Emergency Medicine to establish evidence-based guidelines for nursing and provider care. The committee measures the effect of such guidelines, along with other quality measures, through pre- and postguideline patient care medical record audits. These measures are fed back to the providers in a provider-specific, peer-matched "scorecard." The Committee for Procedural Quality and Evidence-Based Practice affects practice and performance within our department. Multiple physician and nursing guidelines have been developed and put into use. Using asthma as an example, time to first nebulizer treatment and time to disposition from the emergency department decreased. Initial therapeutic agent changed and documentation improved. A comprehensive, guideline-driven, evidence-based approach to clinical practice is feasible within the structure of a department of emergency medicine. High-level departmental support with dedicated personnel is necessary for the success of such a system. Internet site development (available at http://www.CPQE.com) for product storage has proven valuable. Patient care has been improved in several ways; however, consistent and

  9. Education and training for medicines development, regulation and clinical research in emerging countries.

    Directory of Open Access Journals (Sweden)

    Sandor - Kerpel-Fronius

    2015-04-01

    Full Text Available The aim of this satellite workshop held at the 17th World Congress of Basic and Clinical Pharmacology (WCP2014 was to discuss the needs, optimal methods and practical approaches for extending education teaching of medicines development, regulation and clinical research to Low and Middle Income Countries (LMIC’s. It was generally agreed that, for efficiently treating the rapidly growing number of patients suffering from non-communicable diseases, modern drug therapy has to become available more widely and with a shorter time lag in these countries. To achieve this goal many additional experts working in medicines development, regulation and clinical research have to be trained in parallel. The competence-oriented educational programs designed within the framework of the European Innovative Medicine Initiative-PharmaTrain (IMI-PhT project were developed with the purpose to cover these interconnected fields. In addition, the programs can be easily adapted to the various local needs, primarily due to their modular architecture and well defined learning outcomes. Furthermore, the program is accompanied by stringent quality assurance standards which are essential for providing internationally accepted certificates. Effective cooperation between international and local experts and organizations, the involvement of the industry, health care centers and governments is essential for successful education. The initiative should also support the development of professional networks able to manage complex health care strategies. In addition it should help establish cooperation between neighboring countries for jointly managing clinical trials, as well as complex regulatory and ethical issues.

  10. Emerging Utility of Virtual Reality as a Multidisciplinary Tool in Clinical Medicine.

    Science.gov (United States)

    Pourmand, Ali; Davis, Steven; Lee, Danny; Barber, Scott; Sikka, Neal

    2017-10-01

    Among the more recent products borne of the evolution of digital technology, virtual reality (VR) is gaining a foothold in clinical medicine as an adjunct to traditional therapies. Early studies suggest a growing role for VR applications in pain management, clinical skills training, cognitive assessment and cognitive therapy, and physical rehabilitation. To complete a review of the literature, we searched PubMed and MEDLINE databases with the following search terms: "virtual reality," "procedural medicine," "oncology," "physical therapy," and "burn." We further limited our search to publications in the English language. Boolean operators were used to combine search terms. The included search terms yielded 97 potential articles, of which 45 were identified as meeting study criteria, and are included in this review. These articles provide data, which strongly support the hypothesis that VR simulations can enhance pain management (by reducing patient perception of pain and anxiety), can augment clinical training curricula and physical rehabilitation protocols (through immersive audiovisual environments), and can improve clinical assessment of cognitive function (through improved ecological validity). Through computer-generated, life-like digital landscapes, VR stands to change the current approach to pain management, medical training, neurocognitive diagnosis, and physical rehabilitation. Additional studies are needed to help define best practices in VR utilization, and to explore new therapeutic uses for VR in clinical practice.

  11. Capabilities for Clinical Management of Radiation Injuries of the Nikiforov Russian Center of Emergency and Radiation Medicine (EMERCOM of Russia)

    International Nuclear Information System (INIS)

    Aleksanin, S.

    2016-01-01

    This article presents an overview of the capabilities for clinical management of radiation injuries available at the Nikiforov Russian Center of Emergency and Radiation Medicine (NRCERM) of the Ministry of the Russian Federation for Civil Defense, Emergencies and Elimination of Consequences of Natural Disasters (EMERCOM). NRCERM is a federal state budgetary institution and the Russian Federation's head organization for providing medical assistance for persons overexposed to ionizing radiation, responders to radiation emergencies and people evacuated from radiation contaminated areas. As the WHO Collaborating Center for Treatment and Rehabilitation of Accident Recovery Workers of Nuclear and Other Disasters and a member of the WHO Radiation Emergency Medical Preparedness and Assistance Network (REMPAN), NRCERM is prepared to provide assistance and technical support in case of a radiation accident. For this purpose, NRCERM hospitals are equipped with technologically advanced facilities and possess well-trained specialist staff. (authors)

  12. [Ambulance in emergency medicine].

    Science.gov (United States)

    Aksoy, Fikret; Ergun, Alper

    2002-07-01

    The ambulance service is very important in emergency medicine. The aim of this study was to investigate the new governing statuate of private ambulance service and to propose some new ideas. We examinated the new governing statuate of private ambulance service, rules of patient transporte between the hospitals and reports written by SSK Goztepe Educational Hospital ambulance drivers. We concluded that SSK Goztepe Educational Hospital ambulance drivers have a iot of problems especially at the rules of patient transport between the hospitals and there are some defiencies at the new governing statuate of private ambulance service. We concluded that it is necesssary to manage all the ambulance services in one center; all the private ambulance services have to have a specialist and all these must be determinated by the special rules. Key words: Regulation ofprivate ambulance, emergency head maintanence, ambulance services

  13. Employment of telemedicine in emergency medicine. Clinical requirement analysis, system development and first test results.

    Science.gov (United States)

    Czaplik, M; Bergrath, S; Rossaint, R; Thelen, S; Brodziak, T; Valentin, B; Hirsch, F; Beckers, S K; Brokmann, J C

    2014-01-01

    Demographic change, rising co-morbidity and an increasing number of emergencies are the main challenges that emergency medical services (EMS) in several countries worldwide are facing. In order to improve quality in EMS, highly trained personnel and well-equipped ambulances are essential. However several studies have shown a deficiency in qualified EMS physicians. Telemedicine emerges as a complementary system in EMS that may provide expertise and improve quality of medical treatment on the scene. Hence our aim is to develop and test a specific teleconsultation system. During the development process several use cases were defined and technically specified by medical experts and engineers in the areas of: system administration, start-up of EMS assistance systems, audio communication, data transfer, routine tele-EMS physician activities and research capabilities. Upon completion, technical field tests were performed under realistic conditions to test system properties such as robustness, feasibility and usability, providing end-to-end measurements. Six ambulances were equipped with telemedical facilities based on the results of the requirement analysis and 55 scenarios were tested under realistic conditions in one month. The results indicate that the developed system performed well in terms of usability and robustness. The major challenges were, as expected, mobile communication and data network availability. Third generation networks were only available in 76.4% of the cases. Although 3G (third generation), such as Universal Mobile Telecommunications System (UMTS), provides beneficial conditions for higher bandwidth, system performance for most features was also acceptable under adequate 2G (second generation) test conditions. An innovative concept for the use of telemedicine for medical consultations in EMS was developed. Organisational and technical aspects were considered and practical requirements specified. Since technical feasibility was demonstrated in these

  14. Emergency medicine and general practice

    OpenAIRE

    Abela, Gunther

    2005-01-01

    Emergency Medicine and Immediate Medical Care are relatively new specialties. In Malta, there is quite a considerable area of overlap between these specialties and general practice. Indeed, the family physician is confronted with some sort of medical emergency quite regularly. The brief of this article is to go through recent developments in Emergency Medicine as applied to General Practice. The areas considered are Basic Life Support, Head Injury, Asthma, Anaphylaxis, Community Acquired Pneu...

  15. Incorporating teledermatology into emergency medicine.

    Science.gov (United States)

    Muir, Jim; Xu, Cathy; Paul, Sanjoy; Staib, Andrew; McNeill, Iain; Singh, Philip; Davidson, Samantha; Soyer, H Peter; Sinnott, Michael

    2011-10-01

    The aim of the present study was to investigate the feasibility of using a store-and-forward Skin Emergency Telemedicine Service (SETS) to provide rapid specialist diagnostic and management advice for dermatological cases in an ED. This pilot study was conducted at the Princess Alexandra Hospital between August 2008 and August 2009. Study subjects were consenting patients over 18 years of age who presented with a dermatological condition to the ED. The ED doctor sent the patient's history, examination findings and the digital images of the skin conditions to a secure email address, which automatically forwarded this to the teledermatologist. The teledermatologist reviewed the cases and sent advice on diagnosis and management to the referring ED doctor via email and/or telephone. Face-to-face follow-up consultations with the patients were conducted within 2 weeks. The diagnostic and management concordance between ED doctors, teledermatologists and reviewing dermatologists were analysed. A total of 60 patients participated in the present study. SETS provided a rapid response with 56 (93%) of ED consultations receiving a dermatology opinion within 2 h. Face-to-face follow up occurred in 50 patients (83%). Statistical analysis showed significant levels of agreement between tele-diagnosis and ED diagnosis of 71.2% (Kappa 0.42) and tele-diagnosis and final clinical diagnosis of 98% (Kappa: 0.93). The clinical management concordance was 96% in complete agreement and 4% in relative agreement between the teledermatologists and reviewing dermatologists, based on chart review. The present study has shown that SETS can provide rapid and accurate diagnostic and treatment advice from a specialist for dermatological presentations to the ED. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  16. Radiology in emergency medicine

    International Nuclear Information System (INIS)

    Levy, R.; Barsan, W.G.

    1986-01-01

    This book gives a discussion of radiologic modalities currently being used in emergency situations. Radiographs, echocardiographs, radionuclide scans and CT scans are systematically analyzed and evaluated to provide a step-by-step diagnostic process for emergency physicians to follow when a radiologist is not present

  17. Impact of Health Information Exchange on Emergency Medicine Clinical Decision Making.

    Science.gov (United States)

    Gordon, Bradley D; Bernard, Kyle; Salzman, Josh; Whitebird, Robin R

    2015-12-01

    The objective of the study was to understand the immediate utility of health information exchange (HIE) on emergency department (ED) providers by interviewing them shortly after the information was retrieved. Prior studies of physician perceptions regarding HIE have only been performed outside of the care environment. Trained research assistants interviewed resident physicians, physician assistants and attending physicians using a semi-structured questionnaire within two hours of making a HIE request. The responses were recorded, then transcribed for qualitative analysis. The transcribed interviews were analyzed for emerging qualitative themes. We analyzed 40 interviews obtained from 29 providers. Primary qualitative themes discovered included the following: drivers for requests for outside information; the importance of unexpected information; historical lab values as reference points; providing context when determining whether to admit or discharge a patient; the importance of information in refining disposition; improved confidence of provider; and changes in decisions for diagnostic imaging. ED providers are driven to use HIE when they're missing a known piece of information. This study finds two additional impacts not previously reported. First, providers sometimes find additional unanticipated useful information, supporting a workflow that lowers the threshold to request external information. Second, providers sometimes report utility when no changes to their existing plan are made as their confidence is increased based on external records. Our findings are concordant with previous studies in finding exchanged information is useful to provide context for interpreting lab results, making admission decisions, and prevents repeat diagnostic imaging.

  18. Football emergency medicine

    African Journals Online (AJOL)

    may be called upon to intervene medically when a football player succumbs to a severe ... including safety and security services, emergency and primary health care medical ..... of the European Resuscitation Council (ERC) guidelines 2005.

  19. Work shifts in Emergency Medicine

    Directory of Open Access Journals (Sweden)

    Roberto Recupero

    2007-06-01

    Full Text Available Emergency Medicine is known as a high stress specialty. The adverse effect of constantly rotating shifts is the single most important reason given for premature attrition from the field. In this work problems tied with night shift work will be taken into account and some solutions to reduce the impact of night work on the emergency physicians will be proposed.

  20. [Emergency medicine and vulnerable populations].

    Science.gov (United States)

    Guillemaud, André-Michel

    2012-01-01

    In emergency medicine, assessing a situation of precarity is sometimes extremely complex. Home visits often provide useful information which can lead to the putting in place of a system of support. Medical marginalisation results from a combination of multiple difficulties, notably financial. This article is the testimony of a doctor working in a structure providing emergency medical care in the home.

  1. The future of emergency medicine.

    Science.gov (United States)

    Schneider, Sandra M; Gardner, Angela F; Weiss, Larry D; Wood, Joseph P; Ybarra, Michael; Beck, Dennis M; Stauffer, Arlen R; Wilkerson, Dean; Brabson, Thomas; Jennings, Anthony; Mitchell, Mark; McGrath, Roland B; Christopher, Theodore A; King, Brent; Muelleman, Robert L; Wagner, Mary J; Char, Douglas M; McGee, Douglas L; Pilgrim, Randy L; Moskovitz, Joshua B; Zinkel, Andrew R; Byers, Michelle; Briggs, William T; Hobgood, Cherri D; Kupas, Douglas F; Krueger, Jennifer; Stratford, Cary J; Jouriles, Nicholas J

    2010-08-01

    The specialty of emergency medicine (EM) continues to experience a significant workforce shortage in the face of increasing demand for emergency care. In July 2009, representatives of the leading EM organizations met in Dallas for the Future of Emergency Medicine Summit. Attendees at the Future of Emergency Medicine Summit agreed on the following: 1) Emergency medical care is an essential community service that should be available to all; 2) An insufficient emergency physician workforce also represents a potential threat to patient safety; 3) Accreditation Council for Graduate Medical Education/American Osteopathic Association (AOA)-accredited EM residency training and American Board of Medical Specialties/AOA EM board certification is the recognized standard for physician providers currently entering a career in emergency care; 4) Physician supply shortages in all fields contribute to-and will continue to contribute to-a situation in which providers with other levels of training may be a necessary part of the workforce for the foreseeable future; 5) A maldistribution of EM residency-trained physicians persists, with few pursuing practice in small hospital or rural settings; 6) Assuring that the public receives high quality emergency care while continuing to produce highly skilled EM specialists through EM training programs is the challenge for EM's future; 7) It is important that all providers of emergency care receive continuing postgraduate education. Copyright 2010. Published by Elsevier Inc.

  2. Resident involvement in civilian tactical emergency medicine.

    Science.gov (United States)

    Ramirez, Mario Luis; Slovis, Corey M

    2010-07-01

    Tactical emergency medicine services (TEMS) has emerged as a specialized niche within the field of emergency medicine. With increasing demand for physician participation in civilian tactical teams, there will be efforts by residents to become involved at earlier points in their clinical training. This article discusses resident involvement with a civilian TEMS unit and provides five maxims for emergency physicians to better understand the difference between working in the emergency department or with emergency medical services vs. in a TEMS environment. Differences between TEMS and other trauma life support models, institutional and political barriers likely to be encountered by the resident, the value of preventive medicine and the role of the physician in long-term tactical operations, opportunities for subspecialty growth, and the role of operational security are all discussed in detail. Tactical emergency medicine is a specialty that utilizes the full array of the emergency physician's skill set. It is also a field that is ripe for continued expansion, but the resident looking to become involved with a team should be aware of the requirements necessary to do so and the obstacles likely to be encountered along the way. Copyright 2010 Elsevier Inc. All rights reserved.

  3. Workplace violence in emergency medicine

    Directory of Open Access Journals (Sweden)

    A. Chatterjee*

    2013-12-01

    Conclusion: Violence against ED health care workers is a real problem with significant implications to the victims, patients, and departments/institutions. ED WPV needs to be addressed urgently by stakeholders through continued research on effective interventions specific to Emergency Medicine. Coordination, cooperation, and active commitment to the development of such interventions are critical.

  4. State of emergency medicine in Azerbaijan

    OpenAIRE

    Sule, Harsh; Kazimov, Shirin; Shahmaliyev, Oktay; Sirois, Adam

    2008-01-01

    Background There has been no previous study into the state of emergency medicine in Azerbaijan. As a legacy of the Soviet Semashko system, the ?specialty? model of emergency medicine and integrated emergency departments do not exist here. Instead, pre-hospital emergency care is delivered by ambulance physicians and in-hospital care by individual departments, often in specialty hospitals. Emergency care is therefore fragmented, highly specialized and inefficient. Aims The Emergency Medicine De...

  5. Peptide radioimmunoassays in clinical medicine

    International Nuclear Information System (INIS)

    Geokas, M.C.; Yalow, R.S.; Straus, E.W.; Gold, E.M.

    1982-01-01

    The radioimmunoassay technique, first developed for the determination of hormones, has been applied to many substances of biologic interest by clinical and research laboratories around the world. It has had an enormous effect in medicine and biology as a diagnostic tool, a guide to therapy, and a probe for the fine structure of biologic systems. For instance, the assays of insulin, gastrin, secretin, prolactin, and certain tissue-specific enzymes have been invaluable in patient care. Further refinements of current methods, as well as the emergence of new immunoassay techniques, are expected to enhance precision, specificity, reliability, and convenience of the radioimmunoassay in both clinical and research laboratories

  6. Laboratory testing in the emergency department: an Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC and Academy of Emergency Medicine and Care (AcEMC consensus report

    Directory of Open Access Journals (Sweden)

    Giuseppe Lippi

    2017-04-01

    Full Text Available The mainstay of patient-oriented laboratory testing in emergency settings entails selecting number and type of tests according to valid criteria of appropriateness. Since the pattern of urgent tests requesting is variable across different institutions, we designed a joined survey between the Academy of Emergency Medicine and Care (AcEMC and the Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC for reaching tentative consensus about the most informative diagnostic tests in emergency settings. A survey, containing the most commonly performed urgent laboratory tests and the relative clinical indications, was disseminated to eight relevant members of AcEMC and eight relevant members of SIBioC. All contributors were asked to provide numerical scores for the different laboratory parameters, where 1 indicated strongly recommended, 2 recommended in specific circumstances, and 3 strongly discouraged. The mean results of the survey were presented as the mean of responders’ values, and the parameters were finally classified as strongly recommended (mean value, 1.0-1.5, somehow recommended (mean value, 1.5-2.0, discouraged (mean value, 2.0-2.5 and strongly discouraged (mean value, 2.5-3.0. The results of the survey allowed defining a hierarchy of priority, wherein 24 tests were strongly recommended. The use of 5 common tests was instead strongly discouraged. For 16 additional parameters in the list, the consensus ranged between somehow recommended and discouraged. We hope that results presented in this joint AcEMC-SIBioC consensus document may help harmonizing panel of tests and requesting patters in emergency setting, at least at a national level.

  7. Differences in the perception of characteristics of excellence of clinical tutors among residents and consultants at an emergency medicine residency program a qualitative research

    Directory of Open Access Journals (Sweden)

    Muna Saleem Aljahany

    2013-01-01

    Full Text Available Introduction: Defining exactly what characterizes a clinical tutor as excellent and another less effective, is an important task in assessing the effectiveness of clinical training and guiding faculty development. Aim: We aimed to evaluate those characteristics and measure differences in their perception among accomplished and non-accomplished consultants and residents in the Emergency Department. We also compared perceptions between the different groups of participants. Methods: The characteristics measured were extracted from an extensive search of previously published studies summarized in a review article. A qualitative study was conducted, using a 20 item questionnaire piloted from the refined characteristics (good indicator of reliability; Cronbach′s Alpha = 0.86. The questionnaire was distributed among all consultants and residents in Saudi Board of Emergency Medicine. Results: No significant difference between consultants′ and residents′ perception was found. "Sincere" was an exception 87.8% versus 55.1%, P = 0.013. Consultants′ specifications did not seem to affect perception on overall scores and its component sub-scores. Conclusion: Since results showed no relation between accomplished and non-accomplished consultants in perceiving those qualities, we excluded the lack of knowledge of those characteristics as a cause of being accomplished or non-accomplished. We suggest a greater dedication from program developers towards creating more opportunities to involve more consultants in basic Emergency Medicine training.

  8. Medical Journalism and Emergency Medicine

    Directory of Open Access Journals (Sweden)

    Saeed Safari

    2015-07-01

    Full Text Available Nowadays, many researches in the field of medicine are conducting all around the world and medical journalism is a way to share the results. In fact, dissemination of the related manuscripts can prevent the repetitive research or may even lead to conducting a better survey. Therefore high quality medical journals are considered as up-to-date resources for further investigations. Medical journals are propagating their papers in various media including television programs, newspapers, internet websites and different social media. So they can influence the government policy makers, health-care professionals and even public. Moreover, most researchers hear about medical discoveries for the first time through medical journals and their related social media. So as well a high quality journal can help to improve medical science, a journal of poor quality can be damaging and distorting. Indeed, popular journals have the power of inventing a “communication storm” to draw attention to a certain topic. Thus they have to respect the accepted international principles to prevent spreading inaccurate and misleading data. This paper aims to review the previous and current situation of medical journalism by focus on field of emergency medicine.

  9. A Short History of Clinical Holistic Medicine

    OpenAIRE

    Ventegodt, Søren; Kandel, Isack; Merrick, Joav

    2007-01-01

    Clinical holistic medicine has its roots in the medicine and tradition of Hippocrates. Modern epidemiological research in quality of life, the emerging science of complementary and alternative medicine, the tradition of psychodynamic therapy, and the tradition of bodywork are merging into a new scientific way of treating patients. This approach seems able to help every second patient with physical, mental, existential or sexual health problem in 20 sessions over one year. The paper discusses ...

  10. Correlation of the National Board of Medical Examiners Emergency Medicine Advanced Clinical Examination given in July to intern American Board of Emergency Medicine in-training examination scores, a predictor of performance?

    Directory of Open Access Journals (Sweden)

    Katherine Hiller

    2015-11-01

    Full Text Available Introduction: There is great variation in the knowledge base of Emergency Medicine (EM interns in July. The first objective knowledge assessment during residency does not occur until eight months later, in February, when the American Board of EM (ABEM administers the in-training examination (ITE. In 2013, the National Board of Medical Examiners (NBME released the EM Advanced Clinical Examination (EM-ACE, an assessment intended for fourth-year medical students. Administration of the EM-ACE to interns at the start of residency may provide an earlier opportunity to assess the new EM residents’ knowledge base. The primary objective of this study was to determine the correlation of the NBME EM-ACE, given early in residency, with the EM ITE. Secondary objectives included determination of the correlation of the United States Medical Licensing Examination (USMLE Step 1 or 2 scores with early intern EM-ACE and ITE scores and the effect, if any, of clinical EM experience on examination correlation. Methods: This was a multi-institutional, observational study. Entering EM interns at six residencies took the EM-ACE in July 2013 and the ABEM ITE in February 2014. We collected scores for the EMACE and ITE, age, gender, weeks of clinical EM experience in residency prior to the ITE, and USMLE Step 1 and 2 scores. Pearson’s correlation and linear regression were performed. Results: Sixty-two interns took the EM-ACE and the ITE. The Pearson’s correlation coefficient between the ITE and the EM-ACE was 0.62. R-squared was 0.5 (adjusted 0.4. The coefficient of determination was 0.41 (95% CI [0.3-0.8]. For every increase of one in the scaled EM-ACE score, we observed a 0.4% increase in the EM in-training score. In a linear regression model using all available variables (EM-ACE, gender, age, clinical exposure to EM, and USMLE Step 1 and Step 2 scores, only the EM-ACE score was significantly associated with the ITE (p<0.05. We observed significant colinearity

  11. Correlation of the National Board of Medical Examiners Emergency Medicine Advanced Clinical Examination Given in July to Intern American Board of Emergency Medicine in-training Examination Scores: A Predictor of Performance?

    Science.gov (United States)

    Hiller, Katherine; Franzen, Doug; Heitz, Corey; Emery, Matthew; Poznanski, Stacy

    2015-11-01

    There is great variation in the knowledge base of Emergency Medicine (EM) interns in July. The first objective knowledge assessment during residency does not occur until eight months later, in February, when the American Board of EM (ABEM) administers the in-training examination (ITE). In 2013, the National Board of Medical Examiners (NBME) released the EM Advanced Clinical Examination (EM-ACE), an assessment intended for fourth-year medical students. Administration of the EM-ACE to interns at the start of residency may provide an earlier opportunity to assess the new EM residents' knowledge base. The primary objective of this study was to determine the correlation of the NBME EM-ACE, given early in residency, with the EM ITE. Secondary objectives included determination of the correlation of the United States Medical Licensing Examination (USMLE) Step 1 or 2 scores with early intern EM-ACE and ITE scores and the effect, if any, of clinical EM experience on examination correlation. This was a multi-institutional, observational study. Entering EM interns at six residencies took the EM-ACE in July 2013 and the ABEM ITE in February 2014. We collected scores for the EM-ACE and ITE, age, gender, weeks of clinical EM experience in residency prior to the ITE, and USMLE Step 1 and 2 scores. Pearson's correlation and linear regression were performed. Sixty-two interns took the EM-ACE and the ITE. The Pearson's correlation coefficient between the ITE and the EM-ACE was 0.62. R-squared was 0.5 (adjusted 0.4). The coefficient of determination was 0.41 (95% CI [0.3-0.8]). For every increase of one in the scaled EM-ACE score, we observed a 0.4% increase in the EM in-training score. In a linear regression model using all available variables (EM-ACE, gender, age, clinical exposure to EM, and USMLE Step 1 and Step 2 scores), only the EM-ACE score was significantly associated with the ITE (pcorrelation with ITE. Clinical EM experience prior to the in-training exam did not affect the

  12. Building emergency medicine in Ethiopia | IDRC - International ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2014-09-05

    Sep 5, 2014 ... Ethiopia faces a critical gap in emergency medical care. ... Dr Biruk Germa, Senior Emergency Medicine Resident at Addis Ababa University, also ... The issue Inaccessibility to veterinary services in Ethiopia's livestock sector.

  13. Self reported involvement in emergency medicine among GPs in Norway.

    Science.gov (United States)

    Hjortdahl, Magnus; Zakariassen, Erik; Halvorsen, Peder A

    2018-04-10

    To examine general practitioners' (GPs') perception of their role in emergency medicine and participation in emergency services including ambulance call outs, and the characteristics of the GPs and casualty clinics associated with the GPs' involvement in emergency medicine. Cross-sectional online survey. General practice. General practitioners in Norway (n = 1002). Proportion of GPs perceiving that they have a large role in emergency medicine, regularly being on call, and the proportion of ambulance callouts with GP participation. Forty six percent of the GPs indicated that they play a large role in emergency medicine, 63 percent of the GPs were regularly on call, and 28 percent responded that they usually took part in ambulance call outs. Multivariable logistic regression analyses indicated that these outcomes were strongly associated with participation in multidisciplinary training. Furthermore, the main outcomes were associated with traits commonly seen at smaller casualty clinics such as those with an absence of nursing personnel and extra physicians, and based on the distance to the hospital. Our findings suggest that GPs play an important role in emergency medicine. Multidisciplinary team training may be important for their continued involvement in prehospital emergencies. Key Points   Health authorities and other stakeholders have raised concerns about general practitioner's (GPs) participation in emergency medicine, but few have studied opinions and perceptions among the GPs themselves.   • Norwegian GPs report playing a large role in emergency medicine, regularly being on call, and taking part in selected ambulance call outs.   • A higher proportion of GPs who took part in team training perceived themselves as playing a large role in emergency medicine, regularly being on call, and taking part in ambulance call outs.   • These outcomes were also associated with attributes commonly seen at smaller casualty clinics.

  14. Customizing anaphylaxis guidelines for emergency medicine.

    Science.gov (United States)

    Nowak, Richard; Farrar, Judith Rosen; Brenner, Barry E; Lewis, Lawrence; Silverman, Robert A; Emerman, Charles; Hays, Daniel P; Russell, W Scott; Schmitz, Natalie; Miller, Judi; Singer, Ethan; Camargo, Carlos A; Wood, Joseph

    2013-08-01

    Most episodes of anaphylaxis are managed in emergency medical settings, where the cardinal signs and symptoms often differ from those observed in the allergy clinic. Data suggest that low recognition of anaphylaxis in the emergency setting may relate to inaccurate coding and lack of a standard, practical definition. Develop a simple, consistent definition of anaphylaxis for emergency medicine providers, supported by clinically relevant consensus statements. Definitions of anaphylaxis and criteria for diagnosis from current anaphylaxis guidelines were reviewed with regard to their utilization in emergency medical settings. The agreed-upon working definition is: Anaphylaxis is a serious reaction causing a combination of characteristic findings, and which is rapid in onset and may cause death. It is usually due to an allergic reaction but can be non-allergic. The definition is supported by Consensus Statements, each with referenced discussion. For a positive outcome, quick diagnosis and treatment of anaphylaxis are critical. However, even in the emergency setting, the patient may not present with life-threatening symptoms. Because mild initial symptoms can quickly progress to a severe, even fatal, reaction, the first-line treatment for any anaphylaxis episode--regardless of severity--is intramuscular injection of epinephrine into the anterolateral thigh; delaying its administration increases the potential for morbidity and mortality. When a reaction appears as "possible anaphylaxis," it is generally better to err on the side of caution and administer epinephrine. We believe that this working definition and the supporting Consensus Statements are a first step to better management of anaphylaxis in the emergency medical setting. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Ethics curriculum for emergency medicine graduate medical education.

    Science.gov (United States)

    Marco, Catherine A; Lu, Dave W; Stettner, Edward; Sokolove, Peter E; Ufberg, Jacob W; Noeller, Thomas P

    2011-05-01

    Ethics education is an essential component of graduate medical education in emergency medicine. A sound understanding of principles of bioethics and a rational approach to ethical decision-making are imperative. This article addresses ethics curriculum content, educational approaches, educational resources, and resident feedback and evaluation. Ethics curriculum content should include elements suggested by the Liaison Committee on Medical Education, Accreditation Council for Graduate Medical Education, and the Model of the Clinical Practice of Emergency Medicine. Essential ethics content includes ethical principles, the physician-patient relationship, patient autonomy, clinical issues, end-of-life decisions, justice, education in emergency medicine, research ethics, and professionalism. The appropriate curriculum in ethics education in emergency medicine should include some of the content and educational approaches outlined in this article, although the optimal methods for meeting these educational goals may vary by institution. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. Teaching emergency medicine with workshops improved medical student satisfaction in emergency medicine education

    Directory of Open Access Journals (Sweden)

    Sricharoen P

    2015-02-01

    Full Text Available Pungkava Sricharoen,1 Chaiyaporn Yuksen,1 Yuwares Sittichanbuncha,1 Kittisak Sawanyawisuth2,3 1Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 3The Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH, Khon Kaen University, Khon Kaen, Thailand Background: There are different teaching methods; such as traditional lectures, bedside teaching, and workshops for clinical medical clerkships. Each method has advantages and disadvantages in different situations. Emergency Medicine (EM focuses on emergency medical conditions and deals with several emergency procedures. This study aimed to compare traditional teaching methods with teaching methods involving workshops in the EM setting for medical students. Methods: Fifth year medical students (academic year of 2010 at Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand participated in the study. Half of students received traditional teaching, including lectures and bedside teaching, while the other half received traditional teaching plus three workshops, namely, airway workshop, trauma workshop, and emergency medical services workshop. Student evaluations at the end of the clerkship were recorded. The evaluation form included overall satisfaction, satisfaction in overall teaching methods, and satisfaction in each teaching method. Results: During the academic year 2010, there were 189 students who attended the EM rotation. Of those, 77 students (40.74% were in the traditional EM curriculum, while 112 students were in the new EM curriculum. The average satisfaction score in teaching method of the new EM curriculum group was higher than the traditional EM curriculum group (4.54 versus 4.07, P-value <0.001. The top three highest average satisfaction scores in the new EM curriculum group were trauma

  17. [Adverse drug reaction reporting in emergency medicine].

    Science.gov (United States)

    Milojevic, Kolia; Chassagnol, Isabelle; Brion, Nathalie; Cléro, Joël; Degrèze, Nathalie; Lambert, Yves

    2004-01-01

    A regional survey was performed between June and September 2002, to evaluate knowledge and attitudes of emergency physicians regarding adverse drug reaction (ADR) reporting in a French district. 100 questionnaires completed by physicians working in emergency departments and/or mobile intensive care units were analysed. The frequency of ADRs encountered by emergency practitioners was estimated at > or = 0.73 per year and per physician. The ADR notification rate in emergency medicine was estimated at advertising ADR reporting procedures could help to improve the notification rate in emergency medicine.

  18. Optimizing clinical operations as part of a global emergency medicine initiative in Kumasi, Ghana: application of Lean manufacturing principals to low-resource health systems.

    Science.gov (United States)

    Carter, Patrick M; Desmond, Jeffery S; Akanbobnaab, Christopher; Oteng, Rockefeller A; Rominski, Sarah D; Barsan, William G; Cunningham, Rebecca M

    2012-03-01

    Although many global health programs focus on providing clinical care or medical education, improving clinical operations can have a significant effect on patient care delivery, especially in developing health systems without high-level operations management. Lean manufacturing techniques have been effective in decreasing emergency department (ED) length of stay, patient waiting times, numbers of patients leaving without being seen, and door-to-balloon times for ST-elevation myocardial infarction in developed health systems, but use of Lean in low to middle income countries with developing emergency medicine (EM) systems has not been well characterized. To describe the application of Lean manufacturing techniques to improve clinical operations at Komfo Anokye Teaching Hospital (KATH) in Ghana and to identify key lessons learned to aid future global EM initiatives. A 3-week Lean improvement program focused on the hospital admissions process at KATH was completed by a 14-person team in six stages: problem definition, scope of project planning, value stream mapping, root cause analysis, future state planning, and implementation planning. The authors identified eight lessons learned during our use of Lean to optimize the operations of an ED in a global health setting: 1) the Lean process aided in building a partnership with Ghanaian colleagues; 2) obtaining and maintaining senior institutional support is necessary and challenging; 3) addressing power differences among the team to obtain feedback from all team members is critical to successful Lean analysis; 4) choosing a manageable initial project is critical to influence long-term Lean use in a new environment; 5) data intensive Lean tools can be adapted and are effective in a less resourced health system; 6) several Lean tools focused on team problem-solving techniques worked well in a low-resource system without modification; 7) using Lean highlighted that important changes do not require an influx of resources; and

  19. Precision medicine needs pioneering clinical bioinformaticians.

    Science.gov (United States)

    Gómez-López, Gonzalo; Dopazo, Joaquín; Cigudosa, Juan C; Valencia, Alfonso; Al-Shahrour, Fátima

    2017-10-25

    Success in precision medicine depends on accessing high-quality genetic and molecular data from large, well-annotated patient cohorts that couple biological samples to comprehensive clinical data, which in conjunction can lead to effective therapies. From such a scenario emerges the need for a new professional profile, an expert bioinformatician with training in clinical areas who can make sense of multi-omics data to improve therapeutic interventions in patients, and the design of optimized basket trials. In this review, we first describe the main policies and international initiatives that focus on precision medicine. Secondly, we review the currently ongoing clinical trials in precision medicine, introducing the concept of 'precision bioinformatics', and we describe current pioneering bioinformatics efforts aimed at implementing tools and computational infrastructures for precision medicine in health institutions around the world. Thirdly, we discuss the challenges related to the clinical training of bioinformaticians, and the urgent need for computational specialists capable of assimilating medical terminologies and protocols to address real clinical questions. We also propose some skills required to carry out common tasks in clinical bioinformatics and some tips for emergent groups. Finally, we explore the future perspectives and the challenges faced by precision medicine bioinformatics. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  20. Emergency Medicine for medical students world wide!

    DEFF Research Database (Denmark)

    Perinpam, Larshan; Thi Huynh, Anh-Nhi

    2015-01-01

    A guest blog from Larshan Perinpam (President of ISAEM) and Anh-Nhi Thi Huynh (Vice president of external affairs, ISAEM) - http://blogs.bmj.com/emj/2015/04/17/emergency-medicine-for-medical-students-world-wide/......A guest blog from Larshan Perinpam (President of ISAEM) and Anh-Nhi Thi Huynh (Vice president of external affairs, ISAEM) - http://blogs.bmj.com/emj/2015/04/17/emergency-medicine-for-medical-students-world-wide/...

  1. Bioethics and Emergency Medicine: problems and perspectives

    Directory of Open Access Journals (Sweden)

    Maurizio Mori

    2005-10-01

    Full Text Available Before examining the specific problems of emergency medicine, the article identifies the cardinal points for orientation in bioethics, in the conviction that the knowledge of the basic aspects of the subject allow the reader to make more conscious and suitable choices. The questions of moral relativism and the consequences of the biomedical revolution are addressed in detail in order to support the argument for a new ethical base for healthcare in general and for emergency medicine.

  2. Emergency department discharge prescription interventions by emergency medicine pharmacists.

    Science.gov (United States)

    Cesarz, Joseph L; Steffenhagen, Aaron L; Svenson, James; Hamedani, Azita G

    2013-02-01

    We determine the rate and details of interventions associated with emergency medicine pharmacist review of discharge prescriptions for patients discharged from the emergency department (ED). Additionally, we evaluate care providers' satisfaction with such services provided by emergency medicine pharmacists. This was a prospective observational study in the ED of an academic medical center that serves both adult and pediatric patients. Details of emergency medicine pharmacist interventions on discharge prescriptions were compiled with a standardized form. Interventions were categorized as error prevention or optimization of therapy. The staff of the ED was surveyed related to the influence and satisfaction of this new emergency medicine pharmacist-provided service. The 674 discharge prescriptions reviewed by emergency medicine pharmacists during the study period included 602 (89.3%) for adult patients and 72 (10.7%) for pediatric patients. Emergency medicine pharmacists intervened on 68 prescriptions, resulting in an intervention rate of 10.1% (95% confidence interval [CI] 8.0% to 12.7%). The intervention rate was 8.5% (95% CI 6.4% to 11.1%) for adult prescriptions and 23.6% for pediatric prescriptions (95% CI 14.7% to 35.3%) (difference 15.1%; 95% CI 5.1% to 25.2%). There were a similar number of interventions categorized as error prevention and optimization of medication therapy, 37 (54%) and 31 (46%), respectively. More than 95% of survey respondents believed that the new pharmacist services improved patient safety, optimized medication regimens, and improved patient satisfaction. Emergency medicine pharmacist review of discharge prescriptions for discharged ED patients has the potential to significantly improve patient care associated with suboptimal prescriptions and is highly valued by ED care providers. Copyright © 2012. Published by Mosby, Inc.

  3. Medical Journalism and Emergency Medicine

    OpenAIRE

    Saeed Safari; Alireza Baratloo; Mahmoud Yousefifard

    2015-01-01

    Nowadays, many researches in the field of medicine are conducting all around the world and medical journalism is a way to share the results. In fact, dissemination of the related manuscripts can prevent the repetitive research or may even lead to conducting a better survey. Therefore high quality medical journals are considered as up-to-date resources for further investigations. Medical journals are propagating their papers in various media including television programs, newspapers, internet ...

  4. Qualitative Research on Emergency Medicine Physicians

    DEFF Research Database (Denmark)

    Paltved, Charlotte; Musaeus, Peter

    2012-01-01

    Aim: This study aims to systematically review the qualitative research studying Emergency Medicine (EM) physicians in Emergency Departments (ED). Background: Qualitative research aims to study complex social phenomena. EM is a highly complex medical and social environment that can be investigated...... with qualitative research. Methods: Electronic databases of English peer-reviewed articles were searched from 1971 to 2012 using Medline through PubMed and PsychINFO. This search was supplemented with hand-searches of Academic Emergency Medicine and Emergency Medicine Journal from 1999 to 2012 and cross references...... and training, communication, professional roles, and organizational factors, and into 12 sub-themes. Conclusion: The strength of qualitative research is its ability to grasp and operationalize complex relations within EM. Although qualitative research methodologies have gained in rigour in recent years and few...

  5. [Consensus statement of the National AIDS Plan Secretariat, Spanish Society of Emergency Medicine and AIDS Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology on Emergency and Human Immunodeficiency Virus Infection].

    Science.gov (United States)

    2013-01-01

    Supporting non-HIV specialist professionals in the treatment of patients with urgent diseases resulting from HIV infection. These recommendations have been agreed by an expert panel from the National AIDS Plan Secretariat, the Spanish Society of Emergency Medicine, and the AIDS Study Group. A review has been made of the safety and efficacy results of clinical trials and cohort studies published in biomedical journals (PubMed and Embase) or presented at conferences. The strength of each recommendation (A, B, C) and the level of supporting evidence (I, II, III) are based on a modification of the criteria of the Infectious Diseases Society of America. The data to be collected from the emergency medical history in order to recognize the patient at risk of HIV infection were specified. It stressed the basic knowledge of ART principles and its importance in terms of decline in morbidity and mortality of HIV+ patients and referring to the HIV specialist for follow-up, where appropriate, including drug interactions. Management of different emergency situations that may occur in patients with HIV infection is also mentioned. The non-HIV specialist professional, will find the necessary tools to approach HIV patients with an emergency disease. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  6. Electronic Whiteboards in Emergency Medicine

    DEFF Research Database (Denmark)

    Rasmussen, Rasmus

    2012-01-01

    As more and more Emergency Departments replace the manual dry-erase whiteboards used for coordination of patient care and communication among clinicians with IT-based electronic whiteboards a need to clarify the effects of implementing these systems arises. This paper seeks to answer this questio...

  7. The ability of clinical and laboratory findings to predict in-hospital death in patients with thrombotic thrombocytopenic purpura in an internal and emergency medicine department

    Directory of Open Access Journals (Sweden)

    Filippo Pieralli

    2012-01-01

    Full Text Available Introduction: Thrombotic thrombocytopenic purpura (TTP is a rare, life-threatening syndrome characterized by microangiopathic anemia, thrombocytopenia, diffuse microvascular thrombosis, and ischemia. It is associated with very low levels of ADAMTS-13. Measurement of ADAMTS-13 levels is used for diagnostic and prognostic purposes, but in every-day clinical practice, this type of analysis is not always readily available. In this retrospective study, we evaluated prognostic value of clinical and laboratory findings in patients with TTP. Materials and methods: We retrospectively investigated patients with clinically diagnosed TTP treated in a unit of Internal and Emergency Medicine (1996-2007. Clinical and laboratory findings were collected and analyzed in order to assess their ability to predict in-hospital death. Results: Twelve patients were identified (mean age 59 + 22 years; 58% were women. Five (42% died during the hospitalization, and the variables significantly associated with this outcome were: a delay between diagnosis and symptom onset (HR 1.36; 95% CI 1.04-1.78; p < 0.05; a higher severity score (HR 1.48; 95%CI 1,23-3.86; p < 0.05; hemodynamic instability with hypotension and/or shock (HR 3.35; 95%CI 3.02-9.26; p < 0.01; a higher schistocyte count on blood smear (HR 1.84; 95%CI 1.04-3.27; p < 0.05; and higher lactate values (HR 1.85; 95%CI 1.08- 3.16; p < 0.05. Conclusions: TTP is a rare and potentially fatal disease with protean manifestations. Delayed diagnosis after symptom onset is a major determinant of poor outcome. Hypotension and shock are also prognostically unfavourable. Laboratory evidence of cardiocirculatory compromise (i.e., elevated lactate levels and extension of the disease process (i.e., schistocyte count > 3 are predictive of in-hospital death, independently of the hemodynamic profile on admission.

  8. Nanotechnology in medicine emerging applications

    CERN Document Server

    Koprowski, Gene

    2014-01-01

    This book will describe some of the most recent breakthroughs and promising developments in the search for improved diagnostics and therapies at the very small scales of living biological systems. While still very much a technology in the research and development stage, nanotechnology is already transforming today's medicine. This book, written by a general science author, provides a general overview of medical treatment potentials of nanotechnology in new, more effective drug delivery systems, in less invasive, ultra-small scale medical tools, and in new materials that can mimic or enhance natural materials like living tissue.

  9. Approach to Reptile Emergency Medicine.

    Science.gov (United States)

    Long, Simon Y

    2016-05-01

    This article summarizes the physiology and anatomy of reptiles, highlighting points relevant for emergency room veterinarians. Other systems, such as the endocrine and immune systems, have not been covered. The many other aspects of reptile species variation are too numerous to be covered. This article provides an overview but encourages clinicians to seek additional species-specific information to better medically diagnose and treat their reptile patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Interpreter services in emergency medicine.

    Science.gov (United States)

    Chan, Yu-Feng; Alagappan, Kumar; Rella, Joseph; Bentley, Suzanne; Soto-Greene, Marie; Martin, Marcus

    2010-02-01

    Emergency physicians are routinely confronted with problems associated with language barriers. It is important for emergency health care providers and the health system to strive for cultural competency when communicating with members of an increasingly diverse society. Possible solutions that can be implemented include appropriate staffing, use of new technology, and efforts to develop new kinds of ties to the community served. Linguistically specific solutions include professional interpretation, telephone interpretation, the use of multilingual staff members, the use of ad hoc interpreters, and, more recently, the use of mobile computer technology at the bedside. Each of these methods carries a specific set of advantages and disadvantages. Although professionally trained medical interpreters offer improved communication, improved patient satisfaction, and overall cost savings, they are often underutilized due to their perceived inefficiency and the inconclusive results of their effect on patient care outcomes. Ultimately, the best solution for each emergency department will vary depending on the population served and available resources. Access to the multiple interpretation options outlined above and solid support and commitment from hospital institutions are necessary to provide proper and culturally competent care for patients. Appropriate communications inclusive of interpreter services are essential for culturally and linguistically competent provider/health systems and overall improved patient care and satisfaction. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  11. State of emergency medicine in Azerbaijan.

    Science.gov (United States)

    Sule, Harsh; Kazimov, Shirin; Shahmaliyev, Oktay; Sirois, Adam

    2008-04-01

    There has been no previous study into the state of emergency medicine in Azerbaijan. As a legacy of the Soviet Semashko system, the "specialty" model of emergency medicine and integrated emergency departments do not exist here. Instead, pre-hospital emergency care is delivered by ambulance physicians and in-hospital care by individual departments, often in specialty hospitals. Emergency care is therefore fragmented, highly specialized and inefficient. The Emergency Medicine Development Initiative (EMDI) of the International Medical Corps (IMC) was designed to improve the quality of emergency care in four pilot regional centers in Azerbaijan. The objective of this study was to assess the baseline emergency medical capacity of these four centers. EMDI staff conducted a four-part baseline survey in April 2006 to assess emergency care in Ganja (the second largest city in Azerbaijan), Kurdamir, Shamkir and Yevlakh. Data collection involved interviews with relevant personnel and a retrospective records review in each city. Pre-hospital: The number of ambulance teams per 10,000 inhabitants is below the number required by local regulations. On average, 45% of 27 medications and 37% of 17 pieces of critical equipment were available. Of the emergency procedures, 21% could be performed in the pre-hospital setting. In-hospital: Admission rates were near 100% for the admissions department-an area that is supposed to function as an emergency department would. On average 57% of 40 medications and 42% of 22 pieces of critical equipment were available. Of the emergency procedures, 62% could be performed in the in-hospital setting. The emergency medical system surveyed in Azerbaijan is inefficiently organized, under-financed, poorly equipped and lacks adequately trained staff. Reforms need to be directed towards achieving international standards, while adapting new models for service delivery into the existing framework and improving system capacity as highlighted by this baseline

  12. More about ... Paediatric emergency medicine

    African Journals Online (AJOL)

    antidote, are often used. In some ... used in children. ... used when caustic agents have been ingested, ... study6 has shown that prophylactic antibiotics ... amitraz, which is often used as a tick dip for livestock. It gives a similar clinical picture.

  13. Delivering bad news in emergency care medicine.

    Science.gov (United States)

    Maynard, Douglas W

    2017-01-01

    Forecasting is a strategy for delivering bad news and is compared to two other strategies, stalling and being blunt. Forecasting provides some warning that bad news is forthcoming without keeping the recipient in a state of indefinite suspense (stalling) or conveying the news abruptly (being blunt). Forecasting appears to be more effective than stalling or being blunt in helping a recipient to "realize" the bad news because it involves the deliverer and recipient in a particular social relation. The deliverer of bad news initiates the telling by giving an advance indication of the bad news to come; this allows the recipient to calculate the news in advance of its final presentation, when the deliverer confirms what the recipient has been led to anticipate. Thus, realization of bad news emerges from intimate collaboration, whereas stalling and being blunt require recipients to apprehend the news in a social vacuum. Exacerbating disruption to recipients' everyday world, stalling and being blunt increase the probability of misapprehension (denying, blaming, taking the situation as a joke, etc.) and thereby inhibit rather than facilitate realization. Particular attention is paid to the "perspective display sequence", a particular forecasting strategy that enables both confirming the recipient's perspective and using that perspective to affirm the clinical news. An example from acute or emergency medicine is examined at the close of the paper.

  14. Emergency medicine as a specialty in Asia.

    Science.gov (United States)

    Pek, Jen Heng; Lim, Swee Han; Ho, Hiu Fai; Ramakrishnan, T V; Jamaluddin, Sabariah Faizah; Mesa-Gaerlan, Faith Joan C; Tiru, Mohan; Hwang, Sung Oh; Choi, Wai-Mau; Kanchanasut, Somchai; Khruekarnchana, Pairoj; Avsarogullari, Levent; Shimazu, Takeshi; Hori, Shingo

    2016-04-01

    We aim to examine the similarities and differences in areas of EM development, workload, workforce, and capabilities and support in the Asia region. Emerging challenges faced by our EM community are also discussed. The National Societies for Emergency Medicine of Hong Kong, India, Japan, Malaysia, Philippines, Singapore, South Korea, Taiwan, Thailand and Turkey participated in the joint Japanese Association of Acute Medicine (JAAM) and Asian Conference of Emergency Medicine (ACEM) Special Symposium held in October 2013 at Tokyo, Japan. The findings are reviewed in this paper. Emergency medicine (EM) has over the years evolved into a distinct and recognized medical discipline requiring a unique set of cognitive, administrative and technical skills for managing all types of patients with acute illness or injury. EM has contributed to healthcare by providing effective, safe, efficient and cost-effective patient care. Integrated systems have developed to allow continuity of emergency care from the community into emergency departments. Structured training curriculum for undergraduates, and specialty training programs for postgraduates are in place to equip trainees with the knowledge and skills required for the unique practice of EM. The practice of EM still varies among the Asian countries. However, as a region, we strive to continue in our efforts to develop the specialty and improve the delivery of EM.

  15. Optimizing Clinical Operations as part of a Global Emergency Medicine Initiative in Kumasi, Ghana: Application of Lean Manufacturing Principals to Low Resource Health Systems

    Science.gov (United States)

    Carter, Patrick M.; Desmond, Jeffery S.; Akanbobnaab, Christopher; Oteng, Rockefeller A.; Rominski, Sarah; Barsan, William G.; Cunningham, Rebecca

    2012-01-01

    Background Although many global health programs focus on providing clinical care or medical education, improving clinical operations can have a significant effect on patient care delivery, especially in developing health systems without high-level operations management. Lean manufacturing techniques have been effective in decreasing emergency department (ED) length of stay, patient waiting times, numbers of patients leaving without being seen, and door-to-balloon times for ST-elevation myocardial infarction in developed health systems; but use of Lean in low to middle income countries with developing emergency medicine systems has not been well characterized. Objectives To describe the application of Lean manufacturing techniques to improve clinical operations at Komfo Anokye Teaching Hospital in Ghana and to identify key lessons learned to aid future global EM initiatives. Methods A three-week Lean improvement program focused on the hospital admissions process at Komfo Anokye Teaching Hospital was completed by a 14-person team in six stages: problem definition, scope of project planning, value stream mapping, root cause analysis, future state planning, and implementation planning. Results The authors identified eight lessons learned during our use of Lean to optimize the operations of an ED in a global health setting: 1) the Lean process aided in building a partnership with Ghanaian colleagues; 2) obtaining and maintaining senior institutional support is necessary and challenging; 3) addressing power differences among the team to obtain feedback from all team members is critical to successful Lean analysis; 4) choosing a manageable initial project is critical to influence long-term Lean use in a new environment; 5) data intensive Lean tools can be adapted and are effective in a less resourced health system; 6) several Lean tools focused on team problem solving techniques worked well in a low resource system without modification; 7) using Lean highlighted that

  16. Emergency Medicine Gender-specific Education.

    Science.gov (United States)

    Ashurst, John V; McGregor, Alyson J; Safdar, Basmah; Weaver, Kevin R; Quinn, Shawn M; Rosenau, Alex M; Goyke, Terrence E; Roth, Kevin R; Greenberg, Marna R

    2014-12-01

    The 2014 Academic Emergency Medicine consensus conference has taken the first step in identifying gender-specific care as an area of importance to both emergency medicine (EM) and research. To improve patient care, we need to address educational gaps in this area concurrent with research gaps. In this article, the authors highlight the need for sex- and gender-specific education in EM and propose guidelines for medical student, resident, and faculty education. Specific examples of incorporating this content into grand rounds, simulation, bedside teaching, and journal club sessions are reviewed. Future challenges and strategies to fill the gaps in the current education model are also described. © 2014 by the Society for Academic Emergency Medicine.

  17. Emergency medicine program targets "brain drain" in Ethiopia ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2016-04-29

    Apr 29, 2016 ... ... (TAAAC-EM) project, access to emergency medicine is increasing for Ethiopians. With IDRC support, the TAAAC-EM postgraduate emergency medicine training program ... From hospitals to herbalists: Rx herbal medicines.

  18. Episodes of care: is emergency medicine ready?

    Science.gov (United States)

    Wiler, Jennifer L; Beck, Dennis; Asplin, Brent R; Granovsky, Michael; Moorhead, John; Pilgrim, Randy; Schuur, Jeremiah D

    2012-05-01

    Optimizing resource use, eliminating waste, aligning provider incentives, reducing overall costs, and coordinating the delivery of quality care while improving outcomes have been major themes of health care reform initiatives. Recent legislation contains several provisions designed to move away from the current fee-for-service payment mechanism toward a model that reimburses providers for caring for a population of patients over time while shifting more financial risk to providers. In this article, we review current approaches to episode of care development and reimbursement. We describe the challenges of incorporating emergency medicine into the episode of care approach and the uncertain influence this delivery model will have on emergency medicine care, including quality outcomes. We discuss the limitations of the episode of care payment model for emergency services and advocate retention of the current fee-for-service payment model, as well as identify research gaps that, if addressed, could be used to inform future policy decisions of emergency medicine health policy leaders. We then describe a meaningful role for emergency medicine in an episode of care setting. Copyright © 2011. Published by Mosby, Inc.

  19. Teaching emergency medicine with workshops improved medical student satisfaction in emergency medicine education.

    Science.gov (United States)

    Sricharoen, Pungkava; Yuksen, Chaiyaporn; Sittichanbuncha, Yuwares; Sawanyawisuth, Kittisak

    2015-01-01

    There are different teaching methods; such as traditional lectures, bedside teaching, and workshops for clinical medical clerkships. Each method has advantages and disadvantages in different situations. Emergency Medicine (EM) focuses on emergency medical conditions and deals with several emergency procedures. This study aimed to compare traditional teaching methods with teaching methods involving workshops in the EM setting for medical students. Fifth year medical students (academic year of 2010) at Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand participated in the study. Half of students received traditional teaching, including lectures and bedside teaching, while the other half received traditional teaching plus three workshops, namely, airway workshop, trauma workshop, and emergency medical services workshop. Student evaluations at the end of the clerkship were recorded. The evaluation form included overall satisfaction, satisfaction in overall teaching methods, and satisfaction in each teaching method. During the academic year 2010, there were 189 students who attended the EM rotation. Of those, 77 students (40.74%) were in the traditional EM curriculum, while 112 students were in the new EM curriculum. The average satisfaction score in teaching method of the new EM curriculum group was higher than the traditional EM curriculum group (4.54 versus 4.07, P-value workshop, bedside teaching, and emergency medical services workshop. The mean (standard deviation) satisfaction scores of those three teaching methods were 4.70 (0.50), 4.63 (0.58), and 4.60 (0.55), respectively. Teaching EM with workshops improved student satisfaction in EM education for medical students.

  20. [Scientific concepts in clinical medicine].

    Science.gov (United States)

    Rogler, G

    2003-11-28

    The understanding of the scientific basis and the theory of knowledge are surprisingly heterogeneous in practical and clinical medicine. It is frequently influenced or based on the philosophical theory of critical rationalism founded by Sir Karl Popper. Because the theory of knowledge and the understanding of scientific truth is the central basis for cautious and good clinical practise it is necessary to discuss both points to avoid unscientific auto-immunisation against critique in a type of medicine that regards herself as science-based. Evidence-based medicine would not be possible without interpretation and explanation of existing data into the individual treatment context. Besides an inductive or deductive logic the historical and situative side-conditions of the gathering of knowledge and of experiments are of central importance for their interpretation and their relevance in clinical practice. This historical and situative context warrants reflection but must also be paid attention to in the reflections on medical ethics.

  1. Emergency Medicine Resident Perceptions of Medical Professionalism.

    Science.gov (United States)

    Jauregui, Joshua; Gatewood, Medley O; Ilgen, Jonathan S; Schaninger, Caitlin; Strote, Jared

    2016-05-01

    Medical professionalism is a core competency for emergency medicine (EM) trainees; but defining professionalism remains challenging, leading to difficulties creating objectives and performing assessment. Because professionalism is dynamic, culture-specific, and often taught by modeling, an exploration of trainees' perceptions can highlight their educational baseline and elucidate the importance they place on general conventional professionalism domains. To this end, our objective was to assess the relative value EM residents place on traditional components of professionalism. We performed a cross-sectional, multi-institutional survey of incoming and graduating EM residents at four programs. The survey was developed using the American Board of Internal Medicine's "Project Professionalism" and the Accreditation Council of Graduate Medical Education definition of professionalism competency. We identified 27 attributes within seven domains: clinical excellence, humanism, accountability, altruism, duty and service, honor and integrity, and respect for others. Residents were asked to rate each attribute on a 10-point scale. We analyzed data to assess variance across attributes as well as differences between residents at different training levels or different institutions. Of the 114 residents eligible, 100 (88%) completed the survey. The relative value assigned to different professional attributes varied considerably, with those in the altruism domain valued significantly lower and those in the "respect for others" and "honor and integrity" valued significantly higher (p<0.001). Significant differences were found between interns and seniors for five attributes primarily in the "duty and service" domain (p<0.05). Among different residencies, significant differences were found with attributes within the "altruism" and "duty and service" domains (p<0.05). Residents perceive differences in the relative importance of traditionally defined professional attributes and this may

  2. Experience with Emergency Ultrasound Training by Canadian Emergency Medicine Residents

    Directory of Open Access Journals (Sweden)

    Daniel J. Kim

    2014-05-01

    Full Text Available Introduction: Starting in 2008, emergency ultrasound (EUS was introduced as a core competency to the Royal College of Physicians and Surgeons of Canada (Royal College emergency medicine (EM training standards. The Royal College accredits postgraduate EM specialty training in Canada through 5-year residency programs. The objective of this study is to describe both the current experience with and the perceptions of EUS by Canadian Royal College EM senior residents. Methods: This was a web-based survey conducted from January to March 2011 of all 39 Canadian Royal College postgraduate fifth-year (PGY-5 EM residents. Main outcome measures were characteristics of EUS training and perceptions of EUS. Results: Survey response rate was 95% (37/39. EUS was part of the formal residency curriculum for 86% of respondents (32/37. Residents most commonly received training in focused assessment with sonography for trauma, intrauterine pregnancy, abdominal aortic aneurysm, cardiac, and procedural guidance. Although the most commonly provided instructional material (86% [32/37] was an ultrasound course, 73% (27/37 of residents used educational resources outside of residency training to supplement their ultrasound knowledge. Most residents (95% [35/37] made clinical decisions and patient dispositions based on their EUS interpretation without a consultative study by radiology. Residents had very favorable perceptions and opinions of EUS. Conclusion: EUS training in Royal College EM programs was prevalent and perceived favorably by residents, but there was heterogeneity in resident training and practice of EUS. This suggests variability in both the level and quality of EUS training in Canadian Royal College EM residency programs.

  3. Development of a novel sports medicine rotation for emergency medicine residents

    Directory of Open Access Journals (Sweden)

    Waterbrook AL

    2016-04-01

    Full Text Available Anna L Waterbrook,1 T Gail Pritchard,2 Allison D Lane,1 Lisa R Stoneking,1 Bryna Koch,2 Robert McAtee,1 Kristi H Grall,1 Alice A Min,1 Jessica Prior,1 Isaac Farrell,1 Holly G McNulty,1 Uwe Stolz1 1Department of Emergency Medicine, 2Office of Medical Student Education, The University of Arizona, Tucson, AZ, USA Abstract: Musculoskeletal complaints are the most common reason for patients to visit a physician, yet competency in musculoskeletal medicine is invariably reported as a deficiency in medical education in the USA. Sports medicine clinical rotations improve both medical students' and residents' musculoskeletal knowledge. Despite the importance of this knowledge, a standardized sports medicine curriculum in emergency medicine (EM does not exist. Hence, we developed a novel sports medicine rotation for EM residents to improve their musculoskeletal educational experience and to improve their knowledge in musculoskeletal medicine by teaching the evaluation and management of many common musculoskeletal disorders and injuries that are encountered in the emergency department. The University of Arizona has two distinct EM residency programs, South Campus (SC and University Campus (UC. The UC curriculum includes a traditional 4-week orthopedic rotation, which consistently rated poorly on evaluations by residents. Therefore, with the initiation of a new EM residency at SC, we replaced the standard orthopedic rotation with a novel sports medicine rotation for EM interns. This rotation includes attendance at sports medicine clinics with primary care and orthopedic sports medicine physicians, involvement in sport event coverage, assigned reading materials, didactic experiences, and an on-call schedule to assist with reductions in the emergency department. We analyzed postrotation surveys completed by residents, postrotation evaluations of the residents completed by primary care sports medicine faculty and orthopedic chief residents, as well as the

  4. Human factors and safety in emergency medicine

    Science.gov (United States)

    Schaefer, H. G.; Helmreich, R. L.; Scheidegger, D.

    1994-01-01

    A model based on an input process and outcome conceptualisation is suggested to address safety-relevant factors in emergency medicine. As shown in other dynamic and demanding environments, human factors play a decisive role in attaining high quality service. Attitudes held by health-care providers, organisational shells and work-cultural parameters determine communication, conflict resolution and workload distribution within and between teams. These factors should be taken into account to improve outcomes such as operational integrity, job satisfaction and morale.

  5. Forensic Emergency Medicine - Six-Year Experience of 13823 Cases in a University Emergency Department

    OpenAIRE

    DEMİRCAN, Ahmet; KELEŞ, Ayfer; GÜRBÜZ, Neslihan; BİLDİK, Fikret

    2008-01-01

    Aims: Clinical forensic medicine deals with cases involving both the legal and medical aspects of patient care, such as motor vehicle trauma or poisoning. In this study, we aimed to draw attention to the forensic issues by retrospective investigation of 13823 emergency cases and to share our experiences on this topic. Materials and Methods: This retrospective study was conducted in a university Emergency Department (ED) in Ankara, Turkey. The data were collected from official hospital polic...

  6. Emergency contraception: clinical outcomes.

    Science.gov (United States)

    Glasier, Anna

    2013-03-01

    Emergency contraception (EC) is widely used to prevent unwanted pregnancy. This review considers the safety and efficacy of three commonly used methods -- levonorgestrel (LNG-EC), ulipristal acetate (UPA) and the copper intrauterine device. All are extremely safe, and side effects are minimal. Concerns about increased risks of ectopic pregnancy after EC use have proved unfounded, and possible teratogenic effects seem unlikely. Although the true effectiveness of EC is impossible to estimate, recent research suggests that LNG-EC prevents around 50% of expected pregnancies in women using the method within 72 h of intercourse, whereas UPA appeared to prevent almost two thirds of pregnancies. Emergency intrauterine device insertion probably prevents over 95% of pregnancies. However, although improved accessibility of EC has clearly led to increased use, it does not appear to have had any public health benefit in reducing unintended pregnancy rates. Most of the data on sexual behavior following improved access to EC do not show any detrimental effect on subsequent use of other more effective methods of contraception or on the incidence of unintended pregnancy or sexually transmitted infection. However, unless these other methods of contraception are also made easily available from pharmacies, improved access to EC risks unlinking its use with use of subsequent ongoing contraception. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. Clinical trials and gender medicine.

    Science.gov (United States)

    Cassese, Mariarita; Zuber, Veronica

    2011-01-01

    Women use more medicines than men because they fall ill more often and suffer more from chronic diseases, but also because women pay more attention to their health and have more consciousness and care about themselves. Although medicines can have different effects on women and men, women still represent a small percentage in the first phases of trials (22%) which are essential to verify drugs dosage, side effects, and safety. Even though women are more present in trials, studies results are not presented with a gender approach. This situation is due to educational, social, ethical and economical factors. The scientific research must increase feminine presence in clinical trials in order to be equal and correct, and all the key stakeholder should be involved in this process. We still have a long way to cover and it doesn't concern only women but also children and old people. The aim is to have a medicine not only illness-focused but patient-focused: a medicine able to take into consideration all the patient characteristics and so to produce a really personalized therapy. What above described is part of the reasons why in 2005 was founded the National Observatory for Women's Health (Osservatorio Nazionale sulla Salute della Donna, ONDa) which promotes a gender health awareness and culture in Italy, at all the levels of the civil and scientific society.

  8. Clinical trials and gender medicine

    Directory of Open Access Journals (Sweden)

    Mariarita Cassese

    2011-01-01

    Full Text Available Women use more medicines than men because they fall ill more often and suffer more from chronic diseases, but also because women pay more attention to their health and have more consciousness and care about themselves. Although medicines can have different effects on women and men, women still represent a small percentage in the first phases of trials (22% which are essential to verify drugs dosage, side effects, and safety. Even though women are more present in trials, studies results are not presented with a gender approach. This situation is due to educational, social, ethical and economical factors. The scientific research must increase feminine presence in clinical trials in order to be equal and correct, and all the key stakeholder should be involved in this process. We still have a long way to cover and it doesn't concern only women but also children and old people. The aim is to have a medicine not only illness-focused but patient-focused: a medicine able to take into consideration all the patient characteristics and so to produce a really personalized therapy. What above described is part of the reasons why in 2005 was founded the National Observatory for Women's Health (Osservatorio Nazionale sulla Salute della Donna, ONDa which promotes a gender health awareness and culture in Italy, at all the levels of the civil and scientific society.

  9. Development of a novel sports medicine rotation for emergency medicine residents.

    Science.gov (United States)

    Waterbrook, Anna L; Pritchard, T Gail; Lane, Allison D; Stoneking, Lisa R; Koch, Bryna; McAtee, Robert; Grall, Kristi H; Min, Alice A; Prior, Jessica; Farrell, Isaac; McNulty, Holly G; Stolz, Uwe

    2016-01-01

    Musculoskeletal complaints are the most common reason for patients to visit a physician, yet competency in musculoskeletal medicine is invariably reported as a deficiency in medical education in the USA. Sports medicine clinical rotations improve both medical students' and residents' musculoskeletal knowledge. Despite the importance of this knowledge, a standardized sports medicine curriculum in emergency medicine (EM) does not exist. Hence, we developed a novel sports medicine rotation for EM residents to improve their musculoskeletal educational experience and to improve their knowledge in musculoskeletal medicine by teaching the evaluation and management of many common musculoskeletal disorders and injuries that are encountered in the emergency department. The University of Arizona has two distinct EM residency programs, South Campus (SC) and University Campus (UC). The UC curriculum includes a traditional 4-week orthopedic rotation, which consistently rated poorly on evaluations by residents. Therefore, with the initiation of a new EM residency at SC, we replaced the standard orthopedic rotation with a novel sports medicine rotation for EM interns. This rotation includes attendance at sports medicine clinics with primary care and orthopedic sports medicine physicians, involvement in sport event coverage, assigned reading materials, didactic experiences, and an on-call schedule to assist with reductions in the emergency department. We analyzed postrotation surveys completed by residents, postrotation evaluations of the residents completed by primary care sports medicine faculty and orthopedic chief residents, as well as the total number of dislocation reductions performed by each graduating resident at both programs over the last 5 years. While all residents in both programs exceeded the ten dislocation reductions required for graduation, residents on the sports medicine rotation had a statistically significant higher rate of satisfaction of their educational

  10. Emergency Medicine Resident Perceptions of Medical Professionalism

    Directory of Open Access Journals (Sweden)

    Joshua Jauregui

    2016-05-01

    Full Text Available Introduction: Medical professionalism is a core competency for emergency medicine (EM trainees; but defining professionalism remains challenging, leading to difficulties creating objectives and performing assessment. Because professionalism is dynamic, culture-specific, and often taught by modeling, an exploration of trainees’ perceptions can highlight their educational baseline and elucidate the importance they place on general conventional professionalism domains. To this end, our objective was to assess the relative value EM residents place on traditional components of professionalism. Methods: We performed a cross-sectional, multi-institutional survey of incoming and graduating EM residents at four programs. The survey was developed using the American Board of Internal Medicine’s “Project Professionalism” and the Accreditation Council of Graduate Medical Education definition of professionalism competency. We identified 27 attributes within seven domains: clinical excellence, humanism, accountability, altruism, duty and service, honor and integrity, and respect for others. Residents were asked to rate each attribute on a 10-point scale. We analyzed data to assess variance across attributes as well as differences between residents at different training levels or different institutions. Results: Of the 114 residents eligible, 100 (88% completed the survey. The relative value assigned to different professional attributes varied considerably, with those in the altruism domain valued significantly lower and those in the “respect for others” and “honor and integrity” valued significantly higher (p<0.001. Significant differences were found between interns and seniors for five attributes primarily in the “duty and service” domain (p<0.05. Among different residencies, significant differences were found with attributes within the “altruism” and “duty and service” domains (p<0.05. Conclusion: Residents perceive differences in

  11. Emergency thoracic ultrasound and clinical risk management

    Directory of Open Access Journals (Sweden)

    Interrigi MC

    2017-02-01

    Full Text Available Maria Concetta Interrigi,1 Francesca M Trovato,2,3 Daniela Catalano,3,4 Guglielmo M Trovato3,5 1Accident and Emergency Department, Ospedale Cannizzaro, Catania, 2Accident and Emergency Department, Ospedale Civile, Ragusa, 3Department of Clinical and Experimental Medicine, The School of Medicine, University of Catania, 4Postgraduate School of Clinical Ultrasound, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Policlinico, University of Catania, 5Postgraduate School of e-Learning and ICT in Health Sciences, The School of Medicine, University of Catania, Catania, Italy Purpose: Thoracic ultrasound (TUS has been proposed as an easy-option replacement for chest X-ray (CXR in emergency diagnosis of pneumonia, pleural effusion, and pneumothorax. We investigated CXR unforeseen diagnosis, subsequently investigated by TUS, considering its usefulness in clinical risk assessment and management and also assessing the sustainability of telementoring. Patients and methods: This observational report includes a period of 6 months with proactive concurrent adjunctive TUS diagnosis telementoring, which was done using freely available smartphone applications for transfer of images and movies. Results: Three hundred and seventy emergency TUS scans (excluding trauma patients were performed and telementored. In 310 cases, no significant chest pathology was detected either by CXR, TUS, or the subsequent work-up; in 24 patients, there was full concordance between TUS and CXR (ten isolated pleural effusion; eleven pleural effusion with lung consolidations; and three lung consolidation without pleural effusion; in ten patients with lung consolidations, abnormalities identified by CXR were not detected by TUS. In 26 patients, only TUS diagnosis criteria of disease were present: in 19 patients, CXR was not diagnostic, ie, substantially negative, but TUS detected these conditions correctly, and these were later confirmed by computed

  12. Global Emergency Medicine: A review of the literature from 2017.

    Science.gov (United States)

    Becker, Torben K; Trehan, Indi; Hayward, Alison Schroth; Hexom, Braden J; Kivlehan, Sean M; Lunney, Kevin M; Modi, Payal; Osei-Ampofo, Maxwell; Pousson, Amelia; Cho, Daniel K; Levine, Adam C

    2018-05-23

    The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a global audience of academics and clinical practitioners. This year, 17,722 articles written in three languages were identified by our electronic search. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM. Another two reviewers searched the gray literature, yielding an additional 11 articles. All articles that were deemed appropriate by at least one reviewer and approved by their editor underwent formal scoring of overall quality and importance. Two independent reviewers scored all articles. A total of 848 articles met our inclusion criteria and underwent full review. 63% were categorized as emergency care in resource-limited settings, 23% as disaster and humanitarian response, and 14% as emergency medicine development. 21 articles received scores of 18.5 or higher out of a maximum score 20 and were selected for formal summary and critique. Inter-rater reliability testing between reviewers revealed a Cohen's Kappa of 0.344. In 2017, the total number of articles identified by our search continued to increase. Studies and reviews with a focus on infectious diseases, pediatrics, and trauma represented the majority of top-scoring articles. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  13. Emergency department operations and management education in emergency medicine training

    Institute of Scientific and Technical Information of China (English)

    Bret A Nicks; Darrell Nelson

    2012-01-01

    BACKGROUND:This study was undertaken to examine the current level of operations and management education within US-based Emergency Medicine Residency programs.METHODS:Residency program directors at all US-based Emergency Medicine Residency programs were anonymously surveyed via a web-based instrument.Participants indicated their levels of residency education dedicated to documentation,billing/coding,core measure/quality indicator compliance,and operations management.Data were analyzed using descriptive statistics for the ordinal data/Likert scales.RESULTS:One hundred and six(106)program directors completed the study instrument of one hundred and fifty-six(156)programs(70%).Of these,82.6%indicated emergency department(ED)operations and management education within the training curriculum.Dedicated documentation training was noted in all but 1 program(99%).Program educational offerings also included billing/coding(83%),core measure/quality indicators(78%)and operations management training(71%).In all areas,the most common means of educating came through didactic sessions and direct attending feedback or 69%-94%and 72%-98%respectively.Residency leadership was most confident with resident understanding of quality documentation(80%)and less so with core measures(72%),billing/coding/RVUs(58%),and operations management tools(23%).CONCLUSIONS:While most EM residency programs integrate basic operational education related to documentation and billing/coding,a smaller number provide focused education on the dayto-day management and operations of the ED.Residency leadership perceives graduating resident understanding of operational management tools to be limited.All respondents value further resident curriculum development of ED operations and management.

  14. Clinical holistic medicine: holistic adolescent medicine.

    Science.gov (United States)

    Ventegodt, Søren; Morad, Mohammed; Press, Joseph; Merrick, Joav; Shek, Daniel T L

    2004-08-04

    The holistic medical approach seems to be efficient and can also be used in adolescent medicine. Supporting the teenager to grow and develop is extremely important in order to prevent many of the problems they can carry into adulthood. The simple consciousness-based, holistic medicine--giving love, winning trust, giving holding, and getting permission to help the patient feel, understand, and let go of negative beliefs--is easy for the physician interested in this kind of practice and it requires little previous training for the physician to be able to care for his/her patient. A deeper insight into the principles of holistic treatment and a thorough understanding of our fellow human beings are making it work even better. Holistic medicine is not a miracle cure, but rather a means by which the empathic physician can support the patient in improving his/her future life in respect to quality of life, health, and functional capacity--through coaching the patient to work on him/herself in a hard and disciplined manner. When the patient is young, this work is so much easier. During our lifetime, we have several emotional traumas arranged in the subconscious mind with the smallest at the top, and it is normal for the person to work on a large number of traumatic events that have been processed to varying degrees. Some traumas have been acknowledged, some are still being explored by the person, and yet others are still preconscious, which can be seen for example in the form of muscle tension. Sometimes the young dysfunctional patient carries severe traumas of a violent or sexual nature, but the physician skilled in the holistic medical toolbox can help the patient on his/her way to an excellent quality of life, full self-expression, a love and sex life, and a realization of his/her talents--all that a young patient is typically dreaming about. Biomedicine is not necessary or even recommended when the physical or mental symptoms are caused by disturbances in the personal

  15. Clinical Holistic Medicine: Holistic Adolescent Medicine

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2004-01-01

    Full Text Available The holistic medical approach seems to be efficient and can also be used in adolescent medicine. Supporting the teenager to grow and develop is extremely important in order to prevent many of the problems they can carry into adulthood. The simple consciousness-based, holistic medicine — giving love, winning trust, giving holding, and getting permission to help the patient feel, understand, and let go of negative beliefs — is easy for the physician interested in this kind of practice and it requires little previous training for the physician to be able to care for his/her patient. A deeper insight into the principles of holistic treatment and a thorough understanding of our fellow human beings are making it work even better. Holistic medicine is not a miracle cure, but rather a means by which the empathic physician can support the patient in improving his/her future life in respect to quality of life, health, and functional capacity — through coaching the patient to work on him/herself in a hard and disciplined manner. When the patient is young, this work is so much easier. During our lifetime, we have several emotional traumas arranged in the subconscious mind with the smallest at the top, and it is normal for the person to work on a large number of traumatic events that have been processed to varying degrees. Some traumas have been acknowledged, some are still being explored by the person, and yet others are still preconscious, which can be seen for example in the form of muscle tension. Sometimes the young dysfunctional patient carries severe traumas of a violent or sexual nature, but the physician skilled in the holistic medical toolbox can help the patient on his/her way to an excellent quality of life, full self-expression, a love and sex life, and a realization of his/her talents — all that a young patient is typically dreaming about. Biomedicine is not necessary or even recommended when the physical or mental symptoms are caused

  16. Emergency medicine: an operations management view.

    Science.gov (United States)

    Soremekun, Olan A; Terwiesch, Christian; Pines, Jesse M

    2011-12-01

    Operations management (OM) is the science of understanding and improving business processes. For the emergency department (ED), OM principles can be used to reduce and alleviate the effects of crowding. A fundamental principle of OM is the waiting time formula, which has clear implications in the ED given that waiting time is fundamental to patient-centered emergency care. The waiting time formula consists of the activity time (how long it takes to complete a process), the utilization rate (the proportion of time a particular resource such a staff is working), and two measures of variation: the variation in patient interarrival times and the variation in patient processing times. Understanding the waiting time formula is important because it presents the fundamental parameters that can be managed to reduce waiting times and length of stay. An additional useful OM principle that is applicable to the ED is the efficient frontier. The efficient frontier compares the performance of EDs with respect to two dimensions: responsiveness (i.e., 1/wait time) and utilization rates. Some EDs may be "on the frontier," maximizing their responsiveness at their given utilization rates. However, most EDs likely have opportunities to move toward the frontier. Increasing capacity is a movement along the frontier and to truly move toward the frontier (i.e., improving responsiveness at a fixed capacity), we articulate three possible options: eliminating waste, reducing variability, or increasing flexibility. When conceptualizing ED crowding interventions, these are the major strategies to consider. © 2011 by the Society for Academic Emergency Medicine.

  17. Female authorship in emergency medicine parallels women practicing academic emergency medicine.

    Science.gov (United States)

    Tinjum, Banu E; Getto, Leila; Tiedemann, Juliah; Marri, Maaya; Brodowy, Michelle; Bollinger, Melissa; O'Connor, Robert E; Breyer, Michael J

    2011-12-01

    Studies have shown that women in emergency medicine (EM) lag behind their male counterparts in academic productivity. We compared the proportion of female attending physicians from EM academic programs to the proportion of female first or second authors of original scientific manuscripts and case reports from four major EM journals in a single year. We used a retrospective cross-sectional design. Original scientific manuscripts and case reports from four major EM journals published in 2005: Academic Emergency Medicine, Annals of Emergency Medicine, American Journal of Emergency Medicine, and Journal of Emergency Medicine were reviewed to determine genders of first and second authors. The proportion of female first or second authorship was then compared to the proportion of female EM attending physicians from 134 academic EM programs in the United States. Data were analyzed using Pearson's chi-squared and Clopper-Pearson binomial confidence intervals as appropriate. A p-value of ≤ 0.05 was considered significant. The percentage of female faculty; 940/3571 (26.32%, 95% confidence interval [CI] 24.9-27.8%) vs. the percentage of female first or second authorship 289/1123 (25.73%, 95% CI 23.3-28.4%) was not statistically significant (p = 0.562). There was no difference in the proportion of male and female authors with multiple manuscripts (p = 0.889). As measured by first and second authorship, there was no discrepancy between the proportion of female EM faculty and the proportion of female authorship in EM literature from 2005. Copyright © 2011 Elsevier Inc. All rights reserved.

  18. Global Emergency Medicine: A Review of the Literature From 2016.

    Science.gov (United States)

    Becker, Torben K; Hansoti, Bhakti; Bartels, Susan; Hayward, Alison Schroth; Hexom, Braden J; Lunney, Kevin M; Marsh, Regan H; Osei-Ampofo, Maxwell; Trehan, Indi; Chang, Julia; Levine, Adam C

    2017-09-01

    The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a global audience of academics and clinical practitioners. This year 13,890 articles written in four languages were identified by our search. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM. An additional two reviewers searched the gray literature. All articles that were deemed appropriate by at least one reviewer and approved by their editor underwent formal scoring of overall quality and importance. Two independent reviewers scored all articles. A total of 716 articles met our inclusion criteria and underwent full review. Fifty-nine percent were categorized as emergency care in resource-limited settings, 17% as EM development, and 24% as disaster and humanitarian response. Nineteen articles received scores of 18.5 or higher out of a maximum score of 20 and were selected for formal summary and critique. Inter-rater reliability testing between reviewers revealed Cohen's kappa of 0.441. In 2016, the total number of articles identified by our search continued to increase. The proportion of articles in each of the three categories remained stable. Studies and reviews with a focus on infectious diseases, pediatrics, and the use of ultrasound in resource-limited settings represented the majority of articles selected for final review. © 2017 The Authors. Academic Emergency Medicine published by Wiley Periodicals, Inc. on behalf of the Society for Academic Emergency Medicine (SAEM).

  19. Refining the Enrolment Process in Emergency Medicine Research.

    Science.gov (United States)

    Sahan, Kate M; Channon, Keith M; Choudhury, Robin P; Kharbanda, Rajesh K; Lee, Regent; Sheehan, Mark

    2016-04-01

    Research in the emergency setting involving patients with acute clinical conditions is needed if there are to be advances in diagnosis and treatment. But research in these areas poses ethical and practical challenges. One of these is the general inability to obtain informed consent due to the patient's lack of mental capacity and insufficient time to contact legal representatives. Regulatory frameworks which allow this research to proceed with a consent 'waiver', provided patients lack mental capacity, miss important ethical subtleties. One of these is the varying nature of mental capacity among emergency medicine patients. Not only is their capacity variable and often unclear, but some patients are also likely to be able to engage with the researcher and the context to varying degrees. In this paper we describe the key elements of a novel enrolment process for emergency medicine research that refines the consent waiver and fully engages with the ethical rationale for consent and, in this context, its waiver. The process is verbal but independently documented during the 'emergent' stages of the research. It provides appropriate engagement with the patient, is context-sensitive and better addresses ethical subtleties. In line with regulation, full written consent for on-going participation in the research is obtained once the emergency is passed.

  20. The Biology of Emergency Medicine: what have 30 years meant for Rosen's original concepts?

    Science.gov (United States)

    Zink, Brian J

    2011-03-01

    In 1979 Peter Rosen, MD, a leading academic figure in the developing field of emergency medicine (EM), wrote an article, "The Biology of Emergency Medicine," in response to criticism from other specialties and medical leaders that there was no unique biology of EM that would qualify it as a legitimate medical specialty. This essay received much attention at the time and served as rallying cry for emergency physicians (EPs) who were trying to find their places in the house of medicine and especially in medical schools and academic teaching hospitals. Thirty years later, the opposition that prompted many of Rosen's strongly worded impressions and observations on the biology of EM, clinical emergency department (ED) practice, education, and research has largely faded. Many of Rosen's predictions on the eventual success of EM have come true. However, core issues that existed then continue to present challenges for academic EM and clinical emergency practice. © 2011 by the Society for Academic Emergency Medicine.

  1. Osteopathic emergency medicine programs infrequently publish in high-impact emergency medicine journals.

    Science.gov (United States)

    Baskin, Sean M; Lin, Christina; Carlson, Jestin N

    2014-11-01

    Both the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) require core faculty to engage in scholarly work, including publication in peer-reviewed journals. With the ACGME/AOA merger, we sought to evaluate the frequency of publication in high-impact peer-reviewed EM journals from authors affiliated with osteopathic emergency medicine (EM) programs. We performed a retrospective literature review using the Journal Citation Report database and identified the top five journals in the category of 'Emergency Medicine' by their 2011 Impact Factor. We examined all publications from each journal for 2011. For each article we recorded article type, authors' names, position of authorship (first, senior or other), the author's degree and affiliated institution. We present the data in raw numbers and percentages. The 2011 EM journals with the highest impact factor were the following: Annals of Emergency Medicine, Resuscitation, Journal of Trauma, Injury, and Academic Emergency Medicine. Of the 9,298 authors published in these journals in 2011; 1,309 (15%) claimed affiliation with U.S.-based EM programs, of which 16 (1%) listed their affiliations with eight different osteopathic EM programs. The 16 authors claimed affiliation with 8 of 46 osteopathic EM programs (17%), while 1,301 authors claimed affiliation with 104 of 148 (70%) U.S.-based allopathic programs. Authors from osteopathic EM programs are under-represented in the top EM journals. With the pending ACGME/AOA merger, there is a significant opportunity for improvement in the rate of publication of osteopathic EM programs in top tier EM journals.

  2. Osteopathic Emergency Medicine Programs Infrequently Publish in High-Impact Emergency Medicine Journals

    OpenAIRE

    Baskin, Sean M; Lin, Christina; Carlson, Jestin N

    2014-01-01

    Introduction: Both the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) require core faculty to engage in scholarly work, including publication in peer-reviewed journals. With the ACGME/AOA merger, we sought to evaluate the frequency of publication in high-impact peer-reviewed EM journals from authors affiliated with osteopathic emergency medicine (EM) programs. Methods: We performed a retrospective literature re...

  3. Recommendations from the Society for Academic Emergency Medicine (SAEM) Taskforce on women in academic emergency medicine.

    Science.gov (United States)

    Kuhn, Gloria J; Abbuhl, Stephanie B; Clem, Kathleen J

    2008-08-01

    The Society for Academic Emergency Medicine (SAEM) convened a taskforce to study issues pertaining to women in academic emergency medicine (EM). The charge to the Taskforce was to "Create a document for the SAEM Board of Directors that defines and describes the unique recruitment, retention, and advancement needs for women in academic emergency medicine." To this end, the Taskforce and authors reviewed the literature to highlight key data points in understanding this issue and made recommendations for individuals at four levels of leadership and accountability: leadership of national EM organizations, medical school deans, department chairs, and individual women faculty members. The broad range of individuals targeted for recommendations reflects the interdependent and shared responsibility required to address changes in the culture of academic EM. The following method was used to determine the recommendations: 1) Taskforce members discussed career barriers and potential solutions that could improve the recruitment, retention, and advancement of women in academic EM; 2) the authors reviewed recommendations in the literature by national consensus groups and experts in the field to validate the recommendations of Taskforce members and the authors; and 3) final recommendations were sent to all Taskforce members to obtain and incorporate additional comments and ensure a consensus. This article contains those recommendations and cites the relevant literature addressing this topic.

  4. Clinical Competency in Podiatric Medicine.

    Science.gov (United States)

    Lanham, Richard H., Jr.

    1979-01-01

    The Council on Podiatry Education evaluates colleges of podiatric medicine with on-site accreditation teams, and has established criteria and guidelines for colleges of podiatric medicine. A Delphi technique survey, need for defining competency, and establishment of educational objectives are discussed. (MLW)

  5. A Model Curriculum for an Emergency Medical Services (EMS Rotation for Emergency Medicine Residents

    Directory of Open Access Journals (Sweden)

    Michael Mancera

    2018-01-01

    Full Text Available Audience: This EMS curriculum is designed for Emergency Medicine residents at all levels of training. Introduction: Emergency Medicine (EM physicians have routine interaction with Emergency Medical Services (EMS in their clinical practice. Additionally, the American College of Graduate Medical Education (ACGME mandates that all Emergency Medicine resident physicians receive specific training in the area of EMS.1 Historically, EMS training for EM residents has been conducted in the absence of a standardized didactic curriculum. Despite advancements in the area of prehospital training, there remains wide inconsistency in EMS training experiences among EM residency training programs.2 To our knowledge a standardized and reproducible EMS curriculum for EM residents does not exist. Objectives: The aim of this curriculum is to provide a robust learning experience for EM residents around prehospital care and EMS that fulfills the ACGME requirements and which can be easily replicated and implemented in a variety of EM residency training programs. Method: The educational strategies used in this curriculum include didactics, asynchronous learning through online modules and a focused reading list, experiential learning through ride-alongs, structured small group discussion, supervised medical command shifts, and mentored practice in organizing and delivering didactics to EMS providers.

  6. A Systems Medicine Approach: Translating Emerging Science into Individualized Wellness

    Directory of Open Access Journals (Sweden)

    J. S. Bland

    2017-01-01

    Full Text Available In today’s aging society, more people are living with lifestyle-related noncommunicable diseases (NCDs such as cardiovascular disease, type 2 diabetes, obesity, and cancer. Numerous opinion-leader organizations recommend lifestyle medicine as the first-line approach in NCD prevention and treatment. However, there is a strong need for a personalized approach as “one-size-fits-all” public health recommendations have been insufficient in addressing the interindividual differences in the diverse populations. Advancement in systems biology and the “omics” technologies has allowed comprehensive analysis of how complex biological systems are impacted upon external perturbations (e.g., nutrition and exercise, and therefore is gradually pushing personalized lifestyle medicine toward reality. Clinicians and healthcare practitioners have a unique opportunity in advocating lifestyle medicine because patients see them as a reliable source of advice. However, there are still numerous technical and logistic challenges to overcome before personal “big data” can be translated into actionable and clinically relevant solutions. Clinicians are also facing various issues prior to bringing personalized lifestyle medicine to their practice. Nevertheless, emerging ground-breaking research projects have given us a glimpse of how systems thinking and computational methods may lead to personalized health advice. It is important that all stakeholders work together to create the needed paradigm shift in healthcare before the rising epidemic of NCDs overwhelm the society, the economy, and the dated health system.

  7. Emergency Medicine: On the Frontlines of Medical Education Transformation.

    Science.gov (United States)

    Holmboe, Eric S

    2015-11-01

    Emergency medicine (EM) has always been on the frontlines of healthcare in the United States. I experienced this reality first hand as a young general medical officer assigned to an emergency department (ED) in a small naval hospital in the 1980s. For decades the ED has been the only site where patients could not be legally denied care. Despite increased insurance coverage for millions of Americans as a result of the Affordable Care Act, ED directors report an increase in patient volumes in a recent survey.1 EDs care for patients from across the socioeconomic spectrum suffering from a wide range of clinical conditions. As a result, the ED is still one of few components of the American healthcare system where social justice is enacted on a regular basis. Constant turbulence in the healthcare system, major changes in healthcare delivery, technological advances and shifting demographic trends necessitate that EM constantly adapt and evolve as a discipline in this complex environment.

  8. Quantifying Burnout among Emergency Medicine Professionals.

    Science.gov (United States)

    Wilson, William; Raj, Jeffrey Pradeep; Narayan, Girish; Ghiya, Murtuza; Murty, Shakuntala; Joseph, Bobby

    2017-01-01

    Burnout is a syndrome explained as serious emotional depletion with poor adaptation at work due to prolonged occupational stress. It has three principal components namely emotional exhaustion(EE), depersonalization(DP) and diminished feelings of personal accomplishment(PA). Thus, we aimed at measuring the degree of burnout in doctors and nurses working in emergency medicine department (EMD) of 4 select tertiary care teaching hospitals in South India. A cross sectional survey was conducted among EMD professionals using a 30-item standardized pilot tested questionnaire as well as the Maslach burnout inventory. Univariate and Multivariate analyses were conducted using binary logistic regression models to identify predictors of burnout. Total number of professionals interviewed were 105 of which 71.5% were women and 51.4% were doctors. Majority (78.1%) belonged to the age group 20-30 years. Prevalence of moderate to severe burnout in the 3 principal components EE, DP and PA were 64.8%, 71.4% and 73.3% respectively. After multivariate analysis, the risk factors [adjusted odds ratio (95% confidence intervals) for DP included facing more criticism [3.57(1.25,10.19)], disturbed sleep [6.44(1.45,28.49)] and being short tempered [3.14(1.09,9.09)]. While there were no statistically significant risk factors for EE, being affected by mortality [2.35(1.12,3.94)] and fear of medication errors [3.61(1.26, 10.37)] appeared to be significant predictors of PA. Degree of burn out among doctors and nurses is moderately high in all of the three principal components and some of the predictors identified were criticism, disturbed sleep, short tempered nature, fear of committing errors and witnessing death in EMD.

  9. Quantifying Burnout among Emergency Medicine Professionals

    Directory of Open Access Journals (Sweden)

    William Wilson

    2017-01-01

    Full Text Available Background: Burnout is a syndrome explained as serious emotional depletion with poor adaptation at work due to prolonged occupational stress. It has three principal components namely emotional exhaustion(EE, depersonalization(DP and diminished feelings of personal accomplishment(PA. Thus, we aimed at measuring the degree of burnout in doctors and nurses working in emergency medicine department (EMD of 4 select tertiary care teaching hospitals in South India. Methods: A cross sectional survey was conducted among EMD professionals using a 30-item standardized pilot tested questionnaire as well as the Maslach burnout inventory. Univariate and Multivariate analyses were conducted using binary logistic regression models to identify predictors of burnout. Results: Total number of professionals interviewed were 105 of which 71.5% were women and 51.4% were doctors. Majority (78.1% belonged to the age group 20-30 years. Prevalence of moderate to severe burnout in the 3 principal components EE, DP and PA were 64.8%, 71.4% and 73.3% respectively. After multivariate analysis, the risk factors [adjusted odds ratio (95% confidence intervals for DP included facing more criticism [3.57(1.25,10.19], disturbed sleep [6.44(1.45,28.49] and being short tempered [3.14(1.09,9.09]. While there were no statistically significant risk factors for EE, being affected by mortality [2.35(1.12,3.94] and fear of medication errors [3.61(1.26, 10.37] appeared to be significant predictors of PA. Conclusion: Degree of burn out among doctors and nurses is moderately high in all of the three principal components and some of the predictors identified were criticism, disturbed sleep, short tempered nature, fear of committing errors and witnessing death in EMD.

  10. Burnout among female emergency medicine physicians: A nationwide study.

    Science.gov (United States)

    Soltanifar, Atefeh; Pishbin, Elham; Attaran Mashhadi, Negin; Najaf Najafi, Mona; Siahtir, Maryam

    2018-02-13

    The challenging and stressful nature of emergency medicine place the practitioners of this young branch of medicine at risk of burnout. In Iran, the number of women choosing the specialty of emergency medicine has been increasing in recent years. No studies have focused on burnout among female emergency medicine physicians. We conducted this study to evaluate the level of burnout in female emergency medicine physicians in Iran. In this cross-sectional study, all Iranian female emergency medicine physicians with more than 2 years of work experience as specialists, received a questionnaire containing 22-item Maslach Burnout Inventory scales and 7-item Cassidy social support scale, as well as questions about workload and career satisfaction. In total, 77 questionnaires were analysed (response rate: 75%; median age: 36 years, median for work experience = 3 years). A total of 34% of participants were academic faculties. The level of burnout in three subscales of emotional exhaustion, depersonalisation and perceived low personal accomplishment was moderate to high in 84.5, 48.1 and 80.5% of participants respectively. A total of 94.8% of female emergency medicine physicians perceived their workload to be moderate to high and only 1.3% of them had high job satisfaction. Alarming high rate of burnout and job dissatisfaction among female emergency medicine physicians in our study requires careful attention. Further investigations are suggested to identify the contributory factors to burnout and the probability of some gender disparities in this field. © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  11. Simulation in Medical School Education: Review for Emergency Medicine

    Directory of Open Access Journals (Sweden)

    Shahram Lotfipour

    2011-05-01

    Full Text Available Medical education is rapidly evolving. With the paradigm shift to small-group didactic sessions and focus on clinically oriented case-based scenarios, simulation training has provided educators a novel way to deliver medical education in the 21st century. The field continues to expand in scope and practice and is being incorporated into medical school clerkship education, and specifically in emergency medicine (EM. The use of medical simulation in graduate medical education is well documented. Our aim in this article is to perform a retrospective review of the current literature, studying simulation use in EM medical student clerkships. Studies have demonstrated the effectiveness of simulation in teaching basic science, clinical knowledge, procedural skills, teamwork, and communication skills. As simulation becomes increasingly prevalent in medical school curricula, more studies are needed to assess whether simulation training improves patient-related outcomes.

  12. The British Columbia Emergency Medicine Network: A Paradigm Shift in a Provincial System of Emergency Care.

    Science.gov (United States)

    Abu-Laban, Riyad B; Drebit, Sharla; Lindstrom, Ronald R; Archibald, Chantel; Eggers, Kim; Ho, Kendall; Khazei, Afshin; Lund, Adam; MacKinnon, Carolyn; Markham, Ray; Marsden, Julian; Martin, Ed; Christenson, Jim

    2018-01-04

    As generalists, emergency practitioners face challenges in providing state-of-the-art care owing to the broad spectrum of practice and the rapid rate of new knowledge generation. Networks have become increasingly prevalent in health care, and it was in this backdrop, and the resulting opportunity to advance evidence-informed emergency care in the Canadian province of British Columbia (BC), that a new "Emergency Medicine Network" (EM Network) was launched in 2017. The EM Network consists of four programs, each led by a physician with expertise and a track record in the domain: (1) Clinical Resources; (2) Innovation; (3) Continuing Professional Development; and (4) Real-time Support. This paper provides an overview of the EM Network, including its background, purpose, programs, anticipated evolution, and impact on the BC health care system.

  13. A probable radiological emergency in nuclear medicine

    International Nuclear Information System (INIS)

    Colombo, J.C.

    1998-01-01

    Full text: When a therapeutic dose of 131 I is indicated, especially in the thyroid carcinomas, the authorized doctor must always have present the possibility that the patient eliminates high activities of the radio-active material with the vomit. Keeping in mind that dose of 100 to 200 mCi is habitual in the carcinoma of thyroid, this episode can constitute a true radiological emergency, particularly because the first ones in taking knowledge of the fact can be people without appropriate preparation to this situation, what can cause contaminations difficult to manage them. Because it is not acceptable that a source open of high activity remains without treatment long time, the authorized doctor must act immediately, for that which should be prepared with anticipation, and have the necessary elements, to have an operative routine and to administer the storage of the polluted elements appropriately. To such an effect, we have orchestrated a sequential program of performance of 11 points, in the cases of plentiful vomits, with contamination of floors and things of the room. The program begins with the writing instructions for the patient and the personnel of infirmary in case of feeling desires to vomit, and de program is completed in case of being necessary. The elements are detailed in a handbag that contains for radiological emergencies for vomit. It notes that the low cost of the elements and clothes kind for surgery disposable. It discusses about the necessity of having prepared rooms for to receive patient with treatment with 131 I, in the clinics and public hospitals. (author) [es

  14. Nigerian Journal of Clinical Medicine

    African Journals Online (AJOL)

    The Nigerian Journal of Medicine (NJCM) is a biannual journal of the Association of Resident Doctors of the Lagos State University Teaching Hospital, which hopes to provide a platform for medical researchers to make contributions that advances/illuminates medical science or practice in all its spheres.

  15. Pediatric Abdominal Pain: An Emergency Medicine Perspective.

    Science.gov (United States)

    Smith, Jeremiah; Fox, Sean M

    2016-05-01

    Abdominal pain is a common complaint that leads to pediatric patients seeking emergency care. The emergency care provider has the arduous task of determining which child likely has a benign cause and not missing the devastating condition that needs emergent attention. This article reviews common benign causes of abdominal pain as well as some of the cannot-miss emergent causes. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Evidence Based Studies in Clinical Transfusion Medicine

    NARCIS (Netherlands)

    A.J.G. Jansen (Gerard)

    2007-01-01

    textabstractAfter the introduction of blood component therapy in the 1960s, more and more attention is given to clinical transfusion medicine. Although blood transfusion is an important treatment in different clinical settings, there are still lack of much randomized clinical trials. Nowadays

  17. Academic Emergency Medicine Physicians’ Knowledge of Mechanical Ventilation

    Directory of Open Access Journals (Sweden)

    Susan R. Wilcox

    2016-05-01

    Full Text Available Introduction: Although emergency physicians frequently intubate patients, management of mechanical ventilation has not been emphasized in emergency medicine (EM education or clinical practice. The objective of this study was to quantify EM attendings’ education, experience, and knowledge regarding mechanical ventilation in the emergency department. Methods: We developed a survey of academic EM attendings’ educational experiences with ventilators and a knowledge assessment tool with nine clinical questions. EM attendings at key teaching hospitals for seven EM residency training programs in the northeastern United States were invited to participate in this survey study. We performed correlation and regression analyses to evaluate the relationship between attendings’ scores on the assessment instrument and their training, education, and comfort with ventilation. Results: Of 394 EM attendings surveyed, 211 responded (53.6%. Of respondents, 74.5% reported receiving three or fewer hours of ventilation-related education from EM sources over the past year and 98 (46% reported receiving between 0-1 hour of education. The overall correct response rate for the assessment tool was 73.4%, with a standard deviation of 19.9. The factors associated with a higher score were completion of an EM residency, prior emphasis on mechanical ventilation during one’s own residency, working in a setting where an emergency physician bears primary responsibility for ventilator management, and level of comfort with managing ventilated patients. Physicians’ comfort was associated with the frequency of ventilator changes and EM management of ventilation, as well as hours of education. Conclusion: EM attendings report caring for mechanically ventilated patients frequently, but most receive fewer than three educational hours a year on mechanical ventilation, and nearly half receive 0-1 hour. Physicians’ performance on an assessment tool for mechanical ventilation is

  18. Nanotechnology in reproductive medicine: emerging applications of nanomaterials.

    Science.gov (United States)

    Barkalina, Natalia; Charalambous, Charis; Jones, Celine; Coward, Kevin

    2014-07-01

    In the last decade, nanotechnology has been extensively introduced for biomedical applications, including bio-detection, drug delivery and diagnostic imaging, particularly in the field of cancer diagnostics and treatment. However, there is a growing trend towards the expansion of nanobiotechnological tools in a number of non-cancer applications. In this review, we discuss the emerging uses of nanotechnology in reproductive medicine and reproductive biology. For the first time, we summarise the available evidence regarding the use of nanomaterials as experimental tools for the detection and treatment of malignant and benign reproductive conditions. We also present an overview of potential applications for nanomaterials in reproductive biology, discuss the benefits and concerns associated with their use in a highly delicate system of reproductive tissues and gametes, and address the feasibility of this innovative and potentially controversial approach in the clinical setting and for investigative research into the mechanisms underlying reproductive diseases. This unique review paper focuses on the emerging use of nanotechnology in reproductive medicine and reproductive biology, highlighting the role of nanomaterials in the detection and treatment of various reproductive conditions, keeping in mind the benefits and potential concerns associated with nanomaterial use in the delicate system of reproductive tissue and gametes. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Personalizing medicine with clinical pharmacogenetics

    Science.gov (United States)

    Scott, Stuart A.

    2012-01-01

    Clinical genetic testing has grown substantially over the past 30 years as the causative mutations for Mendelian diseases have been identified, particularly aided in part by the recent advances in molecular-based technologies. Importantly, the adoption of new tests and testing strategies (e.g., diagnostic confirmation, prenatal testing, and population-based carrier screening) has often been met with caution and careful consideration before clinical implementation, which facilitates the appropriate use of new genetic tests. Although the field of pharmacogenetics was established in the 1950s, clinical testing for constitutional pharmacogenetic variants implicated in interindividual drug response variability has only recently become available to help clinicians guide pharmacotherapy, in part due to US Food and Drug Administration-mediated product insert revisions that include pharmacogenetic information for selected drugs. However, despite pharmacogenetic associations with adverse outcomes, physician uptake of clinical pharmacogenetic testing has been slow. Compared with testing for Mendelian diseases, pharmacogenetic testing for certain indications can have a lower positive predictive value, which is one reason for underutilization. A number of other barriers remain with implementing clinical pharmacogenetics, including clinical utility, professional education, and regulatory and reimbursement issues, among others. This review presents some of the current opportunities and challenges with implementing clinical pharmacogenetic testing. PMID:22095251

  20. CLINICAL CONCEPTS ON THYROID EMERGENCIES

    Directory of Open Access Journals (Sweden)

    Alfredo ePontecorvi

    2014-07-01

    Full Text Available Objective. Thyroid-related emergencies are caused by overt dysfunction of the gland that are so severe that require admission to intensive care units frequently. Nonetheless, in the ICU setting, it is crucial to differentiate patients with non-thyroidal illness and alterations in thyroid function tests from those with intrinsic thyroid disease. This review presents and discusses the main etiopathogenetical and clinical aspects of hypothyroid coma (HC and thyrotoxic storm (TS, including therapeutic strategy flow-charts. Furthermore, a special chapter is dedicated to the approach to massive goiter, which represents a surgical thyroid emergency.Data source. We searched the electronic MEDLINE database to September 2013.Data selection and Data extraction. Reviews, original articles and case reports on myxedematous coma, hypothyroid coma, thyroid storm, thyrotoxic storm, massive goiter, huge goiter, prevalence, etiology, diagnosis, therapy, prognosis were selected.Data synthesis and conclusions. Severe excess or defect of thyroid hormone are rare conditions which jeopardize the life of patients in most cases. Both HC and TS are triggered by precipitating factors, which occur in patients with severe hypothyroidism or thyrotoxicosis, respectively. The pillars of HC therapy are: high dose l-thyroxine and/or tri-iodothyroinine; i.v. glucocorticoids; treatment of hydro-electrolyte imbalance (mainly, hyponatraemia; treatment of hypothermia; not rarely, endotracheal intubation and assisted mechanic ventilation are needed. Therapy of TS is based on beta-blockers, thyrostatics, and i.v. glucocorticoids; eventually, high-dose iodide compounds or lithium carbonate may be of benefit. Surgery represents the gold standard treatment in patients with euthyroid massive nodular goiter, although new techniques – e.g., percutaneous laser ablation - are helpful in subjects at high surgical risk or refusing operation.

  1. Emergency Medicine Curriculum: Complications of Pregnancy Small Group Module

    Directory of Open Access Journals (Sweden)

    Linda L Herman

    2017-07-01

    Full Text Available Audience: This curriculum, created and implemented at Kaweah Delta HCD emergency medicine program, was designed to educate our emergency medicine (EM residents, PGY-1 to PGY-3, as well as medical students and attending physicians. Introduction: Obstetrical (OB emergencies pose a unique challenge to the EM physician. Given the relative rarity of these presentations within the Emergency Department (ED, it is important that residents are educated in a comprehensive manner to ensure understanding and retention.1 The exact prevalence of emergency department (ED visits that are associated with complications of pregnancy is unknown, but they are likely a sizeable portion of the patient population of the ED. Also, many hospitals in rural areas have closed their labor and delivery units due to higher operating costs and lack of available medical personnel.2 New models of high-quality teaching that ensure retention of clinically rare, but critical presentations are required. There is a body of research that suggests a small-group discussion model rather than traditional lecture-based content may improve learner engagement and retention. This model encourages active learning, which requires simultaneous instructor and learner engagement.3, 4, 5, 6, 7 Studies have revealed that the application of knowledge through case studies, personal interaction with content experts, and integrated questions are effective learning strategies for emergency medicine.3 The small group discussion classroom is facilitated by content experts with personal experience in the topic at hand. Objectives: We aim to teach the presentation and management of pregnancy complications through interactive teaching during small group discussions concerning patient cases. This curriculum utilizes resources chosen by education faculty, study questions, actual experience, and small group discussions in place of a traditional lecture-based format. In doing so, a goal of the curriculum is to

  2. Virtual alternative to the oral examination for emergency medicine residents.

    Science.gov (United States)

    McGrath, Jillian; Kman, Nicholas; Danforth, Douglas; Bahner, David P; Khandelwal, Sorabh; Martin, Daniel R; Nagel, Rollin; Verbeck, Nicole; Way, David P; Nelson, Richard

    2015-03-01

    The oral examination is a traditional method for assessing the developing physician's medical knowledge, clinical reasoning and interpersonal skills. The typical oral examination is a face-to-face encounter in which examiners quiz examinees on how they would confront a patient case. The advantage of the oral exam is that the examiner can adapt questions to the examinee's response. The disadvantage is the potential for examiner bias and intimidation. Computer-based virtual simulation technology has been widely used in the gaming industry. We wondered whether virtual simulation could serve as a practical format for delivery of an oral examination. For this project, we compared the attitudes and performance of emergency medicine (EM) residents who took our traditional oral exam to those who took the exam using virtual simulation. EM residents (n=35) were randomized to a traditional oral examination format (n=17) or a simulated virtual examination format (n=18) conducted within an immersive learning environment, Second Life (SL). Proctors scored residents using the American Board of Emergency Medicine oral examination assessment instruments, which included execution of critical actions and ratings on eight competency categories (1-8 scale). Study participants were also surveyed about their oral examination experience. We observed no differences between virtual and traditional groups on critical action scores or scores on eight competency categories. However, we noted moderate effect sizes favoring the Second Life group on the clinical competence score. Examinees from both groups thought that their assessment was realistic, fair, objective, and efficient. Examinees from the virtual group reported a preference for the virtual format and felt that the format was less intimidating. The virtual simulated oral examination was shown to be a feasible alternative to the traditional oral examination format for assessing EM residents. Virtual environments for oral examinations

  3. Emergency medicine and the airline passenger

    Science.gov (United States)

    Mohler, S. R.; Nicogossian, A.; Margulies, R. A.

    1980-01-01

    Problems related to immediate medical care in case of in-flight emergencies are discussed with reference to such critical types of medical emergencies as obstructed airway, cardiac dysfunction, trauma, hemorrhage, hypoxia, and pain. It is shown that training flight attendants to deal with in-flight medical emergencies and to use first-aid support equipment and essential and useful drugs may later help with stabilization of a victim and allow continuing the flight to the scheduled destination without the need for a diverted landing. Among the steps suggested in order to upgrade inflight welfare and safety of passengers are the development of an advisory circular by the FAA covering standardized training for flight attendants, regulatory action requiring upgrading of the present rudimentary first-aid kit, and the enactment of Good Samaritan legislation by the U.S. Government.

  4. Burnout and Associated Factors among Iranian Emergency Medicine Practitioners

    OpenAIRE

    JALILI, Mohammad; SADEGHIPOUR ROODSARI, Gholamreza; BASSIR NIA, Anahita

    2013-01-01

    Abstract Background Emergency physicians are at risk of burnout, which can affect their mental health, as well as patient care. We assessed burnout level among Iranian emergency physicians and investigated demographic, work-related factors and stressors associated with higher burnout. Methods In a cross-sectional study, we surveyed all 188 emergency medicine residents and practitioners in Iran. We measured burnout using 22-item Maslach Burnout Inventory assessing emotional exhaustion, deperso...

  5. [The department of interdisciplinary emergency medicine: organization, structure and process optimization].

    Science.gov (United States)

    Bernhard, Michael; Pietsch, Christian; Gries, André

    2009-06-01

    The essential tasks of a department of interdisciplinary emergency medicine are the initial triage and assessment of vital function as well as the subsequent organization und initiation of emergency treatment. A previously defined set of diagnostic and therapeutic measures is carried out before the patient is allocated to an in-hospital clinical service and is admitted to a ward. Moreover, diagnosis and treatment for outpatients are performed. "Time" is a critical factor to be considered for all organizational and structural aspects of a department of interdisciplinary emergency medicine.

  6. Mental health triage in emergency medicine.

    Science.gov (United States)

    Smart, D; Pollard, C; Walpole, B

    1999-02-01

    The aim of this study was to: (i) develop a triage scale consistent with the National Triage Scale (NTS) for patients with mental health problems attending emergency departments; and (ii) to reduce emergency waiting times, transit times and improve skills assessing mental health problems. We developed a Mental Health Triage Scale (MHTS) consistent with the NTS. The MHTS was then implemented using a structured education package, and evaluated from March to August 1994. Further evaluation occurred after 2 years. A four-tiered MHTS was produced: category 2, violent, aggressive or suicidal, danger to self or others or with police escort; category 3, very distressed or psychotic, likely to deteriorate, situational crisis, danger to self or others; category 4, long-standing semi-urgent mental health disorder, supporting agency present; and category 5, long-standing non-acute mental health disorder, no support agency present. Patients with illness, injury or self-harm were triaged using combined mental health and medical information. Mean emergency waiting times and transit times were reduced. More consistent triaging for mental health patients occurred, and more consistent admission rates by urgency. Reduced mental health 'did not waits' showed improved customer satisfaction. Mental Health Triage Scale was considered appropriate by liaison psychiatry and its use has continued at 2 years follow-up. A systematic approach to mental health triaging produced a workable scale, reduced waiting times, transit times, and provided effective and consistent integration of mental health patients into a general emergency department.

  7. [Spanish doctoral theses in emergency medicine (1978-2013)].

    Science.gov (United States)

    Fernández-Guerrero, Inés María

    2015-01-01

    To quantitatively analyze the production of Spanish doctoral theses in emergency medicine. Quantitative synthesis of productivity indicators for 214 doctoral theses in emergency medicine found in the database (TESEO) for Spanish universities from 1978 to 2013. We processed the data in 3 ways as follows: compilation of descriptive statistics, regression analysis (correlation coefficients of determination), and modeling of linear trend (time-series analysis). Most of the thesis supervisors (84.1%) only oversaw a single project. No major supervisor of 10 or more theses was identified. Analysis of cosupervision indicated there were 1.6 supervisors per thesis. The theses were defended in 67 departments (both general and specialist departments) because no emergency medicine departments had been established. The most productive universities were 2 large ones (Universitat de Barcelona and Universidad Complutense de Madrid) and 3 medium-sized ones (Universidad de Granada, Universitat Autónoma de Barcelona, and Universidad de La Laguna). Productivity over time analyzed as the trend for 2-year periods in the time-series was expressed as a polynomial function with a correlation coefficient of determination of R2 = 0.80. Spanish doctoral research in emergency medicine has grown markedly. Work has been done in various university departments in different disciplines and specialties. The findings confirm that emergency medicine is a disciplinary field.

  8. [(Early) Palliative Care in Emergency Medicine].

    Science.gov (United States)

    Spickermann, Maximilian; Lenz, Philipp

    2018-04-01

    At the end of life patients with a life-limiting disease are often admitted to emergency departments (ED). Mostly, in the setting of an ED there may not be enough time to meet the needs for palliative care (PC) of these patients. Therefore, integration of PC into the ED offers a solution to improve their treatment. In the outpatient setting a cooperation between prehospital emergency services, the patient's general practitioner and specialized outpatient PC teams may allow the patient to die at home - this is what most patients prefer at the end of life. Furthermore, due to the earlier integration of PC after admission the hospital stay is shortened. Also the number of PC consultations may increase. Additionally, a screening of PC hneeds among all patients visiting the ED may be beneficial: to avoid not meeting existing PC needs and to standardize the need of PC consultation. An example for such a screening tool is the "Palliative Care and Rapid Emergency Screening" (P-CaRES). © Georg Thieme Verlag KG Stuttgart · New York.

  9. FOAMSearch.net: A custom search engine for emergency medicine and critical care.

    Science.gov (United States)

    Raine, Todd; Thoma, Brent; Chan, Teresa M; Lin, Michelle

    2015-08-01

    The number of online resources read by and pertinent to clinicians has increased dramatically. However, most healthcare professionals still use mainstream search engines as their primary port of entry to the resources on the Internet. These search engines use algorithms that do not make it easy to find clinician-oriented resources. FOAMSearch, a custom search engine (CSE), was developed to find relevant, high-quality online resources for emergency medicine and critical care (EMCC) clinicians. Using Google™ algorithms, it searches a vetted list of >300 blogs, podcasts, wikis, knowledge translation tools, clinical decision support tools and medical journals. Utilisation has increased progressively to >3000 users/month since its launch in 2011. Further study of the role of CSEs to find medical resources is needed, and it might be possible to develop similar CSEs for other areas of medicine. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  10. Virtual Alternative to the Oral Examination for Emergency Medicine Residents

    Directory of Open Access Journals (Sweden)

    McGrath, Jillian

    2015-02-01

    Full Text Available Introduction: The oral examination is a traditional method for assessing the developing physician’s medical knowledge, clinical reasoning and interpersonal skills. The typical oral examination is a face-to-face encounter in which examiners quiz examinees on how they would confront a patient case. The advantage of the oral exam is that the examiner can adapt questions to the examinee’s response. The disadvantage is the potential for examiner bias and intimidation. Computer-based virtual simulation technology has been widely used in the gaming industry. We wondered whether virtual simulation could serve as a practical format for delivery of an oral examination. For this project, we compared the attitudes and performance of emergency medicine (EM residents who took our traditional oral exam to those who took the exam using virtual simulation. Methods: EM residents (n=35 were randomized to a traditional oral examination format (n=17 or a simulated virtual examination format (n=18 conducted within an immersive learning environment, Second Life (SL. Proctors scored residents using the American Board of Emergency Medicine oral examination assessment instruments, which included execution of critical actions and ratings on eight competency categories (1-8 scale. Study participants were also surveyed about their oral examination experience. Results: We observed no differences between virtual and traditional groups on critical action scores or scores on eight competency categories. However, we noted moderate effect sizes favoring the Second Life group on the clinical competence score. Examinees from both groups thought that their assessment was realistic, fair, objective, and efficient. Examinees from the virtual group reported a preference for the virtual format and felt that the format was less intimidating. Conclusion: The virtual simulated oral examination was shown to be a feasible alternative to the traditional oral examination format for

  11. Nanotechnology: emerging tools for biology and medicine.

    Science.gov (United States)

    Wong, Ian Y; Bhatia, Sangeeta N; Toner, Mehmet

    2013-11-15

    Historically, biomedical research has been based on two paradigms. First, measurements of biological behaviors have been based on bulk assays that average over large populations. Second, these behaviors have then been crudely perturbed by systemic administration of therapeutic treatments. Nanotechnology has the potential to transform these paradigms by enabling exquisite structures comparable in size with biomolecules as well as unprecedented chemical and physical functionality at small length scales. Here, we review nanotechnology-based approaches for precisely measuring and perturbing living systems. Remarkably, nanotechnology can be used to characterize single molecules or cells at extraordinarily high throughput and deliver therapeutic payloads to specific locations as well as exhibit dynamic biomimetic behavior. These advances enable multimodal interfaces that may yield unexpected insights into systems biology as well as new therapeutic strategies for personalized medicine.

  12. Technology and work within emergency medicine

    DEFF Research Database (Denmark)

    Kristensen, Margit

    and technologies, they make use of, are most often of very diverse character.Below I describe the characteristics for the mobile and nomadic work for the two different work situations of an anaesthesiologist - in-hospital and pre-hospital - and in these descriptions I include description of which technologies...... are used and how they are used.   The paper builds on use-driven research carried out through the last 3½ years within the context of the PalCom project (PalCom). As a part of the research we have carried out extensive fieldstudies within the emergency response area, have held interviews and have had...

  13. Just allocation and team loyalty: a new virtue ethic for emergency medicine

    Science.gov (United States)

    Girod, J; Beckman, A

    2005-01-01

    When traditional virtue ethics is applied to clinical medicine, it often claims as its goal the good of the individual patient, and focuses on the dyadic relationship between one physician and one patient. An alternative model of virtue ethics, more appropriate to the practice of emergency medicine, will be outlined by this paper. This alternative model is based on the assumption that the appropriate goal of the practice of emergency medicine is a team approach to the medical wellbeing of individual patients, constrained by the wellbeing of the patient population served by a particular emergency department. By defining boundaries and using the key virtues of justice and team loyalty, this model fits emergency practice well and gives care givers the conceptual clarity to apply this model to various conflicts both within the department and with those outside the department. PMID:16199595

  14. Assessing interpersonal and communication skills in emergency medicine.

    Science.gov (United States)

    Chan, Teresa M; Wallner, Clare; Swoboda, Thomas K; Leone, Katrina A; Kessler, Chad

    2012-12-01

    Interpersonal and communication skills (ICS) are a key component of several competency-based schemata and key competency in the set of six Accreditation Council for Graduate Medical Education (ACGME) core competencies. With the shift toward a competency-based educational framework, the importance of robust learner assessment becomes paramount. The journal Academic Emergency Medicine (AEM) hosted a consensus conference to discuss education research in emergency medicine (EM). This article summarizes the initial preparatory research that was conducted to brief consensus conference attendees and reports the results of the consensus conference breakout session as it pertains to ICS assessment of learners. The goals of this consensus conference session were to twofold: 1) to determine the state of assessment of observable learner performance and 2) to determine a research agenda within the ICS field for medical educators. The working group identified six key recommendations for medical educators and researchers. © 2012 by the Society for Academic Emergency Medicine.

  15. An hypnotic suggestion: review of hypnosis for clinical emergency care.

    Science.gov (United States)

    Iserson, Kenneth V

    2014-04-01

    Hypnosis has been used in medicine for nearly 250 years. Yet, emergency clinicians rarely use it in emergency departments or prehospital settings. This review describes hypnosis, its historical use in medicine, several neurophysiologic studies of the procedure, its uses and potential uses in emergency care, and a simple technique for inducing hypnosis. It also discusses reasons why the technique has not been widely adopted, and suggests methods of increasing its use in emergency care, including some potential research areas. A limited number of clinical studies and case reports suggest that hypnosis may be effective in a wide variety of conditions applicable to emergency medical care. These include providing analgesia for existing pain (e.g., fractures, burns, and lacerations), providing analgesia and sedation for painful procedures (e.g., needle sticks, laceration repair, and fracture and joint reductions), reducing acute anxiety, increasing children's cooperation for procedures, facilitating the diagnosis and treatment of acute psychiatric conditions, and providing analgesia and anxiolysis for obstetric/gynecologic problems. Although it is safe, fast, and cost-effective, emergency clinicians rarely use hypnosis. This is due, in part, to the myths surrounding hypnosis and its association with alternative-complementary medicine. Genuine barriers to its increased clinical use include a lack of assured effectiveness and a lack of training and training requirements. Based on the results of further research, hypnosis could become a powerful and safe nonpharmacologic addition to the emergency clinician's armamentarium, with the potential to enhance patient care in emergency medicine, prehospital care, and remote medical settings. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Nigerian Journal of Clinical Medicine: Submissions

    African Journals Online (AJOL)

    Consequently, NJCM, its Editorial Board and LASUTH-ARD bear no legal responsibility for such opinions. Authors are encouraged to send their manuscripts to the LASUTH-ARD Secretariat addressed to: The Editor, Nigerian Journal of Clinical Medicine (NJCM). An electronic copy of the manuscript in Microsoft Word format ...

  17. Clinical Reasoning in Medicine: A Concept Analysis

    Directory of Open Access Journals (Sweden)

    Shahram Yazdani

    2018-01-01

    Full Text Available Background: Clinical reasoning plays an important role in the ability of physicians to make diagnoses and decisions. It is considered the physician’s most critical competence, but it is an ambiguous conceptin medicine that needs a clear analysis and definition. Our aim was to clarify the concept of clinical reasoning in medicine by identifying its components and to differentiate it from other similar concepts.It is necessary to have an operational definition of clinical reasoning, and its components must be precisely defined in order to design successful interventions and use it easily in future research.Methods: McKenna’s nine-step model was applied to facilitate the clarification of the concept of clinical reasoning. The literature for this concept analysis was retrieved from several databases, including Scopus, Elsevier, PubMed, ISI, ISC, Medline, and Google Scholar, for the years 1995– 2016 (until September 2016. An extensive search of the literature was conducted using the electronic database. Accordingly, 17 articles and one book were selected for the review. We applied McKenna’s method of concept analysis in studying clinical reasoning, so that definitional attributes, antecedents, and consequences of this concept were extracted.Results: Clinical reasoning has nine major attributes in medicine. These attributes include: (1 clinical reasoning as a cognitive process; (2 knowledge acquisition and application of different types of knowledge; (3 thinking as a part of the clinical reasoning process; (4 patient inputs; (5 contextdependent and domain-specific processes; (6 iterative and complex processes; (7 multi-modal cognitive processes; (8 professional principles; and (9 health system mandates. These attributes are influenced by the antecedents of workplace context, practice frames of reference, practice models of the practitioner, and clinical skills. The consequences of clinical reasoning are the metacognitive improvement of

  18. Society for Academic Emergency Medicine Statement on Plagiarism.

    Science.gov (United States)

    Asher, Shellie L; Iserson, Kenneth V; Merck, Lisa H

    2017-10-01

    The integrity of the research enterprise is of the utmost importance for the advancement of safe and effective medical practice for patients and for maintaining the public trust in health care. Academic societies and editors of journals are key participants in guarding scientific integrity. Avoiding and preventing plagiarism helps to preserve the scientific integrity of professional presentations and publications. The Society for Academic Emergency Medicine (SAEM) Ethics Committee discusses current issues in scientific publishing integrity and provides a guideline to avoid plagiarism in SAEM presentations and publications. © 2017 by the Society for Academic Emergency Medicine.

  19. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario

    OpenAIRE

    Addison, Reuben; Skinner, Tate; Zhou, Felix; Parsons, Michael

    2017-01-01

    Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of undergraduate and postgraduate training. Similarly, effective professional development activities stand t...

  20. Ancestral assumptions and the clinical uncertainty of evolutionary medicine.

    Science.gov (United States)

    Cournoyea, Michael

    2013-01-01

    Evolutionary medicine is an emerging field of medical studies that uses evolutionary theory to explain the ultimate causes of health and disease. Educational tools, online courses, and medical school modules are being developed to help clinicians and students reconceptualize health and illness in light of our evolutionary past. Yet clinical guidelines based on our ancient life histories are epistemically weak, relying on the controversial assumptions of adaptationism and advocating a strictly biophysical account of health. To fulfill the interventionist goals of clinical practice, it seems that proximate explanations are all we need to develop successful diagnostic and therapeutic guidelines. Considering these epistemic concerns, this article argues that the clinical relevance of evolutionary medicine remains uncertain at best.

  1. Clinical Holistic Medicine: Applied Consciousness-Based Medicine

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2004-01-01

    Full Text Available Consciousness-based medicine is our term for a form of medical treatment that works by direct appeal to the consciousness of the patient, in contrast to modern biomedical treatment where drugs are used to affect body chemistry. With this concept, maybe we are (in a sense turning back to the “old medicine”, where the family physician was the all-concerned “old country doctor” who knew the child, the siblings, the parents, the family, and the village. In a series of papers on clinical holistic medicine, we would like to present the classic art of healing, where the physician works mostly with his hands, then show how the modern biomedical physician performs with biochemistry, and finally introduce consciousness-based medicine. Some of our questions will be: If you improve your quality of life, will you also improve your health? Will learning more about yourself bring more purpose in your life? Will finding someone to live with in a loving and mutually respectful relationship improve your health? Scientists and thinkers like Antonovsky, Frankl, Maslow, and Jung have pointed to love as a unique way to coherence in life, and thus to biological order and a better health. Several scientific studies have also suggested that patients who focus on improving their quality of life usually will not follow the general statistics for survival, since somehow other factors are at play, which sometimes you will find referred to as “exceptional”.

  2. Psychedelics as Medicines: An Emerging New Paradigm.

    Science.gov (United States)

    Nichols, D E; Johnson, M W; Nichols, C D

    2017-02-01

    Scientific interest in serotonergic psychedelics (e.g., psilocybin and LSD; 5-HT 2A receptor agonists) has dramatically increased within the last decade. Clinical studies administering psychedelics with psychotherapy have shown preliminary evidence of robust efficacy in treating anxiety and depression, as well as addiction to tobacco and alcohol. Moreover, recent research has suggested that these compounds have potential efficacy against inflammatory diseases through novel mechanisms, with potential advantages over existing antiinflammatory agents. We propose that psychedelics exert therapeutic effects for psychiatric disorders by acutely destabilizing local brain network hubs and global network connectivity via amplification of neuronal avalanches, providing the occasion for brain network "resetting" after the acute effects have resolved. Antiinflammatory effects may hold promise for efficacy in treatment of inflammation-related nonpsychiatric as well as potentially for psychiatric disorders. Serotonergic psychedelics operate through unique mechanisms that show promising effects for a variety of intractable, debilitating, and lethal disorders, and should be rigorously researched. © 2016 American Society for Clinical Pharmacology and Therapeutics.

  3. The role of emergency physicians in the institutionalization of emergency medicine.

    Science.gov (United States)

    van Schothorst, Jannine; van den Brand, Crispijn L; Gaakeer, Menno I; Wallenburg, Iris

    2017-08-01

    Emergency medicine is a fast-growing medical profession. Nevertheless, the clinical activities emergency physicians (EPs) carry out and the responsibilities they have differ considerably between hospitals. This article addresses the question how the role of EPs is shaped and institutionalized in the everyday context of acute care in hospitals. A cross-case ethnographic study was conducted, comprising observations, document analysis, and in-depth interviews in three emergency departments in the Netherlands. Drawing on the theoretical concept of institutional work, we show that managers, already established medical specialties, and EPs all conduct institutional work to enhance private interests, which both restricts and enlarges EPs' work domain. These actions are strategic and intentional, as well as unintentional and part of EPs' everyday work in acute care delivery. It is in this very process that tasks and responsibilities are redistributed and the role of the EP is shaped. In contemporary literature it is often argued that the role and status of EPs should be enhanced by strengthening regulation and improving training programs. This article shows that attention should also be paid to the more subtle everyday processes of role development.

  4. An Emergency Medicine Research Priority Setting Partnership to establish the top 10 research priorities in emergency medicine.

    Science.gov (United States)

    Smith, Jason; Keating, Liza; Flowerdew, Lynsey; O'Brien, Rachel; McIntyre, Sam; Morley, Richard; Carley, Simon

    2017-07-01

    Defining research priorities in a specialty as broad as emergency medicine is a significant challenge. In order to fund and complete the most important research projects, it is imperative that we identify topics that are important to all clinicians, society and to our patients. We have undertaken a priority setting partnership to establish the most important questions facing emergency medicine. The top 10 questions reached through a consensus process are discussed. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  5. [Narrative-based medicine and clinical knowledge].

    Science.gov (United States)

    Saito, Seiji

    2006-01-01

    Narrative Based Medicine (NBM) can be defined as follows; a) It views the patient's illness as an unfolding story within the wider story of the patient's life and life-world; b) It acknowledges the patient as the narrator of the story and the subject of the tale; c) It recognizes that all medical theories, hypothesis and pathophysiologies as socially constructed narratives and accepts the coexistence of multiple different narratives; d) It regards the emergence of new stories from dialogue and discourse between patients and healthcare professionals as part of the treatment. Because psychiatry is the only area of specialist medicine where talking and listening are explicitly understood to be therapeutic, NBM can be adopted an effective perspective and method in psychiatry.

  6. Assessing Team Leadership in Emergency Medicine: The Milestones and Beyond

    Science.gov (United States)

    Rosenman, Elizabeth D.; Branzetti, Jeremy B.; Fernandez, Rosemarie

    2016-01-01

    Background Team leadership is a critical skill for emergency medicine physicians that directly affects team performance and the quality of patient care. There exists a robust body of team science research supporting team leadership conceptual models and behavioral skill sets. However, to date, this work has not been widely incorporated into health care team leadership education. Objective This narrative review has 3 aims: (1) to synthesize the team science literature and to translate important concepts and models to health care team leadership; (2) to describe how team leadership is currently represented in the health care literature and in the Accreditation Council for Graduate Medical Education Milestones for emergency medicine; and (3) to propose a novel, evidence-based framework for the assessment of team leadership in emergency medicine. Methods We conducted a narrative review of the team science and health care literature. We summarized our findings and identified a list of team leadership behaviors that were then used to create a framework for team leadership assessment. Results Current health care team leadership measurement tools do not incorporate evidence-based models of leadership concepts from other established domains. The emergency medicine milestones include several team leadership behaviors as part of a larger resident evaluation program. However, they do not offer a comprehensive or cohesive representation of the team leadership construct. Conclusions Despite the importance of team leadership to patient care, there is no standardized approach to team leadership assessment in emergency medicine. Based on the results of our review, we propose a novel team leadership assessment framework that is supported by the team science literature. PMID:27413434

  7. Assessing Team Leadership in Emergency Medicine: The Milestones and Beyond.

    Science.gov (United States)

    Rosenman, Elizabeth D; Branzetti, Jeremy B; Fernandez, Rosemarie

    2016-07-01

    Team leadership is a critical skill for emergency medicine physicians that directly affects team performance and the quality of patient care. There exists a robust body of team science research supporting team leadership conceptual models and behavioral skill sets. However, to date, this work has not been widely incorporated into health care team leadership education. This narrative review has 3 aims: (1) to synthesize the team science literature and to translate important concepts and models to health care team leadership; (2) to describe how team leadership is currently represented in the health care literature and in the Accreditation Council for Graduate Medical Education Milestones for emergency medicine; and (3) to propose a novel, evidence-based framework for the assessment of team leadership in emergency medicine. We conducted a narrative review of the team science and health care literature. We summarized our findings and identified a list of team leadership behaviors that were then used to create a framework for team leadership assessment. Current health care team leadership measurement tools do not incorporate evidence-based models of leadership concepts from other established domains. The emergency medicine milestones include several team leadership behaviors as part of a larger resident evaluation program. However, they do not offer a comprehensive or cohesive representation of the team leadership construct. Despite the importance of team leadership to patient care, there is no standardized approach to team leadership assessment in emergency medicine. Based on the results of our review, we propose a novel team leadership assessment framework that is supported by the team science literature.

  8. Systematic Molecular Phenotyping: A Path Toward Precision Emergency Medicine?

    Science.gov (United States)

    Limkakeng, Alexander T; Monte, Andrew A; Kabrhel, Christopher; Puskarich, Michael; Heitsch, Laura; Tsalik, Ephraim L; Shapiro, Nathan I

    2016-10-01

    Precision medicine is an emerging approach to disease treatment and prevention that considers variability in patient genes, environment, and lifestyle. However, little has been written about how such research impacts emergency care. Recent advances in analytical techniques have made it possible to characterize patients in a more comprehensive and sophisticated fashion at the molecular level, promising highly individualized diagnosis and treatment. Among these techniques are various systematic molecular phenotyping analyses (e.g., genomics, transcriptomics, proteomics, and metabolomics). Although a number of emergency physicians use such techniques in their research, widespread discussion of these approaches has been lacking in the emergency care literature and many emergency physicians may be unfamiliar with them. In this article, we briefly review the underpinnings of such studies, note how they already impact acute care, discuss areas in which they might soon be applied, and identify challenges in translation to the emergency department (ED). While such techniques hold much promise, it is unclear whether the obstacles to translating their findings to the ED will be overcome in the near future. Such obstacles include validation, cost, turnaround time, user interface, decision support, standardization, and adoption by end-users. © 2016 by the Society for Academic Emergency Medicine.

  9. Emergency Medicine Residency Boot Camp Curriculum: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Ataya, Ramsey

    2015-03-01

    Full Text Available Introduction: Establishing a boot camp curriculum is pertinent for emergency medicine (EM residents in order to develop proficiency in a large scope of procedures and leadership skills.  In this article, we describe our program’s EM boot camp curriculum as well as measure the confidence levels of resident physicians through a pre- and post-boot camp survey. Methods: We designed a one-month boot camp curriculum with the intention of improving the confidence, procedural performance, leadership, communication and resource management of EM interns. Our curriculum consisted of 12 hours of initial training and culminated in a two-day boot camp. The initial day consisted of clinical skill training and the second day included code drill scenarios followed by interprofessional debriefing.   Results: Twelve EM interns entered residency with an overall confidence score of 3.2 (1-5 scale across all surveyed skills. Interns reported the highest pre-survey confidence scores in suturing (4.3 and genitourinary exams (3.9. The lowest pre-survey confidence score was in thoracostomy (2.4. Following the capstone experience, overall confidence scores increased to 4.0. Confidence increased the most in defibrillation and thoracostomy. Additionally, all interns reported post-survey confidence scores of at least 3.0 in all skills, representing an internal anchor of “moderately confident/need guidance at times to perform procedure.” Conclusion: At the completion of the boot camp curriculum, EM interns had improvement in self-reported confidence across all surveyed skills and procedures. The described EM boot camp curriculum was effective, feasible and provided a foundation to our trainees during their first month of residency. [West J Emerg Med. 2015;16(2:356–361.

  10. Family Medicine needs assessment: Studying the clinical work of ...

    African Journals Online (AJOL)

    admin

    Abstract. Background and Objective: Some universities in sub-Saharan Africa have initiated Family Medicine (FM) residency programs. ... were for information technology (78%) and HIV (46%) training. Conclusion: ..... Emergency medicine. 32.

  11. Core Content for Wilderness Medicine Training: Development of a Wilderness Medicine Track Within an Emergency Medicine Residency.

    Science.gov (United States)

    Schrading, Walter A; Battaglioli, Nicole; Drew, Jonathan; McClure, Sarah Frances

    2018-03-01

    Wilderness medicine training has become increasingly popular among medical professionals with numerous educational opportunities nationwide. Curricula for fellowship programs and for medical student education have previously been developed and published, but a specific curriculum for wilderness medicine education during emergency medicine (EM) residency has not. The objective of this study is to create a longitudinal wilderness medicine curriculum that can be incorporated into an EM residency program. Interest-specific tracks are becoming increasingly common in EM training. We chose this model to develop our curriculum specific to wilderness medicine. Outlined in the article is a 3-year longitudinal course of study that includes a core didactic curriculum and a plan for graduated level of responsibility. The core content is specifically related to the required EM core content for residency training with additions specific to wilderness medicine for the residents who pursue the track. The wilderness medicine curriculum would give residencies a framework that can be used to foster learning for residents interested in wilderness medicine. It would enhance the coverage of wilderness and environmental core content education for all EM residents in the program. It would provide wilderness-specific education and experience for interested residents, allowing them to align their residency program requirements through a focused area of study and enhancing their curriculum vitae at graduation. Finally, given the popularity of wilderness medicine, the presence of a wilderness medicine track may improve recruitment for the residency program. Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  12. Exploring Scholarship and the Emergency Medicine Educator: A Workforce Study.

    Science.gov (United States)

    Jordan, Jaime; Coates, Wendy C; Clarke, Samuel; Runde, Daniel P; Fowlkes, Emilie; Kurth, Jacqueline; Yarris, Lalena M

    2017-01-01

    Recent literature calls for initiatives to improve the quality of education studies and support faculty in approaching educational problems in a scholarly manner. Understanding the emergency medicine (EM) educator workforce is a crucial precursor to developing policies to support educators and promote education scholarship in EM. This study aims to illuminate the current workforce model for the academic EM educator. Program leadership at EM training programs completed an online survey consisting of multiple choice, completion, and free-response type items. We calculated and reported descriptive statistics. 112 programs participated. Mean number of core faculty/program: 16.02 ± 7.83 [14.53-17.5]. Mean number of faculty full-time equivalents (FTEs)/program dedicated to education is 6.92 ± 4.92 [5.87-7.98], including (mean FTE): Vice chair for education (0.25); director of medical education (0.13); education fellowship director (0.2); residency program director (0.83); associate residency director (0.94); assistant residency director (1.1); medical student clerkship director (0.8); assistant/associate clerkship director (0.28); simulation fellowship director (0.11); simulation director (0.42); director of faculty development (0.13). Mean number of FTEs/program for education administrative support is 2.34 ± 1.1 [2.13-2.61]. Determination of clinical hours varied; 38.75% of programs had personnel with education research expertise. Education faculty represent about 43% of the core faculty workforce. Many programs do not have the full spectrum of education leadership roles and educational faculty divide their time among multiple important academic roles. Clinical requirements vary. Many departments lack personnel with expertise in education research. This information may inform interventions to promote education scholarship.

  13. Combined residency training in emergency medicine and internal medicine: an update on career outcomes and job satisfaction.

    Science.gov (United States)

    Kessler, Chad S; Stallings, Leonard A; Gonzalez, Andrew A; Templeman, Todd A

    2009-09-01

    This study was designed to provide an update on the career outcomes and experiences of graduates of combined emergency medicine-internal medicine (EM-IM) residency programs. The graduates of the American Board of Emergency Medicine (ABEM) and American Board of Internal Medicine (ABIM)-accredited EM-IM residencies from 1998 to 2008 were contacted and asked to complete a survey concerning demographics, board certification, fellowships completed, practice setting, academic affiliation, and perceptions about EM-IM training and careers. There were 127 respondents of a possible 163 total graduates for a response rate of 78%. Seventy graduates (55%) practice EM only, 47 graduates (37%) practice both EM and IM, and nine graduates (7%) practice IM or an IM subspecialty only. Thirty-one graduates (24%) pursued formal fellowship training in either EM or IM. Graduates spend the majority of their time practicing clinical EM in an urban (72%) and academic (60%) environment. Eighty-seven graduates (69%) spend at least 10% of their time in an academic setting. Most graduates (64%) believe it practical to practice both EM and IM. A total of 112 graduates (88%) would complete EM-IM training again. Dual training in EM-IM affords a great deal of career opportunities, particularly in academics and clinical practice, in a number of environments. Graduates hold their training in high esteem and would do it again if given the opportunity.

  14. Selecting clinical quality indicators for laboratory medicine.

    Science.gov (United States)

    Barth, Julian H

    2012-05-01

    Quality in laboratory medicine is often described as doing the right test at the right time for the right person. Laboratory processes currently operate under the oversight of an accreditation body which gives confidence that the process is good. However, there are aspects of quality that are not measured by these processes. These are largely focused on ensuring that the most clinically appropriate test is performed and interpreted correctly. Clinical quality indicators were selected through a two-phase process. Firstly, a series of focus groups of clinical scientists were held with the aim of developing a list of quality indicators. These were subsequently ranked in order by an expert panel of primary and secondary care physicians. The 10 top indicators included the communication of critical results, comprehensive education to all users and adequate quality assurance for point-of-care testing. Laboratories should ensure their tests are used to national standards, that they have clinical utility, are calibrated to national standards and have long-term stability for chronic disease management. Laboratories should have error logs and demonstrate evidence of measures introduced to reduce chances of similar future errors. Laboratories should make a formal scientific evaluation of analytical quality. This paper describes the process of selection of quality indicators for laboratory medicine that have been validated sequentially by deliverers and users of the service. They now need to be converted into measureable variables related to outcome and validated in practice.

  15. Management of Pneumothorax in Emergency Medicine Departments: Multicenter Trial

    Science.gov (United States)

    Ince, Abdulkadir; Ozucelik, Dogac Niyazi; Avci, Akkan; Nizam, Ozgur; Dogan, Halil; Topal, Mehmet Ali

    2013-01-01

    Background: Pneumothorax is common and life-threatening clinical condition which may require emergency treatment in Emergency Medicine Departments. Objectives: We aimed to reveal the epidemiological analysis of the patients admitted to the Emergency Department with pneumothorax. Material and Methods: This case-control and multi-center study was conducted in the patients treated with the diagnosis of pneumothorax between 01.01.2010-31.12.2010. Patient data were collected from hospital automation system. According to the etiology of the pneumothorax, study groups were arranged like spontaneous pneumothorax and traumatic pneumothorax. Results: 82.2% (n = 106) of patients were male and 17.8% (n = 23) of patients were female and mean age were 31.3 ± 20,2 (Minimum: 1, Maximum: 87). 68.2% (n = 88) of patients were spontaneous pneumothorax (61.36%, n=79 were primary spontaneous pneumothorax) and 31.8% (n = 41) of patients were traumatic pneumothorax (21.95% were iatrogenic pneumothorax). Main complaint is shortness of breath (52.3%, n=67) and 38% (n=49) of patients were smokers. Posteroanterior (PA) Chest X-Ray has been enough for 64.3% (n = 83) of the patients' diagnosis. Tube thoracostomy is applied to 84.5% (n = 109) of patients and surgery is applied to 9.3% (n = 12) of patients and 6.2% (n = 8) of patients were discharged with conservative treatment. Spontaneous pneumothorax showed statistically significant high recurrence compared with traumatic pneumothorax (P = 0.007). 4.65% of (n = 6) patients died. The average age of those who died (9.3 ± 19.9), statistically were significantly lower the mean age of living patients (32.4 ± 19.7) (t test, P = 0,006). 83.33% of the patients who died were neonatals and in the 0-1 years age group, and five of these patients were secondary spontaneous pneumothorax, and one of these patients were iatrogenic pneumothorax due to mechanical ventilation. Conclusions: Pneumothorax in adults can be treated by tube thoracostomy or

  16. Radiologic procedures, policies and protocols for pediatric emergency medicine

    International Nuclear Information System (INIS)

    Woodward, George A.

    2008-01-01

    Protocol development between radiology and pediatric emergency medicine requires a multidisciplinary approach to manage straightforward as well as complex and time-sensitive needs for emergency department patients. Imaging evaluation requires coordination of radiologic technologists, radiologists, transporters, nurses and coordinators, among others, and might require accelerated routines or occur at sub-optimal times. Standardized protocol development enables providers to design a best practice in all of these situations and should be predicated on evidence, mission, and service expectations. As in any new process, constructive feedback channels are imperative for evaluation and modification. (orig.)

  17. Toward a definition of teamwork in emergency medicine.

    Science.gov (United States)

    Fernandez, Rosemarie; Kozlowski, Steve W J; Shapiro, Marc J; Salas, Eduardo

    2008-11-01

    The patient safety literature from the past decade emphasizes the importance of teamwork skills and human factors in preventing medical errors. Simulation has been used within aviation, the military, and now health care domains to effectively teach and assess teamwork skills. However, attempts to expand and generalize research and training principles have been limited due to a lack of a well-defined, well-researched taxonomy. As part of the 2008 Academic Emergency Medicine Consensus Conference on "The Science of Simulation in Healthcare," a subset of the group expertise and group assessment breakout sections identified evidence-based recommendations for an emergency medicine (EM) team taxonomy and performance model. This material was disseminated within the morning session and was discussed both during breakout sessions and via online messaging. Below we present a well-defined, well-described taxonomy that will help guide design, implementation, and assessment of simulation-based team training programs.

  18. Regenerative Medicine as an Emergent Cluster in Tampere Region

    Directory of Open Access Journals (Sweden)

    Tuomo Heinonen

    2015-01-01

    Full Text Available Clusters are important for regional economies and emergent clusters are in a key position, as a means of adding more diversification to the current economic activity by involving new technologies and industries. Science-based industries may be the most promising in this regard since they are encouraged to develop and enhance the economic imaginaries of territories under the umbrella of radical innovations or in the name of broadening the current economic model based on mostly traditional industries. Regenerative medicine (RM could be an example of these so-called emergent clusters. Regenerative medicine is highly dependent on academic research, which means that local territories must fund the research in this field and, hence, they expect some returns as well. As territories do not typically have existing industries specifically in RM, these industries must emerge or expand from existing ones. Regenerative medicine involves a wide spectrum of different technologies and industries that are likely to form a cluster and benefit from it if successfully developed. The first aim of this paper is to show how some obstacles eventually impede the proper development of these emergent clusters. The second aim is to shed light on how innovations emerge in the cluster and what are the main implications for the territory. In this study, existing literature is used in order to describe the technology market and commercial aspects of the RM sector. Empirically this study is based on the emergent RM cluster in the region of Tampere in Finland. Analysis of 24 conducted interviews helps to contextualize the emergence of the RM cluster in Tampere, where academia is both the booster and the driver of the emergent RM cluster. Commercialization of research in the RM field is one of the goals at the university, even though there are no commercial outcomes yet available. This study contributes to the understanding of emergent cluster development in science

  19. Interprofessional education of medical students and paramedics in emergency medicine.

    Science.gov (United States)

    Hallikainen, J; Väisänen, O; Rosenberg, P H; Silfvast, T; Niemi-Murola, L

    2007-03-01

    Emergency medicine is team work from the field to the hospital and therefore it is also important for physicians to understand the work of paramedics, and vice versa. Interprofessional emergency medicine education for medical and paramedic students in Helsinki was started in 2001. It consisted of a 15 European credit transfer system (ECTS) credits programme combining 22 students in 2001. In 2005, the number of students had increased to 25. The programme consisted of three parts: acute illness in childhood and adults (AI), advanced life support (ALS) and trauma life support (TLS). In this paper, we describe the concept of interprofessional education of medical students and paramedics in emergency medicine. After finishing the programmes in 2001 and in 2005, the students' opinions regarding the education were collected using a standardized questionnaire. There were good ratings for the courses in AI (2001 vs. 2005, whole group; 4.3 +/- 0.7 vs. 4.2 +/- 0.4, P = 0.44) ALS (4.7 +/- 0.5 vs. 4.4 +/- 0.5, P = 0.06) and TLS (3.9 +/- 0.7 vs. 4.4 +/- 0.5, P = 0.01) in both years. Most of the medical students considered that this kind of co-education should be arranged for all medical students (2001 vs. 2005; 4.8 +/- 0.6 vs. 4.4 +/- 0.5, P = 0.02) and should be obligatory (3.5 +/- 1.5 vs. 3.1 +/- 1.3, P = 0.35). Co-education was well received and determined by the students as an effective way of improving their knowledge of emergency medicine and medical skills. The programme was rated as very useful and it should be included in the educational curriculum of both student groups.

  20. Designing a clinical dashboard to fill information gaps in the emergency department.

    Science.gov (United States)

    Swartz, Jordan L; Cimino, James J; Fred, Matthew R; Green, Robert A; Vawdrey, David K

    2014-01-01

    Data fragmentation within electronic health records causes gaps in the information readily available to clinicians. We investigated the information needs of emergency medicine clinicians in order to design an electronic dashboard to fill information gaps in the emergency department. An online survey was distributed to all emergency medicine physicians at a large, urban academic medical center. The survey response rate was 48% (52/109). The clinical information items reported to be most helpful while caring for patients in the emergency department were vital signs, electrocardiogram (ECG) reports, previous discharge summaries, and previous lab results. Brief structured interviews were also conducted with 18 clinicians during their shifts in the emergency department. From the interviews, three themes emerged: 1) difficulty accessing vital signs, 2) difficulty accessing point-of-care tests, and 3) difficulty comparing the current ECG with the previous ECG. An emergency medicine clinical dashboard was developed to address these difficulties.

  1. Highlights in emergency medicine medical education research: 2008.

    Science.gov (United States)

    Farrell, Susan E; Coates, Wendy C; Khun, Gloria J; Fisher, Jonathan; Shayne, Philip; Lin, Michelle

    2009-12-01

    The purpose of this article is to highlight medical education research studies published in 2008 that were methodologically superior and whose outcomes were pertinent to teaching and education in emergency medicine. Through a PubMed search of the English language literature in 2008, 30 medical education research studies were independently identified as hypothesis-testing investigations and measurements of educational interventions. Six reviewers independently rated and scored all articles based on eight anchors, four of which related to methodologic criteria. Articles were ranked according to their total rating score. A ranking agreement among the reviewers of 83% was established a priori as a minimum for highlighting articles in this review. Five medical education research studies met the a priori criteria for inclusion and are reviewed and summarized here. Four of these employed experimental or quasi-experimental methodology. Although technology was not a component of the structured literature search employed to identify the candidate articles for this review, 14 of the articles identified, including four of the five highlighted articles, employed or studied technology as a focus of the educational research. Overall, 36% of the reviewed studies were supported by funding; three of the highlighted articles were funded studies. This review highlights quality medical education research studies published in 2008, with outcomes of relevance to teaching and education in emergency medicine. It focuses on research methodology, notes current trends in the use of technology for learning in emergency medicine, and suggests future avenues for continued rigorous study in education.

  2. Diagnostic ultrasound use in physiotherapy, emergency medicine, and anaesthesiology

    Energy Technology Data Exchange (ETDEWEB)

    McKiernan, Sharmaine [School of Health Sciences, University of Newcastle, Callagham, NSW 2308 (Australia)], E-mail: sharmaine.mckiernan@newcastle.edu.au; Chiarelli, Pauline; Warren-Forward, Helen [School of Health Sciences, University of Newcastle, Callagham, NSW 2308 (Australia)

    2010-05-15

    Background: Diagnostic ultrasound is traditionally and extensively used within the radiology department. However in recent years its use has expanded outside this traditional area into health professions such as physiotherapy, emergency medicine and anaesthesiology. Purpose: The radiology community needs to be aware of the expansion of use of diagnostic ultrasound. This article starts this exploration in the health professions mentioned, however it is acknowledged that diagnostic ultrasound use goes beyond what is covered in this article. As diagnostic ultrasound is a user dependant modality and the outcome of an examination is largely influenced by the skill and experience of the operator, the radiology community should take a guiding role in its use, training and protocol development for health professionals. Method: This article explores the literature on the use of diagnostic ultrasound within physiotherapy, emergency medicine and anaesthesiology. Literature was searched for on the databases Medline, Cinahl and Embase. Results: Diagnostic ultrasound is being used in health professions such as physiotherapy, where it is being used to provide biofeedback to patients on contraction of abdominal and pelvic floor muscles; emergency medicine, for the investigation of free fluid within the abdomen of a trauma patient and anaesthesiology, for the placement of catheters and nerve blocks. Conclusion: As members of the radiology community are considered experts in the field, they need to take the lead to guide and mentor the other health professionals who are now using the modality. To be able to achieve this they must have an understanding of what these professions are using the modality for.

  3. Diagnostic ultrasound use in physiotherapy, emergency medicine, and anaesthesiology

    International Nuclear Information System (INIS)

    McKiernan, Sharmaine; Chiarelli, Pauline; Warren-Forward, Helen

    2010-01-01

    Background: Diagnostic ultrasound is traditionally and extensively used within the radiology department. However in recent years its use has expanded outside this traditional area into health professions such as physiotherapy, emergency medicine and anaesthesiology. Purpose: The radiology community needs to be aware of the expansion of use of diagnostic ultrasound. This article starts this exploration in the health professions mentioned, however it is acknowledged that diagnostic ultrasound use goes beyond what is covered in this article. As diagnostic ultrasound is a user dependant modality and the outcome of an examination is largely influenced by the skill and experience of the operator, the radiology community should take a guiding role in its use, training and protocol development for health professionals. Method: This article explores the literature on the use of diagnostic ultrasound within physiotherapy, emergency medicine and anaesthesiology. Literature was searched for on the databases Medline, Cinahl and Embase. Results: Diagnostic ultrasound is being used in health professions such as physiotherapy, where it is being used to provide biofeedback to patients on contraction of abdominal and pelvic floor muscles; emergency medicine, for the investigation of free fluid within the abdomen of a trauma patient and anaesthesiology, for the placement of catheters and nerve blocks. Conclusion: As members of the radiology community are considered experts in the field, they need to take the lead to guide and mentor the other health professionals who are now using the modality. To be able to achieve this they must have an understanding of what these professions are using the modality for.

  4. Systematic Molecular Phenotyping: A Path Towards Precision Emergency Medicine?

    Science.gov (United States)

    Limkakeng, Alexander T.; Monte, Andrew; Kabrhel, Christopher; Puskarich, Michael; Heitsch, Laura; Tsalik, Ephraim L.; Shapiro, Nathan I.

    2016-01-01

    Precision medicine is an emerging approach to disease treatment and prevention that considers variability in patient genes, environment, and lifestyle. However, little has been written about how such research impacts emergency care. Recent advances in analytical techniques have made it possible to characterize patients in a more comprehensive and sophisticated fashion at the molecular level, promising highly individualized diagnosis and treatment. Among these techniques are various systematic molecular phenotyping analyses (e.g., genomics, transcriptomics, proteomics, and metabolomics). Although a number of emergency physicians use such techniques in their research, widespread discussion of these approaches has been lacking in the emergency care literature and many emergency physicians may be unfamiliar with them. In this article, we briefly review the underpinnings of such studies, note how they already impact acute care, discuss areas in which they might soon be applied, and identify challenges in translation to the emergency department. While such techniques hold much promise, it is unclear whether the obstacles to translating their findings to the emergency department will be overcome in the near future. Such obstacles include validation, cost, turnaround time, user interface, decision support, standardization, and adoption by end users. PMID:27288269

  5. Impact of night shifts on emergency medicine resident resuscitation performance.

    Science.gov (United States)

    Edgerley, Sarah; McKaigney, Conor; Boyne, Devon; Ginsberg, Darrell; Dagnone, J Damon; Hall, Andrew K

    2018-03-12

    Emergency medicine (EM) trainees often work nightshifts. We sought to measure how this circadian disruption affects EM resident performance during simulated resuscitations. This retrospective cohort study enrolled EM residents at a single Canadian academic centre over a six-year period. Residents completed twice-annual simulation-based resuscitation-focused objective structured clinical examinations (OSCEs) with assessment in four domains (primary assessment, diagnostic actions, therapeutic actions and communication), and a global assessment score (GAS). Primary and secondary exposures of interest were the presence of a nightshift (late-evening shifts ending between midnight and 03h00 or overnight shifts ending after 06h00) the day before or within three days before an OSCE. A random effects linear regression model was used to quantify the association between nightshifts and OSCE scores. From 57 residents, 136 OSCE scores were collected. Working a nightshift the day before an OSCE did not affect male trainee scores but was associated with a significant absolute decrease in mean total scores (-6% [95% CI -12% to 0%]), GAS (-7% [-13% to 0%]), and communication (-9% [-16% to -2%]) scores among women. Working any nightshift within three days before an OSCE lowered absolute mean total scores by 4% [-7% to 0%] and communication scores by 5% [-5% to 0%] irrespective of gender. Our results suggest that shift work may impact EM resident resuscitation performance, particularly in the communication domain. This impact may be more significant in women than men, suggesting a need for further investigation. Copyright © 2018 Elsevier B.V. All rights reserved.

  6. Cost-effectiveness Analysis Appraisal and Application: An Emergency Medicine Perspective.

    Science.gov (United States)

    April, Michael D; Murray, Brian P

    2017-06-01

    Cost-effectiveness is an important goal for emergency care delivery. The many diagnostic, treatment, and disposition decisions made in the emergency department (ED) have a significant impact upon healthcare resource utilization. Cost-effectiveness analysis (CEA) is an analytic tool to optimize these resource allocation decisions through the systematic comparison of costs and effects of alternative healthcare decisions. Yet few emergency medicine leaders and policymakers have any formal training in CEA methodology. This paper provides an introduction to the interpretation and use of CEA with a focus on application to emergency medicine problems and settings. It applies a previously published CEA to the hypothetical case of a patient presenting to the ED with chest pain who requires risk stratification. This paper uses a widely cited checklist to appraise the CEA. This checklist serves as a vehicle for presenting basic CEA terminology and concepts. General topics of focus include measurement of costs and outcomes, incremental analysis, and sensitivity analysis. Integrated throughout the paper are recommendations for good CEA practice with emphasis on the guidelines published by the U.S. Panel on Cost-Effectiveness in Health and Medicine. Unique challenges for emergency medicine CEAs discussed include the projection of long-term outcomes from emergent interventions, costing ED services, and applying study results to diverse patient populations across various ED settings. The discussion also includes an overview of the limitations inherent in applying CEA results to clinical practice to include the lack of incorporation of noncost considerations in CEA (e.g., ethics). After reading this article, emergency medicine leaders and researchers will have an enhanced understanding of the basics of CEA critical appraisal and application. The paper concludes with an overview of economic evaluation resources for readers interested in conducting ED-based economic evaluation

  7. Publication rate of abstracts presented at the emergency medicine congresses held by the European Society for Emergency Medicine (EUSEM) in 2011 and 2012.

    Science.gov (United States)

    Kalkan, Asim; Kose, Ozkan; Bilir, Ozlem; Ersunan, Gokhan; Ozel, Deniz; Guler, Ferhat

    2015-09-01

    The purpose of this study was to assess the publication rate of the abstracts presented at the 6th Mediterranean Emergency Medicine Congress, 2011 and the 7th European Congress on Emergency Medicine, 2012. All abstracts, both posters and oral presentations, from the international emergency medicine congresses held by the European Society for Emergency Medicine (EUSEM) in 2011 and 2012 were identified. To establish whether these abstracts were subsequently published in peer-reviewed medical journals, the names of all the authors and the title of the abstracts were searched for in the databases of Clinical Key/Elsevier, EBSCO Discovery Service, MD Consult, Science Direct, Scopus, EMBASE, Medscape, Google Scholar and local ULAKBIM. The year of publication, consistency of author names and titles, the type of study, the journals in which papers were published and countries from which reports were submitted were all recorded. A total of 1721 abstracts were examined; 626 from 2011 (307 oral presentations and 319 posters) and 1095 from 2012 (154 oral presentations and 941 posters). Of all abstracts in 2011, 172 (27.5%) and of all abstracts in 2012, 265 (24.2%) were subsequently published as full-text reports in peer-reviewed journals. Of the 172 papers published in 2011, 152 (88.4%) were accepted by Science Citation Index (SCI) and/or SCI Expanded (SCI-E) journals and 155 (58.5%) of 265 papers were accepted by SCI and/or SCI-E journals in 2012 (p=0.0001). The publication rate of abstracts submitted to international emergency medicine congresses held by EUSEM over those 2 years was low compared with that of abstracts presented in other emergency medicine congresses. Presenters should be encouraged to send their studies to peer-reviewed journals. During the selection process by the scientific panel, constructive critics should be notified to the presenters instead of simply accepting or rejecting the studies that submitted to the congress, which may increase the

  8. Balancing certainty and uncertainty in clinical medicine.

    Science.gov (United States)

    Hayward, Richard

    2006-01-01

    Nothing in clinical medicine is one hundred per cent certain. Part of a doctor's education involves learning how to cope with the anxiety that uncertainty in decisions affecting life and death inevitably produces. This paper examines: (1) the role of anxiety -- both rational and irrational -- in the provision of health care; (2) the effects of uncertainty upon the doctor-patient relationship; (3) the threat uncertainty poses to medical authority (and the assumption of infallibility that props it up); (4) the contribution of clinical uncertainty to the rising popularity of alternative therapies; and (5) the clash between the medical and the legal understanding of how certainty should be defined, particularly as it affects the paediatric community. It concludes by suggesting some strategies that might facilitate successful navigation between the opposing and ever-present forces of certainty and uncertainty.

  9. Time-Driven Activity-Based Costing in Emergency Medicine.

    Science.gov (United States)

    Yun, Brian J; Prabhakar, Anand M; Warsh, Jonathan; Kaplan, Robert; Brennan, John; Dempsey, Kyle E; Raja, Ali S

    2016-06-01

    Value in emergency medicine is determined by both patient-important outcomes and the costs associated with achieving them. However, measuring true costs is challenging. Without an understanding of costs, emergency department (ED) leaders will be unable to determine which interventions might improve value for their patients. Although ongoing research may determine which outcomes are meaningful, an accurate costing system is also needed. This article reviews current costing mechanisms in the ED and their pitfalls. It then describes how time-driven activity-based costing may be superior to these current costing systems. Time-driven activity-based costing, in addition to being a more accurate costing system, can be used for process improvements in the ED. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  10. The search for common ground: developing emergency medicine in Iran.

    Science.gov (United States)

    Smith, Jeffrey P; Shokoohi, Hamid; Holliman, James C

    2007-05-01

    Academic ties between Iran and the United States were extensive before the 1979 revolution in Iran. After 20 years of negligible academic exchanges, there has been a growing trend of professional contacts between the two countries over the past few years. The genuine warmth of friendship and commitment to excellence in emergency medicine (EM) among Iranians has transcended the political barriers to allow international contribution of EM development in the country. Since 1999, there has been a successful academic collaboration between Iranian and U.S. universities to help develop EM in Iran. Today, remarkable progresses have been achieved through recognition of EM as a distinct profession, developing EM residency programs, improving emergency medical services, establishing qualified emergency departments, training faculty and staff, starting physician exchange programs, and building mutual contributions with professionals throughout the world. A supportive policy environment and a high-quality health care system have had incredible impacts on EM development in the country.

  11. Herbal medicine: biomolecular and clinical aspects

    National Research Council Canada - National Science Library

    Benzie, Iris F. F; Wachtel-Galor, Sissi

    2011-01-01

    "Responding to the increased popularity of herbal medicines and other forms of complementary or alternative medicine in countries around the world, this reference reviews and evaluates various safety...

  12. Current and emerging applications of 3D printing in medicine.

    Science.gov (United States)

    Liaw, Chya-Yan; Guvendiren, Murat

    2017-06-07

    Three-dimensional (3D) printing enables the production of anatomically matched and patient-specific devices and constructs with high tunability and complexity. It also allows on-demand fabrication with high productivity in a cost-effective manner. As a result, 3D printing has become a leading manufacturing technique in healthcare and medicine for a wide range of applications including dentistry, tissue engineering and regenerative medicine, engineered tissue models, medical devices, anatomical models and drug formulation. Today, 3D printing is widely adopted by the healthcare industry and academia. It provides commercially available medical products and a platform for emerging research areas including tissue and organ printing. In this review, our goal is to discuss the current and emerging applications of 3D printing in medicine. A brief summary on additive manufacturing technologies and available printable materials is also given. The technological and regulatory barriers that are slowing down the full implementation of 3D printing in the medical field are also discussed.

  13. Professional Competencies of Cuban Specialists in Intensive Care and Emergency Medicine.

    Science.gov (United States)

    Véliz-Martínez, Pedro L; Jorna-Calixto, Ana R; Oramas-González, René

    2016-10-01

    INTRODUCTION The quality of medical training and practice reflects the competency level of the professionals involved. The intensive care and emergency medicine specialty in Cuba has not defined its competencies. OBJECTIVE Identify the competencies required for specialty practice in intensive care and emergency medicine. METHODS The study was conducted from January 2014 to December 2015, using qualitative techniques; 48 professionals participated. We undertook functional occupational analysis, based on functions defined in a previous study. Three expert groups were utilized: the first used various group techniques; the second, the Delphi method; and the third, the Delphi method and a Likert questionnaire. RESULTS A total of 73 specific competencies were defined, grouped in 11 units: 44 in the patient care function, 16 in management, 7 in teaching and 6 in research. A competency map is provided. CONCLUSIONS The intensive care and emergency medicine specialty competencies identified will help improve professional standards, ensure health workforce quality, improve patient care and academic performance, and enable objective evaluation of specialists' competence and performance. KEYWORDS Clinical competency, competency-based education, professional education, intensive care, emergency medicine, urgent care, continuing medical education, curriculum, medical residency, Cuba.

  14. Acceptability of the flipped classroom approach for in-house teaching in emergency medicine.

    Science.gov (United States)

    Tan, Eunicia; Brainard, Andrew; Larkin, Gregory L

    2015-10-01

    To evaluate the relative acceptability of the flipped classroom approach compared with traditional didactics for in-house teaching in emergency medicine. Our department changed its learning model from a 'standard' lecture-based model to a 'flipped classroom' model. The 'flipped classroom' included provided pre-session learning objectives and resources before each 2 h weekly session. In-session activities emphasised active learning strategies and knowledge application. Feedback was sought from all medical staff regarding the acceptability of the new approach using an online anonymous cross-sectional qualitative survey. Feedback was received from 49/57 (86%) medical staff. Ninety-eight per cent (48/49) of respondents preferred the flipped classroom over the traditional approach. Aspects of the flipped classroom learners liked most included case-based discussion, interaction with peers, application of knowledge, self-directed learning and small-group learning. Barriers to pre-session learning include work commitments, 'life', perceived lack of time, family commitments, exam preparation and high volume of learning materials. Reported motivational factors promoting pre-session learning include formal assessment, participation requirements, more time, less material, more clinical relevance and/or more interesting material. Case studies and 'hands-on' activities were perceived to be the most useful in-session activities. The flipped classroom shows promise as an acceptable approach to in-house emergency medicine teaching. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  15. Emergency medicine physicians performed ultrasound for pediatric intussusceptions

    Directory of Open Access Journals (Sweden)

    Yi-Jung Chang

    2013-08-01

    Full Text Available Background: Intussusception is the common acute abdomen in children with difficult clinical diagnosis. The routine ultrasound has recently been proposed as the initial diagnostic modality with high accuracy, but is not available for 24 h by gastroenterologists. We aimed to evaluate the validation of bedside ultrasound for intussusceptions performed by pediatric emergency physicians with ultrasound training during the night or holiday. Methods: A retrospective study was conducted in children with suspected intussusceptions when routine ultrasounds by gastroenterologists were not available over the period from July 2004 to July 2008. Patients were divided into two groups: those diagnosed by emergency physicians with ultrasound training and without training. The clinical characteristics and course for all patients were reviewed and compared for seeking the difference. Results: A total of 186 children were included. One hundred and thirteen (61% children were diagnosed by pediatric emergency physician with ultrasound training. The clinical symptoms were not statistically different between the two groups. The diagnostic sensitivity of the ultrasound training group was significantly higher (90% vs. 79%, p = 0.034. Children of the training group also had significantly shorter hospital stay duration at emergency departments before reduction (2.41 ± 2.01 vs. 4.58 ± 4.80 h, p = 0.002. Conclusion: Bedside ultrasound performed by pediatric emergency physicians with ultrasound training is a sensitive test for detecting intussusceptions. Knowledge and use of bedside ultrasound can aid the emergency physician in the diagnosis of pediatric intussusceptions with less delay in treatment.

  16. Burnout and Associated Factors among Iranian Emergency Medicine Practitioners.

    Science.gov (United States)

    Jalili, Mohammad; Sadeghipour Roodsari, Gholamreza; Bassir Nia, Anahita

    2013-09-01

    Emergency physicians are at risk of burnout, which can affect their mental health, as well as patient care. We assessed burnout level among Iranian emergency physicians and investigated demographic, work-related factors and stressors associated with higher burnout. In a cross-sectional study, we surveyed all 188 emergency medicine residents and practitioners in Iran. We measured burnout using 22-item Maslach Burnout Inventory assessing emotional exhaustion, depersonalization and personal accomplishment, also demographic factors, work related factors and sources of stress in emergency department using anonymous self-administered questionnaire. Descriptive analysis, univariate analysis to evaluate association with higher score of burnout, and multivariate logistic regression analysis to predict high burnout in 3 subscales was performed. Totally, 165 questionnaires were filled (response rate: 88%; mean age: 33.6 years, 91% male). Mean burnout scores were 22.94 for emotional exhaustion (95% CI=20.78-25.01; moderate), 9.3 for depersonalization (95% CI=8.24-10.36; moderate to high), and 31.47 for personal accomplishment (95% CI=29.87-33.07; moderate to high). Frequent reported sources of stress were shortage of equipment, problem with work physical environment, and relationship with other services. All 19 sources of stress were associated with higher score of emotional exhaustion and depersonalization; while twelve out of 19 were significantly associated with lower level of personal accomplishment. In logistic regression model, the significant predictors for high emotional exhaustion were work overload, feeling of insecurity for future career and difficulties to balance professional and private life. Burnout is high among Iranian emergency medicine practitioners and some interventions can be proposed to reduce stress.

  17. Development of a productive research culture in emergency medicine: Report of the outcomes of a research forum.

    Science.gov (United States)

    Taylor, David McD; Cohen, Donna R; Epstein, Joseph; Freeman, Peter; Gosbell, Andrew D; Judkins, Simon; Mowatt, Elizabeth J M; O'Reilly, Gerard M; Vinen, John

    2016-02-01

    In recent years, the Australasian College for Emergency Medicine (ACEM) has increasingly focused on the need for high-quality research in emergency medicine (EM). One important initiative was the establishment of the ACEM Foundation, which among other responsibilities, is required to support clinical research through the provision of research funding and other measures. In February 2015, the Foundation held a Research Forum that was attended by the leading EM researchers from Australasia. The Forum aimed to determine how a productive research culture could be developed within the ACEM. Nine key objectives were determined including that research should be a core business of the ACEM and a core activity of the EM workforce, and that EM research should be sustainable and adequately supported. This report describes the background and conduct of the Forum, its recommendations and the way in which they could be implemented. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  18. Auckland regional emergency medicine trainee mentoring uptake survey.

    Science.gov (United States)

    Nicholls, Gordon Michael Mike; Lawrey, Emma; Jones, Peter

    2017-10-01

    The primary objective of this study is to quantify how many Auckland region emergency medicine (EM) trainees would like a formal mentoring programme. The secondary objectives were to quantify how many Auckland region EM trainees would like to participate in a formal mentoring programme; to determine trainees' current understanding of mentoring; how trainees prefer mentors to be allocated; why trainees may want a mentor; what mentees perceive would be good qualities in a mentor; and trainees' prior experience with mentoring. Online survey of EM trainees in the Auckland region in June 2015. Of 61 potential respondents, 40 (65.6%) respondents replied to the survey. Of the 40, 38 (95%; 95% confidence interval (CI) 82.6-99.5) respondents indicated they would like some form of mentoring system, and of the 38, 25 (65.8%; 95% CI 49.8-78.9) preferred this to be formal. Of the 38, 19 (50%; 95% CI 34.9-65.2) currently wanted assistance obtaining a mentor. Of the 40, 30 (75%; 95% CI 59.6-86.0) are not currently in any form of mentoring relationship. Respondents believed that mentors would be most beneficial in critical incidents, career development and with work/life balance. The attributes participants considered most important in a mentor were respecting confidentiality, being honest and the ability to provide constructive feedback. Many EM trainees in Auckland want a formal mentoring system and would like a mentor. Appropriate mentor-mentee matching through a formalised voluntary system, with adequate mentor training, may enable the Auckland region to develop a suitable mentoring programme for EM trainees. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  19. Time characteristics of photon fields at a nuclear medicine clinic

    International Nuclear Information System (INIS)

    Zimak, J.; Hermanska, J.; Sabol, J.

    1998-01-01

    The radiation fields were measured at the Nuclear Medicine Clinic of the Faculty Hospital in Prague-Motol. Gamma photons from iodine 131 administered to the patients is the main contributor to the fields. The dose rates at short distances from the patients can be as high as 20 mSv/h, whereby the cumulated doses to the health care personnel can exceed the annual limits for professional exposures. It is very important that unnecessary close contact with the patients be avoided unless emergency of other urgent procedures are required. Administration of high activities to several patients sharing a room in the ward should also be taken into account when handling the patients (including food service, housekeeping, changing linen, etc.). In normal circumstances, the radiation level in corridors and at other places accessible to cancer patients within the clinic are usually below 5 μSv/h averaged for 1 min intervals. (P.A.)

  20. [The importance of teamwork in emergency medicine training].

    Science.gov (United States)

    Vermeulen, B; Carron, P-N

    2007-08-15

    The study of dynamics in relation to performing in small groups has increased pedagogic knowledge about teamwork. The successful management of patients with life-threatening pathologies depends highly from a succession of teams with a specific mission as: the call centre 144, Paramedics, the ED, the Operating Theatre and the Intensive care. To enable each team to operate successfully, it is essential to coordinate their qualifications and synergism. This can be efficiently attained by simulating real situations and by following protocols dedicated to teamwork. Emergency Medicine, which is on the brink of acquiring its proper curriculum, must adopt this concept to integrate knowledge and know-how, and the art of being and doing. At this stage, the Emergency Physician will have the competence which will enable him to be a real "team leader".

  1. A top-five list for emergency medicine: a pilot project to improve the value of emergency care.

    Science.gov (United States)

    Schuur, Jeremiah D; Carney, Dylan P; Lyn, Everett T; Raja, Ali S; Michael, John A; Ross, Nicholas G; Venkatesh, Arjun K

    2014-04-01

    IMPORTANCE The mean cost of medical care in the United States is growing at an unsustainable rate; from 2003 through 2011, the cost for an emergency department (ED) visit rose 240%, from $560 to $1354. The diagnostic tests, treatments, and hospitalizations that emergency clinicians order result in significant costs. OBJECTIVE To create a "top-five" list of tests, treatments, and disposition decisions that are of little value, are amenable to standardization, and are actionable by emergency medicine clinicians. DESIGN, SETTING, AND PARTICIPANTS Modified Delphi consensus process and survey of 283 emergency medicine clinicians (physicians, physician assistants, and nurse practitioners) from 6 EDs. INTERVENTION We assembled a technical expert panel (TEP) and conducted a modified Delphi process to identify a top-five list using a 4-step process. In phase 1, we generated a list of low-value clinical decisions from TEP brainstorming and e-mail solicitation of clinicians. In phase 2, the TEP ranked items on contribution to cost, benefit to patients, and actionability by clinicians. In phase 3, we surveyed all ordering clinicians from the 6 EDs regarding distinct aspects of each item. In phase 4, the TEP voted for a final top-five list based on survey results and discussion. MAIN OUTCOMES AND MEASURES A top-five list for emergency medicine. The TEP ranked items on contribution to cost, benefit to patients, and actionability by clinicians. The survey asked clinicians to score items on the potential benefit or harm to patients and the provider actionability of each item. Voting and surveys used 5-point Likert scales. A Pearson interdomain correlation was used. RESULTS Phase 1 identified 64 low-value items. Phase 2 narrowed this list to 7 laboratory tests, 3 medications, 4 imaging studies, and 3 disposition decisions included in the phase 3 survey (71.0% response rate). All 17 items showed a significant positive correlation between benefit and actionability (r, 0.19-0.37 [P

  2. [Current emergency medicine for neurological disorders in children].

    Science.gov (United States)

    Osamura, Toshio

    2010-01-01

    In 2006, the number of pediatric outpatients consulting our hospital during non-practice hours increased by 218.1% of that in 1996. The number of pediatric inpatients during non-practice hours in 2006 increased by 71.3% of that in 1996. In 2006, the number of patients who were admitted with neurological disorders in children during non-practice hours increased to 213.3% of that in 1996. The proportion of these pediatric patients among those who were admitted during non-practice hours was 16.6% in our hospital, suggesting the importance of neurological disorders in pediatric emergency medicine. More than 60% of inpatients with neurological disorders in children were 3 years old or younger. The most common neurological symptoms observed at admission included convulsion (81.6%) and disturbance of consciousness (8.5%). The disorders were mainly febrile seizure (41.4%) and epilepsy (29.0%). Most patients with severe disorders requiring emergency medicine, such as head bruise, acute encephalitis/encephalopathy, purulent meningitis, and head trauma, were admitted during non-practice hours. The prognoses of most neurological disorders in children were favorable. However, patients with sequelae (especially, hypoxic encephalopathy, acute encephalitis/encephalopathy) showed an unfavorable neurological prognosis. Early rehabilitation during admission was useful as a support method for their families. In the future, a comprehensive rehabilitation program for children with acquired brain injury should be established and laws to promote home care must be passed.

  3. Complementary and alternative medicine use among paediatric emergency department patients.

    Science.gov (United States)

    Taylor, David McDonald; Dhir, Reetika; Craig, Simon S; Lammers, Thalia; Gardiner, Kaya; Hunter, Kirrily; Joffe, Paul; Krieser, David; Babl, Franz E

    2015-09-01

    To determine the period prevalence and nature of complementary and alternative medicine (CAM) use among paediatric emergency department (ED) patients and the perceptions of CAM among the CAM administrators. A survey was undertaken in four Victorian EDs (January to September 2013). A convenience sample of parents/carers accompanying paediatric patients completed a self-administered questionnaire. The main outcome measures were CAM use and perceptions of CAM. The parents/carers of 883 patients participated. Three hundred eighty-eight (43.9%, 95% confidence interval (CI) 40.6-47.3) and 53 (6.0%, 95% CI 4.6-7.8) patients had taken a CAM within the previous 12 months and on the day of presentation, respectively. There were no gender differences between CAM users and non-users (P = 0.83). The use of CAM was significantly more common among older patients (P effective than prescription medicines and safe when taken with prescription medicines. CAM use is common among paediatric ED patients although rarely reported to the ED doctor. Parents/carers who administer CAM have differing perceptions of CAM safety from those who do not. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  4. Clinical Nihilism in Neuro-Emergencies

    Science.gov (United States)

    Hemphill, J. Claude; White, Douglas B.

    2009-01-01

    Mortality and morbidity remain high from neurological emergencies such as acute stroke, traumatic brain injury, and hypoxic-ischemic encephalopathy after cardiac arrest. Decisions regarding initial aggressiveness of care must be made at the time of presentation and perceived prognosis is often used as part of this decision-making process. However, these decisions are predicated on the accuracy of early outcome prediction. Decisions to limit treatment early after neuro-emergencies must be balanced with avoidance of self-fulfilling prophecies of poor outcome due to clinical nihilism. This article examines the role of prognostication early after neuro-emergencies, the potential impact of early treatment limitations, and how these may relate to communication with patients and surrogate decision makers in the context of these acute neurological events. PMID:19218017

  5. Development of geriatric competencies for emergency medicine residents using an expert consensus process.

    Science.gov (United States)

    Hogan, Teresita M; Losman, Eve D; Carpenter, Christopher R; Sauvigne, Karen; Irmiter, Cheryl; Emanuel, Linda; Leipzig, Rosanne M

    2010-03-01

    The emergency department (ED) visit rate for older patients exceeds that of all age groups other than infants. The aging population will increase elder ED patient utilization to 35% to 60% of all visits. Older patients can have complex clinical presentations and be resource-intensive. Evidence indicates that emergency physicians fail to provide consistent high-quality care for elder ED patients, resulting in poor clinical outcomes. The objective was to develop a consensus document, "Geriatric Competencies for Emergency Medicine Residents," by identified experts. This is a minimum set of behaviorally based performance standards that all residents should be able to demonstrate by completion of their residency training. This consensus-based process utilized an inductive, qualitative, multiphase method to determine the minimum geriatric competencies needed by emergency medicine (EM) residents. Assessments of face validity and reliability were used throughout the project. In Phase I, participants (n=363) identified 12 domains and 300 potential competencies. In Phase II, an expert panel (n=24) clustered the Phase I responses, resulting in eight domains and 72 competencies. In Phase III, the expert panel reduced the competencies to 26. In Phase IV, analysis of face validity and reliability yielded a 100% consensus for eight domains and 26 competencies. The domains identified were atypical presentation of disease; trauma, including falls; cognitive and behavioral disorders; emergent intervention modifications; medication management; transitions of care; pain management and palliative care; and effect of comorbid conditions. The Geriatric Competencies for EM Residents is a consensus document that can form the basis for EM residency curricula and assessment to meet the demands of our aging population. Copyright (c) 2010 by the Society for Academic Emergency Medicine.

  6. Social Media in the Emergency Medicine Residency Curriculum: Social Media Responses to the Residents' Perspective Article

    OpenAIRE

    Hayes, BD; Kobner, S; Trueger, NS; Yiu, S; Lin, M

    2015-01-01

    © 2015 American College of Emergency Physicians. In July to August 2014, Annals of Emergency Medicine continued a collaboration with an academic Web site, Academic Life in Emergency Medicine (ALiEM), to host an online discussion session featuring the 2014 Annals Residents' Perspective article "Integration of Social Media in Emergency Medicine Residency Curriculum" by Scott et al. The objective was to describe a 14-day worldwide clinician dialogue about evidence, opinions, and early relevant i...

  7. Web technology for emergency medicine and secure transmission of electronic patient records.

    Science.gov (United States)

    Halamka, J D

    1998-01-01

    The American Heritage dictionary defines the word "web" as "something intricately contrived, especially something that ensnares or entangles." The wealth of medical resources on the World Wide Web is now so extensive, yet disorganized and unmonitored, that such a definition seems fitting. In emergency medicine, for example, a field in which accurate and complete information, including patients' records, is urgently needed, more than 5000 Web pages are available today, whereas fewer than 50 were available in December 1994. Most sites are static Web pages using the Internet to publish textbook material, but new technology is extending the scope of the Internet to include online medical education and secure exchange of clinical information. This article lists some of the best Web sites for use in emergency medicine and then describes a project in which the Web is used for transmission and protection of electronic medical records.

  8. Evidence-based integrative medicine in clinical veterinary oncology.

    Science.gov (United States)

    Raditic, Donna M; Bartges, Joseph W

    2014-09-01

    Integrative medicine is the combined use of complementary and alternative medicine with conventional or traditional Western medicine systems. The demand for integrative veterinary medicine is growing, but evidence-based research on its efficacy is limited. In veterinary clinical oncology, such research could be translated to human medicine, because veterinary patients with spontaneous tumors are valuable translational models for human cancers. An overview of specific herbs, botanics, dietary supplements, and acupuncture evaluated in dogs, in vitro canine cells, and other relevant species both in vivo and in vitro is presented for their potential use as integrative therapies in veterinary clinical oncology. Published by Elsevier Inc.

  9. Goal-setting in clinical medicine.

    Science.gov (United States)

    Bradley, E H; Bogardus, S T; Tinetti, M E; Inouye, S K

    1999-07-01

    The process of setting goals for medical care in the context of chronic disease has received little attention in the medical literature, despite the importance of goal-setting in the achievement of desired outcomes. Using qualitative research methods, this paper develops a theory of goal-setting in the care of patients with dementia. The theory posits several propositions. First, goals are generated from embedded values but are distinct from values. Goals vary based on specific circumstances and alternatives whereas values are person-specific and relatively stable in the face of changing circumstances. Second, goals are hierarchical in nature, with complex mappings between general and specific goals. Third, there are a number of factors that modify the goal-setting process, by affecting the generation of goals from values or the translation of general goals to specific goals. Modifying factors related to individuals include their degree of risk-taking, perceived self-efficacy, and acceptance of the disease. Disease factors that modify the goal-setting process include the urgency and irreversibility of the medical condition. Pertinent characteristics of the patient-family-clinician interaction include the level of participation, control, and trust among patients, family members, and clinicians. The research suggests that the goal-setting process in clinical medicine is complex, and the potential for disagreements regarding goals substantial. The nature of the goal-setting process suggests that explicit discussion of goals for care may be necessary to promote effective patient-family-clinician communication and adequate care planning.

  10. Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

    DEFF Research Database (Denmark)

    Gadegaard Jensen, Anders; Callesen, T; Hagemo, J S

    2010-01-01

    Emergency patients need special considerations and the number and severity of complications from general anaesthesia can be higher than during scheduled procedures. Guidelines are therefore needed. The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care...... Medicine appointed a working group to develop guidelines based on literature searches to assess evidence, and a consensus meeting was held. Consensus opinion was used in the many topics where high-grade evidence was unavailable. The recommendations include the following: anaesthesia for emergency patients...... breathing for 3 min or eight deep breaths over 60 s and oxygen flow 10 l/min should be used. Pre-oxygenation in the obese patients should be performed in the head-up position. The use of cricoid pressure is not considered mandatory, but can be used on individual judgement. The hypnotic drug has a minor...

  11. Laboratory research at the clinical trials of Veterinary medicinal Products

    OpenAIRE

    ZHYLA M.I.

    2011-01-01

    The article analyses the importance of laboratory test methods, namely pathomorfological at conduct of clinical trials. The article focuses on complex laboratory diagnostics at determination of clinical condition of animals, safety and efficacy of tested medicinal product.

  12. Radioactive isotopes in clinical medicine and research. Abstracts

    International Nuclear Information System (INIS)

    2005-01-01

    The contribution displays 44 abstracts and 35 posters from the 27th International Symposium on ''radioactive isotopes in clinical medicine and research'', organized by the Austrian society of nuclear medicine and the department of nuclear medicine and the center for biomedical engineering and physics of the Vienna medical university. The abstracts are sorted according to lecture headers: radiopharmaceutical sciences, endocrinology, clinical PET, neurology, oncology, physics and instrumentation, cardiology, inflammation, therapy and varia. (uke)

  13. Multidimensional Attitudes of Emergency Medicine Residents Toward Older Adults

    Directory of Open Access Journals (Sweden)

    Teresita M. Hogan

    2014-07-01

    Full Text Available Introduction: The demands of our rapidly expanding older population strain many emergency departments (EDs, and older patients experience disproportionately high adverse health outcomes. Trainee attitude is key in improving care for older adults. There is negligible knowledge of baseline emergency medicine (EM resident attitudes regarding elder patients. Awareness of baseline attitudes can serve to better structure training for improved care of older adults. The objective of the study is to identify baseline EM resident attitudes toward older adults using a validated attitude scale and multidimensional analysis. Methods: Six EM residencies participated in a voluntary anonymous survey delivered in summer and fall 2009. We used factor analysis using the principal components method and Varimax rotation, to analyze attitude interdependence, translating the 21 survey questions into 6 independent dimensions. We adapted this survey from a validated instrument by the addition of 7 EM-specific questions to measures attitudes relevant to emergency care of elders and the training of EM residents in the geriatric competencies. Scoring was performed on a 5-point Likert scale. We compared factor scores using student t and ANOVA. Results: 173 EM residents participated showing an overall positive attitude toward older adults, with a factor score of 3.79 (3.0 being a neutral score. Attitudes trended to more negative in successive post-graduate year (PGY levels. Conclusion: EM residents demonstrate an overall positive attitude towards the care of older adults. We noted a longitudinal hardening of attitude in social values, which are more negative in successive PGY-year levels. [West J Emerg Med. 2014;15(4:511–517.

  14. Education Scholarship and its Impact on Emergency Medicine Education

    Science.gov (United States)

    Sherbino, Jonathan

    2015-01-01

    Emergency medicine (EM) education is becoming increasingly challenging as a result of changes to North American medical education and the growing complexity of EM practice. Education scholarship (ES) provides a process to develop solutions to these challenges. ES includes both research and innovation. ES is informed by theory, principles and best practices, is peer reviewed, and is disseminated and archived for others to use. Digital technologies have improved the discovery of work that informs ES, broadened the scope and timing of peer review, and provided new platforms for the dissemination and archiving of innovations. This editorial reviews key steps in raising an education innovation to the level of scholarship. It also discusses important areas for EM education scholars to address, which include the following: the delivery of competency-based medical education programs, the impact of social media on learning, and the redesign of continuing professional development. PMID:26594270

  15. Education Scholarship and its Impact on Emergency Medicine Education.

    Science.gov (United States)

    Sherbino, Jonathan

    2015-11-01

    Emergency medicine (EM) education is becoming increasingly challenging as a result of changes to North American medical education and the growing complexity of EM practice. Education scholarship (ES) provides a process to develop solutions to these challenges. ES includes both research and innovation. ES is informed by theory, principles and best practices, is peer reviewed, and is disseminated and archived for others to use. Digital technologies have improved the discovery of work that informs ES, broadened the scope and timing of peer review, and provided new platforms for the dissemination and archiving of innovations. This editorial reviews key steps in raising an education innovation to the level of scholarship. It also discusses important areas for EM education scholars to address, which include the following: the delivery of competency-based medical education programs, the impact of social media on learning, and the redesign of continuing professional development.

  16. Functional Somatic Syndromes: Emerging Biomedical Models and Traditional Chinese Medicine

    Directory of Open Access Journals (Sweden)

    Steven Tan

    2004-01-01

    Full Text Available The so-called functional somatic syndromes comprise a group of disorders that are primarily symptom-based, multisystemic in presentation and probably involve alterations in mind-brain-body interactions. The emerging neurobiological models of allostasis/allostatic load and of the emotional motor system show striking similarities with concepts used by Traditional Chinese Medicine (TCM to understand the functional somatic disorders and their underlying pathogenesis. These models incorporate a macroscopic perspective, accounting for the toll of acute and chronic traumas, physical and emotional stressors and the complex interactions between the mind, brain and body. The convergence of these biomedical models with the ancient paradigm of TCM may provide a new insight into scientifically verifiable diagnostic and therapeutic approaches for these common disorders.

  17. Emergence of occupational medicine in Victorian times1

    Science.gov (United States)

    Lee, W. R.

    1973-01-01

    Lee, W. R. (1973).British Journal of Industrial Medicine,30, 118-124. Emergence of occupational medicine in Victorian times. The events surrounding the establishment and development of legislation to protect the health of people at work in Victorian times are already well documented. This paper deals with some other aspects of the development of occupational medicine. Medical opinions at the time did not always see the misuse of child labour as due simply to avaricious mill owners, but in part due to the parents and in part to the workmen subcontractors. The establishment of the certifying surgeons is briefly reviewed and their coming together to form an association in 1868 may be related to questions about the need for medical certificates of age which were being requested by the many factory owners brought under factory legislation for the first time in 1864 and 1867. The plight of injured workmen and their dependents was early recognized, although it was late in the Victorian era before any statutory provision was made for them. The idea of linking compensation with preventive measures came to the fore in 1845 when some Manchester doctors, later supported by Edwin Chadwick, examined the workings at the Woodhead railway tunnel across the Pennines. When compensation legislation was passed some half a century later the idea was lost, and to this day compensation for and prevention of industrial injury and disease remain separated. The change of industrial diseases from a medical curiosity to a problem requiring State intervention is traced over the latter part of the Victorian era. The whole piecemeal pattern illustrating the precept that `social problems come first, social philosophy after' has persisted until the far-reaching changes in health and safety legislation of the present day. PMID:4267346

  18. The association between money and opinion in academic emergency medicine.

    Science.gov (United States)

    Birkhahn, Robert H; Blomkalns, Andra; Klausner, Howard; Nowak, Richard; Raja, Ali S; Summers, Richard; Weber, Jim E; Briggs, William M; Arkun, Alp; Diercks, Deborah

    2010-05-01

    Financial conflicts of interest have come under increasing scrutiny in medicine, but their impact has not been quantified. Our objective was to use the results of a national survey of academic emergency medicine (EM) faculty to determine if an association between money and personal opinion exists. We conducted a web-based survey of EM faculty. Opinion questions were analyzed with regard to whether the respondent had either 1) received research grant money or 2) received money from industry as a speaker, consultant, or advisor. Responses were unweighted, and tests of differences in proportions were made using Chi-squared tests, with pmoney. Respondents with research money were more likely to be comfortable accepting gifts (40% vs. 29%) and acting as paid consultants (50% vs. 37%). They had a more favorable attitude with regard to societal interactions with industry and felt that industry-sponsored lectures could be fair and unbiased (52% vs. 29%). Faculty with fee-for-service money mirrored those with research money. They were also more likely to believe that industry-sponsored research produces fair and unbiased results (61% vs. 45%) and less likely to believe that honoraria biased speakers (49% vs. 69%). Accepting money for either service or research identified a distinct population defined by their opinions. Faculty engaged in industry-sponsored research benefitted socially (collaborations), academically (publications), and financially from the relationship.

  19. Can Emergency Medicine Residents Predict Cost of Diagnostic Testing?

    Directory of Open Access Journals (Sweden)

    Tainter, Christopher R

    2017-01-01

    Full Text Available Diagnostic testing represents a significant portion of healthcare spending, and cost should be considered when ordering such tests. Needless and excessive spending may occur without an appreciation of the impact on the larger healthcare system. Knowledge regarding the cost of diagnostic testing among emergency medicine (EM residents has not previously been studied. A survey was administered to 20 EM residents from a single ACGME-accredited three-year EM residency program, asking for an estimation of patient charges for 20 commonly ordered laboratory tests and seven radiological exams. We compared responses between residency classes to evaluate whether there was a difference based on level of training. The survey completion rate was 100% (20/20 residents. We noted significant discrepancies between the median resident estimates and actual charge to patient for both laboratory and radiological exams. Nearly all responses were an underestimate of the actual cost. The group median underestimation for laboratory testing was $114, for radiographs $57, and for computed tomography exams was $1,058. There was improvement in accuracy with increasing level of training. This pilot study demonstrates that EM residents have a poor understanding of the charges burdening patients and health insurance providers. In order to make balanced decisions with regard to diagnostic testing, providers must appreciate these factors. Education regarding the cost of providing emergency care is a potential area for improvement of EM residency curricula, and warrants further attention and investigation.

  20. Workplace Violence and Harassment Against Emergency Medicine Residents.

    Science.gov (United States)

    Schnapp, Benjamin H; Slovis, Benjamin H; Shah, Anar D; Fant, Abra L; Gisondi, Michael A; Shah, Kaushal H; Lech, Christie A

    2016-09-01

    Several studies have shown that workplace violence in the emergency department (ED) is common. Residents may be among the most vulnerable staff, as they have the least experience with these volatile encounters. The goal for this study was to quantify and describe acts of violence against emergency medicine (EM) residents by patients and visitors and to identify perceived barriers to safety. This cross-sectional survey study queried EM residents at multiple New York City hospitals. The primary outcome was the incidence of violence experienced by residents while working in the ED. The secondary outcomes were the subtypes of violence experienced by residents, as well as the perceived barriers to safety while at work. A majority of residents (66%, 78/119) reported experiencing at least one act of physical violence during an ED shift. Nearly all residents (97%, 115/119) experienced verbal harassment, 78% (93/119) had experienced verbal threats, and 52% (62/119) reported sexual harassment. Almost a quarter of residents felt safe "Occasionally," "Seldom" or "Never" while at work. Patient-based factors most commonly cited as contributory to violence included substance use and psychiatric disease. Self-reported violence against EM residents appears to be a significant problem. Incidence of violence and patient risk factors are similar to what has been found previously for other ED staff. Understanding the prevalence of workplace violence as well as the related systems, environmental, and patient-based factors is essential for future prevention efforts.

  1. [Organizational forms of emergency medicine in international comparison].

    Science.gov (United States)

    Lipp, M

    1993-09-01

    The tasks of preclinical emergency medicine systems (PEMS) are to stabilize and maintain the vital functions and to guarantee qualified transport to the hospital. Worldwide, different structures exist as a result of historical developments. Legal regulations for PEMS have been introduced in most of the industrialized countries since 1960. More and more aspects have been subject to detailed regulations. PEMS are provided either by state-owned or by state-controlled (private) organisations. In most of the "underdeveloped" countries legal regulations do not exist and PEMS is often provided by social workers, by the army or by volunteers. In most countries, PEMS are financed by the state with a charge on the patient. In a few states PEMS are totally financed by the public health structure. Modern PEMS are controlled from dispatch centres which receive emergency calls (mostly by telephone) and send the appropriate rescue unit. In most states the staff of dispatch centres are paramedics; in some countries and in some urban areas physicians control the dispatch centre. In PEMS without physicians on the scene, an information exchange between the scene and the hospital can be observed frequently, in contrast to systems with physicians on the scene. Worldwide, ground-based PEMS are preferred, but in most countries an additional air rescue system has been established. The quality and quantity of the technical equipment of the ground-based PEMS differ widely: nationwide regulations exist, however, in the USA and Germany. Generally, there are two main concepts concerning the personnel structure: PEMS are either physician based or not. Requirements for emergency physicians differ greatly: in some countries no formal requirements exist, in others extensive practical and theoretical training is required.(ABSTRACT TRUNCATED AT 250 WORDS)

  2. Identifying Nonprovider Factors Affecting Pediatric Emergency Medicine Provider Efficiency.

    Science.gov (United States)

    Saleh, Fareed; Breslin, Kristen; Mullan, Paul C; Tillett, Zachary; Chamberlain, James M

    2017-10-31

    The aim of this study was to create a multivariable model of standardized relative value units per hour by adjusting for nonprovider factors that influence efficiency. We obtained productivity data based on billing records measured in emergency relative value units for (1) both evaluation and management of visits and (2) procedures for 16 pediatric emergency medicine providers with more than 750 hours worked per year. Eligible shifts were in an urban, academic pediatric emergency department (ED) with 2 sites: a tertiary care main campus and a satellite community site. We used multivariable linear regression to adjust for the impact of shift and pediatric ED characteristics on individual-provider efficiency and then removed variables from the model with minimal effect on productivity. There were 2998 eligible shifts for the 16 providers during a 3-year period. The resulting model included 4 variables when looking at both ED sites combined. These variables include the following: (1) number of procedures billed by provider, (2) season of the year, (3) shift start time, and (4) day of week. Results were improved when we separately modeled each ED location. A 3-variable model using procedures billed by provider, shift start time, and season explained 23% of the variation in provider efficiency at the academic ED site. A 3-variable model using procedures billed by provider, patient arrivals per hour, and shift start time explained 45% of the variation in provider efficiency at the satellite ED site. Several nonprovider factors affect provider efficiency. These factors should be considered when designing productivity-based incentives.

  3. Emerging Technologies for the Clinical Microbiology Laboratory

    Science.gov (United States)

    Buchan, Blake W.

    2014-01-01

    SUMMARY In this review we examine the literature related to emerging technologies that will help to reshape the clinical microbiology laboratory. These topics include nucleic acid amplification tests such as isothermal and point-of-care molecular diagnostics, multiplexed panels for syndromic diagnosis, digital PCR, next-generation sequencing, and automation of molecular tests. We also review matrix-assisted laser desorption ionization–time of flight (MALDI-TOF) and electrospray ionization (ESI) mass spectrometry methods and their role in identification of microorganisms. Lastly, we review the shift to liquid-based microbiology and the integration of partial and full laboratory automation that are beginning to impact the clinical microbiology laboratory. PMID:25278575

  4. Herbal medicine: biomolecular and clinical aspects

    National Research Council Canada - National Science Library

    Benzie, Iris F. F; Wachtel-Galor, Sissi

    2011-01-01

    .... With over 3,550 current references, the book highlights the role of herbal medicine in national health care while providing case studies of widely used herbal remedies and their effects on human...

  5. Training in Emergency Obstetrics: A Needs Assessment of U.S. Emergency Medicine Program Directors

    Directory of Open Access Journals (Sweden)

    Daniel W. Robinson

    2017-12-01

    Full Text Available Introduction Obstetrical emergencies are a high-risk yet infrequent occurrence in the emergency department. While U.S. emergency medicine (EM residency graduates are required to perform 10 low-risk normal spontaneous vaginal deliveries, little is known about how residencies prepare residents to manage obstetrical emergencies. We sought to profile the current obstetrical training curricula through a survey of U.S. training programs. Methods We sent a web-based survey covering the four most common obstetrical emergencies (pre-eclampsia/eclampsia, postpartum hemorrhage (PPH, shoulder dystocia, and breech presentation through email invitations to all program directors (PD of U.S. EM residency programs. The survey focused on curricular details as well as the comfort level of the PDs in the preparation of their graduating residents to treat obstetrical emergencies and normal vaginal deliveries. Results Our survey had a 55% return rate (n=105/191. Of the residencies responding, 75% were in the academic setting, 20.2% community, 65% urban, and 29.8% suburban, and the obstetrical curricula were 2–4 weeks long occurring in post-graduate year one. The most common teaching method was didactics (84.1–98.1%, followed by oral cases for pre-eclampsia (48% and PPH (37.2%, and homemade simulation for shoulder dystocia (37.5% and breech delivery (33.3%. The PDs’ comfort about residency graduate skills was highest for normal spontaneous vaginal delivery, pre-eclampsia, and PPH. PDs were not as comfortable about their graduates’ skill in handling shoulder dystocia or breech delivery. Conclusion Our survey found that PDs are less comfortable in their graduates’ ability to perform non-routine emergency obstetrical procedures.

  6. Current Status of Gender and Racial/Ethnic Disparities Among Academic Emergency Medicine Physicians.

    Science.gov (United States)

    Madsen, Tracy E; Linden, Judith A; Rounds, Kirsten; Hsieh, Yu-Hsiang; Lopez, Bernard L; Boatright, Dowin; Garg, Nidhi; Heron, Sheryl L; Jameson, Amy; Kass, Dara; Lall, Michelle D; Melendez, Ashley M; Scheulen, James J; Sethuraman, Kinjal N; Westafer, Lauren M; Safdar, Basmah

    2017-10-01

    A 2010 survey identified disparities in salaries by gender and underrepresented minorities (URM). With an increase in the emergency medicine (EM) workforce since, we aimed to 1) describe the current status of academic EM workforce by gender, race, and rank and 2) evaluate if disparities still exist in salary or rank by gender. Information on demographics, rank, clinical commitment, and base and total annual salary for full-time faculty members in U.S. academic emergency departments were collected in 2015 via the Academy of Administrators in Academic Emergency Medicine (AAAEM) Salary Survey. Multiple linear regression was used to compare salary by gender while controlling for confounders. Response rate was 47% (47/101), yielding data on 1,371 full-time faculty: 33% women, 78% white, 4% black, 5% Asian, 3% Asian Indian, 4% other, and 7% unknown race. Comparing white race to nonwhite, 62% versus 69% were instructor/assistant, 23% versus 20% were associate, and 15% versus 10% were full professors. Comparing women to men, 74% versus 59% were instructor/assistant, 19% versus 24% were associate, and 7% versus 17% were full professors. Of 113 chair/vice-chair positions, only 15% were women, and 18% were nonwhite. Women were more often fellowship trained (37% vs. 31%), less often core faculty (59% vs. 64%), with fewer administrative roles (47% vs. 57%; all p disparities in salary and rank persist among full-time U.S. academic EM faculty. There were gender and URM disparities in rank and leadership positions. Women earned less than men regardless of rank, clinical hours, or training. Future efforts should focus on evaluating salary data by race and developing systemwide practices to eliminate disparities. © 2017 by the Society for Academic Emergency Medicine.

  7. Factors influencing emergency medicine physicians' management of sports-related concussions: a community-wide study.

    Science.gov (United States)

    Giebel, Stephen; Kothari, Rashmi; Koestner, Amy; Mohney, Gretchen; Baker, Robert

    2011-12-01

    Numerous guidelines to grade and manage sports-related concussions have been published. However, little is known about how frequently they are implemented in the emergency department. This study evaluates the current practices of emergency physicians (EPs) in managing sports-related concussions. To evaluate the current practice of EP evaluation and management of sports-related concussions. All EPs and emergency medicine residents in Kalamazoo County were surveyed regarding their management of sports-related concussions. The surveys obtained demographic data, participants' use of guidelines, and the importance of clinical and non-clinical factors in deciding when to allow a player to return to play. Of the 73 EP respondents, only 23% used a nationally recognized guideline, with no significant difference between attending and resident EPs. The symptomatic complaints of loss of consciousness, amnesia of the event, and difficulty concentrating were ranked most important by EPs in assessing patients with sports-related concussions. Among non-clinical factors, residents were significantly more likely than attendings to report that medical-legal, parental, and players' concerns were more likely to influence their decision in allowing a patient to return to play. EPs take into consideration important clinical factors in assessing patients with sports-related concussion. However, almost 75% do not use any nationally recognized guideline in their evaluation. Residents are more likely than attendings to be influenced by non-clinical factors. Copyright © 2011 Elsevier Inc. All rights reserved.

  8. Glycosides from Medicinal Plants as Potential Anticancer Agents: Emerging Trends towards Future Drugs.

    Science.gov (United States)

    Khan, Haroon; Saeedi, Mina; Nabavi, Seyed Mohammad; Mubarak, Mohammad S; Bishayee, Anupam

    2018-04-03

    Cancer continues to be a global burden, despite the advancement of various technological and pharmaceutical improvements over the past two decades. Methods for treating cancer include surgery, radiotherapy and chemotherapy in addition to other specialized techniques. On the other hand, medicinal plants have been traditionally employed either as the complementary medicine or dietary agents in the treatment and management of cancer. Medicinal plants are a rich source of secondary metabolites with interesting biological and pharmacological activities. Among these metabolites, glycosides are naturally occurring substances and have outstanding therapeutic potential and clinical utility. Different medical research engines such GoogleScholar, PubMed, SpringerLink, ScienceDirect were used to collect related literature on the subject matter. In this regard, only peer reviewed journals were considered. Emerging results showed that numerous glycosides isolated from various plants possessed marked anticancer activity against a variety of cancer cell lines. Accordingly, the aim of the present review is to shed light on the anticancer effects of glycosides, analyze possible mechanisms of action, and highlight the role of these natural agents as complementary and alternative medicine in combating and managing cancer. The glycosides isolated from different plants demonstrated potent cytotoxic effects against various cancer cell lines in initial preclinical studies. The anticancer effect was mediated through multiple mechanisms; however further detail studies are needed to understand the full potential of glycosides for clinical utility. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  9. Advances in point-of-care ultrasound in pediatric emergency medicine.

    Science.gov (United States)

    Gallagher, Rachel A; Levy, Jason A

    2014-06-01

    Point-of-care ultrasound (POCUS) has become an integral part of emergency medicine practice. Research evaluating POCUS in the care of pediatric patients has improved the understanding of its potential role in clinical care. Recent work has investigated the ability of pediatric emergency medicine (PEM) physicians to perform a wide array of diagnostic and procedural applications in POCUS ultrasound. Studies have demonstrated that PEM providers are able to identify an array of diseases, including intussusception, pyloric stenosis and appendicitis. Novel applications of ultrasound, such as a cardiac evaluation in the acutely ill patient or identification of skull fractures in the assessment of a patient with head injury, have shown excellent promise in recent studies. These novel applications have the potential to reshape pediatric diagnostic algorithms. Key applications in PEM have been investigated in the recent publications. Further exploration of the ability to integrate ultrasound into routine practice will require larger-scale studies and continued growth of education in the field. The use of ultrasound in clinical practice has the potential to improve safety and efficiency of care in the pediatric emergency department.

  10. Capturing the 'art' of emergency medicine: Does film foster reflection in medical students?

    Science.gov (United States)

    Brand, Gabrielle; Wise, Steve; Siddiqui, Zarrin S; Celenza, Antonio; Fatovich, Daniel M

    2017-08-01

    Integrating arts and humanities-based pedagogy into curricula is of growing interest among medical educators, particularly how it promotes reflection and empathy. Our aim was to explore whether a 2.50 min film titled 'The Art of the ED' stimulated reflective learning processes in a group of first year medical students. The film was shown prior to their first clinical placement in an ED. Student participation was voluntary and not assessable. Using an exploratory qualitative research approach, this study drew on data collected from students' individual written reflections, exploring their perceptions towards clinical experience in an emergency medicine (EM) attachment. A total of 123 (51% of 240) students submitted a reflection. The qualitative data revealed three main themes: the opportunity for students to preview EM ('While watching the film, I felt like I was the patient and the doctor all at once, in that I was living the experience both from within and as an observer …'); exposed the reality of ED; and fostered a growing awareness of the fragility of human life. These findings highlight how visual methodologies (like film) create a safe, non-threatening space to access, experience and process emotion around their perceptions towards EM, and to anticipate and emotionally prepare for their impending clinical experience in the ED. These data support the use of visual methodologies to foster reflective processes that assist medical students to integrate the 'art' of EM, and the development and commitment of core doctoring values of empathy, service and respect for patients. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  11. Emergency ultrasound usage among recent emergency medicine residency graduates of a convenience sample of 14 residencies.

    Science.gov (United States)

    Dean, Anthony J; Breyer, Michael J; Ku, Bon S; Mills, Angela M; Pines, Jesse M

    2010-02-01

    Emergency Medicine (EM) residency graduates are trained to perform Emergency Medicine bedside ultrasound (EMBU). However, the degree to which they use this skill in their practice after graduation is unknown. We sought to test the amount and type of usage of EMBU among recent residency graduates, and how usage and barriers vary among various types of EM practice settings. Graduates from 14 EM residency programs in 2003-2005 were surveyed on their current practice setting and use of EMBU. There were 252 (73%) graduates who completed the survey. Of the 73% of respondents reporting access to EMBU, 98% had used it within the past 3 months. Access to EMBU was higher in academic (97%) vs. community teaching (79%) vs. community non-teaching settings (62%) (p < 0.001), and in Emergency Departments (EDs) where yearly census exceeded 60,000 visits (87% vs. 65%, p < 0.001). Physicians in academic settings reported "high use" of EMBU more frequently than those in community settings for most modalities. FAST (focused assessment by sonography in trauma) was the most common high-use application and the most useful in practice. The greatest impediment to EMBU use was "not enough time" (61%). Ultrasound usage among recent EM residency graduates is significantly higher in teaching than in community settings and in high-volume EDs. Its use is more widespread than in previous reports in all types of practice. There is a wide range of utilization of ultrasound in the various applications in emergency practice, with the evaluation of trauma being the most common. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  12. Abstract to publication ratio for papers presented at scientific meetings: how does emergency medicine compare?

    Science.gov (United States)

    Walby, A; Kelly, A M; Georgakas, C

    2001-12-01

    The aims of the present study were to determine the publication rate of abstracts presented by Australasian emergency physicians at major emergency medicine meetings and to identify the site of publication of papers. All free paper abstracts presented (oral and poster) by Australasian emergency physicians and trainees at five Australasian College for Emergency Medicine/Australasian Society for Emergency Medicine and International Conference on Emergency Medicine meetings between 1995 and 1998 were identified retrospectively from conference programmes. In order to determine whether or not the abstract had been published, the PubMed database (http://www4.ncbi.nlm.nih.gov/PubMed/) was searched using the presenter's name and key words from the abstract. In addition, a hand search of the non-abstracted journal Emergency Medicine was conducted. Of the 207 free paper abstracts identified, 73 (35%) had been published as full articles. Papers were published in a variety of journals; however, Emergency Medicine accounted for almost half the published papers. The mean time between presentation and publication was 12.6 months (median 11 months). The abstract to publication rate for papers presented by Australasian emergency physicians and trainees at Australasian College for Emergency Medicine/Australasian Society for Emergency Medicine and International Conference on Emergency Medicine meetings is 35%, which is lower than that reported by some other established specialities, but comparable to rates reported for US-based national and international emergency medicine meetings. Future research should look at barriers to the publication of findings and ways to assist the publication process.

  13. The Effect of Emergency Department Overcrowding on Efficiency of Emergency Medicine Residents’ Education

    Directory of Open Access Journals (Sweden)

    Anita Sabzghabaei

    2014-09-01

    Full Text Available Introduction: Creating a calm and stress-free environment affects education significantly. The effects of the emergency department overcrowding (EDO on the training of emergency medicine residents (EMR is a highly debated subject. Therefore, this study aimed to evaluate the effect of EDO on efficiency of EMR’s education. Methods: In this cross-sectional study, the effects of overcrowding on EMR’s education in the resuscitation room and acute care unit. Data collection was done using a questionnaire, which was filled out by the second year EMRs.  The crowding level was calculated based on the national emergency department overcrowding scale (NEDOCS. The relationship between the two studied variables was evaluated using independent sample t-test and SPSS 21 statistical software. Results: 130 questionnaires were filled out during 61 shifts. 47 (77.05% shifts were overcrowded. The attend’s ability to teach was not affected by overcrowding in the resuscitation room (p=0.008. The similar results were seen regarding the attend’s training ability in the acute care unit. Conclusion: It seems that the emergency department overcrowding has no effect on the quality of education to the EMRs.

  14. Emergency medicine resident education in palliative care: a needs assessment.

    Science.gov (United States)

    Lamba, Sangeeta; Pound, Amy; Rella, Joseph G; Compton, Scott

    2012-05-01

    Hospice and Palliative Medicine is a newly designated subspecialty of Emergency Medicine (EM). As yet, no well defined palliative care (PC) models for education or training exist. A needs assessment is the first step towards developing a curriculum. To characterize emergency physicians' (EP) perceived educational and formal training needs for PC related skills. All EM residents and faculty of one academic facility were asked to complete an anonymous needs-assessment survey. Participants were asked to rank statements related to attitudes about PC and rate their formal training and knowledge in 10 aspects of PC using a 5-point Likert-scale. EPs also ranked 4 learning modalities in order of preference and 12 PC educational topics in order of perceived importance in an EM curriculum. Ninety-three percent (42/45) of eligible participants completed the survey (28 residents, 14 faculty). Respondents agreed/strongly agreed that PC skills are an important competence for EM (88%, 37/42) and that they would "like to have more training/education in PC" (79%, 33/42). Respondents also disagreed/strongly disagreed with the statement that "PC consult is called when no more can be done for the patient" (90%, 38/42). Important PC topics identified were pain management, discussing code status, and management of dyspnea and other symptoms in terminal illness. Bedside teaching was listed as the preferred learning modality. EM residents reported minimal training in pain management (46%, 13/28), managing hospice patients (54%, 15/28), withdrawal/withholding life support (54%, 15/28), and managing the imminently dying (43%, 12/28). There was no consistent, significant improvement reported in any domain as training and experience progressed from PGY (postgraduate year) 1 to PGY 4 to attending physician. EPs view PC skills as important for EM practice and report that they are not yet adequately educated and trained in providing PC. Domains of particular interest and targeted areas for PC

  15. Clinical practice in community medicine: Challenges and opportunities

    Directory of Open Access Journals (Sweden)

    Rajesh Kumar

    2017-01-01

    Full Text Available Clinical practice with community health perspective makes community medicine a unique specialty. In their health centers, community physicians not only implement disease prevention programs, assess community health needs, manage healthcare teams and advocate for health promoting policies but also diagnose and treat diseases. However, participation of community medicine faculty in the delivery of clinical care varies from place to place due to administrative constraints. Health centers attached with medical college are not dependent on community medicine faculty for clinical service as these centers have their own medical and paramedical staff; whereas, other clinical departments in medical colleges depend on their faculty for delivery of clinical care in the hospital. Consequently, a perception is gaining ground that community medicine is a para-clinical specialty. Strategies for a fixed tenured rotation of faculty in the health centers should be evolved. All faculty members of community medicine must also provide clinical care in the health centers and the quantum of clinical services provided by each one of them should be reported widely to all stakeholders. Community medicine residency programs must ensure that trainee community physicians acquire competency to deliver comprehensive primary health care (promotive, preventive, curative, and rehabilitative in a health center.

  16. Rational and irrational clinical strategies for collaborative medicine.

    Science.gov (United States)

    Hammerly, Milt

    2002-01-01

    Individual practitioners and health care systems/organizations increasingly understand the rationale for collaborative medicine. An absence of collaboration can compromise the quality and safety of patient care. But having a rationale to provide collaborative medicine without also having a rational clinical strategy can be equally compromising to the quality and safety of patient care. Reasonable evidentiary criteria must be used to determine whether specific therapies merit inclusion or exclusion in a collaborative medicine model. Ranking therapies hierarchically on the basis of their risk-benefit ratio simplifies matching of therapies with the needs of the patient. A unifying taxonomy that categorizes all therapies (complementary/alternative and conventional) on the basis of how we think they work (presumed mechanisms of action) facilitates development of a clinical strategy for collaborative medicine. On the basis of these principles, a rational clinical strategy for collaborative medicine is described to help optimize the quality and safety of patient care.

  17. Workplace Violence and Harassment Against Emergency Medicine Residents

    Directory of Open Access Journals (Sweden)

    Benjamin H. Schnapp

    2016-09-01

    Full Text Available Introduction: Several studies have shown that workplace violence in the emergency department (ED is common. Residents may be among the most vulnerable staff, as they have the least experience with these volatile encounters. The goal for this study was to quantify and describe acts of violence against emergency medicine (EM residents by patients and visitors and to identify perceived barriers to safety. Methods: This cross-sectional survey study queried EM residents at multiple New York City hospitals. The primary outcome was the incidence of violence experienced by residents while working in the ED. The secondary outcomes were the subtypes of violence experienced by residents, as well as the perceived barriers to safety while at work. Results: A majority of residents (66%, 78/119 reported experiencing at least one act of physical violence during an ED shift. Nearly all residents (97%, 115/119 experienced verbal harassment, 78% (93/119 had experienced verbal threats, and 52% (62/119 reported sexual harassment. Almost a quarter of residents felt safe “Occasionally,” “Seldom” or “Never” while at work. Patient-based factors most commonly cited as contributory to violence included substance use and psychiatric disease. Conclusion: Self-reported violence against EM residents appears to be a significant problem. Incidence of violence and patient risk factors are similar to what has been found previously for other ED staff. Understanding the prevalence of workplace violence as well as the related systems, environmental, and patient-based factors is essential for future prevention efforts.

  18. Workplace Violence and Harassment Against Emergency Medicine Residents

    Science.gov (United States)

    Schnapp, Benjamin H.; Slovis, Benjamin H.; Shah, Anar D.; Fant, Abra L.; Gisondi, Michael A.; Shah, Kaushal H.; Lech, Christie A.

    2016-01-01

    Introduction Several studies have shown that workplace violence in the emergency department (ED) is common. Residents may be among the most vulnerable staff, as they have the least experience with these volatile encounters. The goal for this study was to quantify and describe acts of violence against emergency medicine (EM) residents by patients and visitors and to identify perceived barriers to safety. Methods This cross-sectional survey study queried EM residents at multiple New York City hospitals. The primary outcome was the incidence of violence experienced by residents while working in the ED. The secondary outcomes were the subtypes of violence experienced by residents, as well as the perceived barriers to safety while at work. Results A majority of residents (66%, 78/119) reported experiencing at least one act of physical violence during an ED shift. Nearly all residents (97%, 115/119) experienced verbal harassment, 78% (93/119) had experienced verbal threats, and 52% (62/119) reported sexual harassment. Almost a quarter of residents felt safe “Occasionally,” “Seldom” or “Never” while at work. Patient-based factors most commonly cited as contributory to violence included substance use and psychiatric disease. Conclusion Self-reported violence against EM residents appears to be a significant problem. Incidence of violence and patient risk factors are similar to what has been found previously for other ED staff. Understanding the prevalence of workplace violence as well as the related systems, environmental, and patient-based factors is essential for future prevention efforts. PMID:27625721

  19. Aspects of radioisotopes utilization in clinical medicine

    International Nuclear Information System (INIS)

    Rocha, A.F.G.; Lima e Forti, C.A. de; Cunha, M. da C.; Souza Maciel, O. de

    1973-01-01

    A revision concerning radioisotope use in Medicine have been dow. Harmless and effeciency of radioisotopes are shown. Techniques and advantages of tracers used for brain scintiscanning, lung scintiscanning, liver scintinscanning, spleen scintiscanning, bone scintiscanning and thyroid scintiscanning are described and images of them are presented [pt

  20. Perceptions of Unprofessional Social Media Behavior Among Emergency Medicine Physicians.

    Science.gov (United States)

    Soares, William; Shenvi, Christina; Waller, Nikki; Johnson, Reuben; Hodgson, Carol S

    2017-02-01

    Use of social media (SM) by physicians has exposed issues of privacy and professionalism. While guidelines have been created for SM use, details regarding specific SM behaviors that could lead to disciplinary action presently do not exist. To compare State Medical Board (SMB) directors' perceptions of investigation for specific SM behaviors with those of emergency medicine (EM) physicians. A multicenter anonymous survey was administered to physicians at 3 academic EM residency programs. Surveys consisted of case vignettes, asking, "If the SMB were informed of the content, how likely would they be to initiate an investigation, possibly leading to disciplinary action?" (1, very unlikely, to 4, very likely). Results were compared to published probabilities using exact binomial testing. Of 205 eligible physicians, 119 (58%) completed the survey. Compared to SMB directors, EM physicians indicated similar probabilities of investigation for themes involving identifying patient images, inappropriate communication, and discriminatory speech. Participants indicated lower probabilities of investigation for themes including derogatory speech (32%, 95% confidence interval [CI] 24-41 versus 46%, P  social identity, compared to SMB directors, particularly for images of alcohol and derogatory speech.

  1. The multiple mini-interview for emergency medicine resident selection.

    Science.gov (United States)

    Hopson, Laura R; Burkhardt, John C; Stansfield, R Brent; Vohra, Taher; Turner-Lawrence, Danielle; Losman, Eve D

    2014-04-01

    The Multiple Mini-Interview (MMI) uses multiple, short-structured contacts to evaluate communication and professionalism. It predicts medical school success better than the traditional interview and application. Its acceptability and utility in emergency medicine (EM) residency selection are unknown. We theorized that participants would judge the MMI equal to a traditional unstructured interview and it would provide new information for candidate assessment. Seventy-one interns from 3 programs in the first month of training completed an eight-station MMI focused on EM topics. Pre- and post-surveys assessed reactions. MMI scores were compared with application data. EM grades correlated with MMI performance (F[1, 66] = 4.18; p interview (mean difference = 1.36; p interview and MMI) was preferred over a MMI alone (mean difference = 1.1; p interview, participants were receptive to a mixed-methods interview. The MMI does correlate with performance on the EM clerkship and therefore can measure important abilities for EM success. Future work will determine whether MMI performance predicts residency performance. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Performance criteria for emergency medicine residents: a job analysis.

    Science.gov (United States)

    Blouin, Danielle; Dagnone, Jeffrey Damon

    2008-11-01

    A major role of admission interviews is to assess a candidate's suitability for a residency program. Structured interviews have greater reliability and validity than do unstructured ones. The development of content for a structured interview is typically based on the dimensions of performance that are perceived as important to succeed in a particular line of work. A formal job analysis is normally conducted to determine these dimensions. The dimensions essential to succeed as an emergency medicine (EM) resident have not yet been studied. We aimed to analyze the work of EM residents to determine these essential dimensions. The "critical incident technique" was used to generate scenarios of poor and excellent resident performance. Two reviewers independently read each scenario and labelled the performance dimensions that were reflected in each. All labels assigned to a particular scenario were pooled and reviewed again until a consensus was reached. Five faculty members (25% of our total faculty) comprised the subject experts. Fifty-one incidents were generated and 50 different labels were applied. Eleven dimensions of performance applied to at least 5 incidents. "Professionalism" was the most valued performance dimension, represented in 56% of the incidents, followed by "self-confidence" (22%), "experience" (20%) and "knowledge" (20%). "Professionalism," "self-confidence," "experience" and "knowledge" were identified as the performance dimensions essential to succeed as an EM resident based on our formal job analysis using the critical incident technique. Performing a formal job analysis may assist training program directors with developing admission interviews.

  3. Increasing emergency medicine residents' confidence in disaster management: use of an emergency department simulator and an expedited curriculum.

    Science.gov (United States)

    Franc, Jeffrey Michael; Nichols, Darren; Dong, Sandy L

    2012-02-01

    Disaster Medicine is an increasingly important part of medicine. Emergency Medicine residency programs have very high curriculum commitments, and adding Disaster Medicine training to this busy schedule can be difficult. Development of a short Disaster Medicine curriculum that is effective and enjoyable for the participants may be a valuable addition to Emergency Medicine residency training. A simulation-based curriculum was developed. The curriculum included four group exercises in which the participants developed a disaster plan for a simulated hospital. This was followed by a disaster simulation using the Disastermed.Ca Emergency Disaster Simulator computer software Version 3.5.2 (Disastermed.Ca, Edmonton, Alberta, Canada) and the disaster plan developed by the participants. Progress was assessed by a pre- and post-test, resident evaluations, faculty evaluation of Command and Control, and markers obtained from the Disastermed.Ca software. Twenty-five residents agreed to partake in the training curriculum. Seventeen completed the simulation. There was no statistically significant difference in pre- and post-test scores. Residents indicated that they felt the curriculum had been useful, and judged it to be preferable to a didactic curriculum. In addition, the residents' confidence in their ability to manage a disaster increased on both a personal and and a departmental level. A simulation-based model of Disaster Medicine training, requiring approximately eight hours of classroom time, was judged by Emergency Medicine residents to be a valuable component of their medical training, and increased their confidence in personal and departmental disaster management capabilities.

  4. 76 FR 71345 - Patient Safety Organizations: Voluntary Relinquishment From Emergency Medicine Patient Safety...

    Science.gov (United States)

    2011-11-17

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment From Emergency Medicine Patient Safety Foundation AGENCY: Agency for... notification of voluntary relinquishment from Emergency Medicine Patient Safety Foundation of its status as a...

  5. Psychiatry and Emergency Medicine: Medical Student and Physician Attitudes toward Homeless Persons

    Science.gov (United States)

    Morrison, Ann; Roman, Brenda; Borges, Nicole

    2012-01-01

    Objective: The purpose of the study was to explore changes in medical students' attitudes toward homeless persons during the Psychiatry and Emergency Medicine clerkships. Simultaneously, this study explored attitudes toward homeless persons held by Psychiatry and Emergency Medicine residents and faculty in an attempt to uncover the "hidden…

  6. Optimizing the Internal Medicine Clinic at Evans Army Community Hospital

    National Research Council Canada - National Science Library

    Bonilla, Jose

    2003-01-01

    ...) 2002, the Internal Medicine (IM) clinic at Evans Army Community Hospital, Fort Carson, Colorado, failed to meet access to care standards for routine appointments, and was only marginally successful in meeting standards for urgent appointments...

  7. 'What the hell is water?' How to use deliberate clinical inertia in common emergency department situations.

    Science.gov (United States)

    Egerton-Warburton, Diana; Cullen, Louise; Keijzers, Gerben; Fatovich, Daniel M

    2018-06-01

    Appropriate deliberate clinical inertia refers to the art of doing nothing as a positive clinical response. It includes shared decision-making to improve patient care with the use of clinical judgement. We discuss common clinical scenarios where the use of deliberate clinical inertia can occur. The insertion of peripheral intravenous cannulae, investigating patients with suspected renal colic and the investigation of low risk chest pain are all opportunities for the thoughtful clinician to 'stand there' and use effective patient communication to avoid low value tests and procedures. Awareness is key to identifying these opportunities to practice deliberate clinical inertia, as many of the situations may be so much a part of our environment that they are hidden in plain view. © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  8. Child abuse training and knowledge: a national survey of emergency medicine, family medicine, and pediatric residents and program directors.

    Science.gov (United States)

    Starling, Suzanne P; Heisler, Kurt W; Paulson, James F; Youmans, Eren

    2009-04-01

    The objective of this study was to determine the level of knowledge, comfort, and training related to the medical management of child abuse among pediatrics, emergency medicine, and family medicine residents. Surveys were administered to program directors and third-year residents at 67 residency programs. The resident survey included a 24-item quiz to assess knowledge regarding the medical management of physical and sexual child abuse. Sites were solicited from members of a network of child abuse physicians practicing at institutions with residency programs. Analyzable surveys were received from 53 program directors and 462 residents. Compared with emergency medicine and family medicine programs, pediatric programs were significantly larger and more likely to have a medical provider specializing in child abuse pediatrics, have faculty primarily responsible for child abuse training, use a written curriculum for child abuse training, and offer an elective rotation in child abuse. Exposure to child abuse training and abused patients was highest for pediatric residents and lowest for family medicine residents. Comfort with managing child abuse cases was lowest among family medicine residents. On the knowledge quiz, pediatric residents significantly outperformed emergency medicine and family medicine residents. Residents with high knowledge scores were significantly more likely to come from larger programs and programs that had a center, provider, or interdisciplinary team that specialized in child abuse pediatrics; had a physician on faculty responsible for child abuse training; used a written curriculum for child abuse training; and had a required rotation in child abuse pediatrics. By analyzing the relationship between program characteristics and residents' child abuse knowledge, we found that pediatric programs provide far more training and resources for child abuse education than emergency medicine and family medicine programs. As leaders, pediatricians must

  9. Clinical trials in nuclear medicine: Present and future

    International Nuclear Information System (INIS)

    Chaumet-Riffaud, P.; Cachin, F.; Couturier, O.; Desruet, M.D.; Kraeber-Bodere, F.; Talbot, J.N.; Vuillez, J.P.

    2009-01-01

    The particular status of radiopharmaceuticals, together with the positioning of nuclear medicine in multidisciplinary approach of oncology, lead to real difficulties for conception, validation and granting of clinical trials which are necessary for demonstrating clinical interest of new compounds, for diagnosis as well as for therapeutic use. This article is a presentation of some recent clinical trials conducted in nuclear medicine in France, showing its dynamism but also pointing out some encountered difficulties. These experiences could lead to reflexion in order to improve the clinical research performances, taking into account a scientific and regulatory context more and more constraining. (authors)

  10. Setting the agenda in emergency medicine in the southern African region: Conference assumptions and recommendations, Emergency Medicine Conference 2014: Gaborone, Botswana

    Directory of Open Access Journals (Sweden)

    Lloyd D. Christopher

    2014-09-01

    Full Text Available The first international emergency medicine (EM conference in Botswana was held on 15th and 16th May 2014 at the Gaborone International Convention Centre. The support from key stakeholders positioned the conference, from its conception, to deliver expert guidance on emergency medicine relevance, education and systems implementation. The conference theme was aptly: “Setting the Agenda in Emergency Medicine in the Southern African Region.” Over 300 local, regional and international delegates convened to participate in this landmark event. Country representation included Botswana, South Africa, Zambia, Namibia, Zimbabwe, Swaziland, Lesotho, Nigeria and the United States of America. Conference assumptions intersected emergency care, African burden of injury and illness and the role of the state; the public protection ethic of emergency care, and the developmental, economic and health interest in promoting EM. The recommendations addressed emergency care relevance; health systems research as an imperative for emergency systems development in southern Africa; community agency as a requisite for emergency care resilience; emergency care workers as pivotal to the emergency medical system, and support of EM system implementation. The conference recommendations – by way of setting an agenda, augur well for emergency care development and implementation in the southern African region and are likely to prove useful to the southern African countries seeking to address health service quality, EM advocacy support and implementation guidance. Emergency medicine is the only discipline with ‘universality’ and ‘responsivity’ at the point of need. This implies the widespread potential for facilitation of access to health care: a public health goal nuanced by the African development agenda.

  11. Simulation in Canadian postgraduate emergency medicine training - a national survey.

    Science.gov (United States)

    Russell, Evan; Hall, Andrew Koch; Hagel, Carly; Petrosoniak, Andrew; Dagnone, Jeffrey Damon; Howes, Daniel

    2018-01-01

    Simulation-based education (SBE) is an important training strategy in emergency medicine (EM) postgraduate programs. This study sought to characterize the use of simulation in FRCPC-EM residency programs across Canada. A national survey was administered to residents and knowledgeable program representatives (PRs) at all Canadian FRCPC-EM programs. Survey question themes included simulation program characteristics, the frequency of resident participation, the location and administration of SBE, institutional barriers, interprofessional involvement, content, assessment strategies, and attitudes about SBE. Resident and PR response rates were 63% (203/321) and 100% (16/16), respectively. Residents reported a median of 20 (range 0-150) hours of annual simulation training, with 52% of residents indicating that the time dedicated to simulation training met their needs. PRs reported the frequency of SBE sessions ranging from weekly to every 6 months, with 15 (94%) programs having an established simulation curriculum. Two (13%) of the programs used simulation for resident assessment, although 15 (94%) of PRs indicated that they would be comfortable with simulation-based assessment. The most common PR-identified barriers to administering simulation were a lack of protected faculty time (75%) and a lack of faculty experience with simulation (56%). Interprofessional involvement in simulation was strongly valued by both residents and PRs. SBE is frequently used by Canadian FRCPC-EM residency programs. However, there exists considerable variability in the structure, frequency, and timing of simulation-based activities. As programs transition to competency-based medical education, national organizations and collaborations should consider the variability in how SBE is administered.

  12. Emergency medicine resident well-being: stress and satisfaction.

    Science.gov (United States)

    Hoonpongsimanont, W; Murphy, M; Kim, C H; Nasir, D; Compton, S

    2014-01-01

    Emergency medicine (EM) residents are exposed to many work-related stressors, which affect them both physically and emotionally. It is unknown, however, how EM residents perceive the effect of these stressors on their well-being and how often they use unhealthy coping mechanisms to manage stress. To evaluate EM residents' perceptions of stressors related to their overall well-being and the prevalence of various coping mechanisms. An online survey instrument was developed to gauge resident stress, satisfaction with current lifestyle, stress coping mechanisms and demographics. A stratified random sample of EM residents from three postgraduate years (PGY-I, PGY-II and PGY-III) was obtained. Descriptive statistics and one-way analysis of variance were used to compare residents across PGY level. There were 120 potential participants in each of the three PGYs. The overall response rate was 30% (109) with mean age of 30 and 61% were male. On a 0-4 scale (0 = completely dissatisfied), respondents in PGY-I reported significantly less satisfaction with lifestyle than those in PGY-II and III (mean rating: 1.29, 1.66 and 1.70, respectively; P stress categories: work relationships (1.37), work environment (1.10) and response to patients (1.08). Residents reported exercise (94%), hobbies (89%) and use of alcohol (71%) as coping methods. Residents reported low satisfaction with current lifestyle. This dissatisfaction was unrelated to perceived work-related stress. Some undesirable coping methods were prevalent, suggesting that training programs could focus on promotion of healthy group activities.

  13. The state of emergency medicine in the United Republic of Tanzania

    Directory of Open Access Journals (Sweden)

    B.A. Nicks

    2012-09-01

    Currently at most hospitals, emergency patients are cared for in Emergency Centres (ECs staffed with rotating personnel who are neither trained nor equipped to provide complete resuscitative care, but dedicated emergency care training projects are emerging. The first Emergency Medicine residency in the country was initiated in 2010 and will produce its first graduates in 2013. In 2011, a dedicated Emergency Nursing curriculum was introduced, and the Emergency Medical Association of Tanzania (EMAT, the first Emergency Medicine professional society in the country, was formed and ratified by the Ministry of Health. EMAT has been given a mandate to develop feasible initiatives for the dissemination of emergency care training to district and sub-district facilities. However, significant gaps exist in the capacity for emergency medical care including deficits in human resources, essential equipment and infrastructure – concurrent issues that EMAT must address within its development strategy.

  14. Quality Improvement Practices in Academic Emergency Medicine: Perspectives from the Chairs

    Directory of Open Access Journals (Sweden)

    DelliFraine, Jami L

    2010-12-01

    Full Text Available Objective: To assess academic emergency medicine (EM chairs’ perceptions of quality improvement (QI training programs.Methods: A voluntary anonymous 20 item survey was distributed to a sample of academic chairs of EM through the Association of Academic Chairs of Emergency Medicine. Data was collected to assess the percentage of academic emergency physicians who had received QI training, the type of training they received, their perception of the impact of this training on behavior, practice and outcomes, and any perceived barriers to implementing QI programs in the emergency department.Results: The response rate to the survey was 69% (N = 59. 59.3% of respondents report that their hospital has a formal QI program for physicians. Chairs received training in a variety of QI programs. The type of QI program used by respondents was perceived as having no impact on goals achieved by QI (χ2 = 12.382; p = 0.260, but there was a statistically significant (χ2 = 14.383; p = 0.006 relationship between whether or not goals were achieved and academic EM chairs’ perceptions about return on investment for QI training. Only 22% of chairs responded that they have already made changes as a result of the QI training. 78.8% of EM chairs responded that quality programs could have a significant positive impact on their practice and the healthcare industry. Chairs perceived that QI programs had the most potential value in the areas of understanding and reducing medical errors and improving patient flow and throughput. Other areas of potential value of QI include improving specific clinical indicators and standardizing physician care.Conclusion: Academic EM chairs perceived that QI programs were an effective way to drive needed improvements. The results suggest that there is a high level of interest in QI but a low level of adoption of training and implementation.[West J Emerg Med. 2010; 11(5:479-485.

  15. Do emergency medicine journals promote trial registration and adherence to reporting guidelines? A survey of "Instructions for Authors".

    Science.gov (United States)

    Sims, Matthew T; Henning, Nolan M; Wayant, C Cole; Vassar, Matt

    2016-11-24

    The aim of this study was to evaluate the current state of two publication practices, reporting guidelines requirements and clinical trial registration requirements, by analyzing the "Instructions for Authors" of emergency medicine journals. We performed a web-based data abstraction from the "Instructions for Authors" of the 27 Emergency Medicine journals catalogued in the Expanded Science Citation Index of the 2014 Journal Citation Reports and Google Scholar Metrics h5-index to identify whether each journal required, recommended, or made no mention of the following reporting guidelines: EQUATOR Network, ICMJE, ARRIVE, CARE, CONSORT, STARD, TRIPOD, CHEERS, MOOSE, STROBE, COREQ, SRQR, SQUIRE, PRISMA-P, SPIRIT, PRISMA, and QUOROM. We also extracted whether journals required or recommended trial registration. Authors were blinded to one another's ratings until completion of the data validation. Cross-tabulations and descriptive statistics were calculated using IBM SPSS 22. Of the 27 emergency medicine journals, 11 (11/27, 40.7%) did not mention a single guideline within their "Instructions for Authors," while the remaining 16 (16/27, 59.3%) mentioned one or more guidelines. The QUOROM statement and SRQR were not mentioned by any journals whereas the ICMJE guidelines (18/27, 66.7%) and CONSORT statement (15/27, 55.6%) were mentioned most often. Of the 27 emergency medicine journals, 15 (15/27, 55.6%) did not mention trial or review registration, while the remaining 12 (12/27, 44.4%) at least mentioned one of the two. Trial registration through ClinicalTrials.gov was mentioned by seven (7/27, 25.9%) journals while the WHO registry was mentioned by four (4/27, 14.8%). Twelve (12/27, 44.4%) journals mentioned trial registration through any registry platform. The aim of this study was to evaluate the current state of two publication practices, reporting guidelines requirements and clinical trial registration requirements, by analyzing the "Instructions for Authors" of

  16. Clinical decision-making and secondary findings in systems medicine.

    Science.gov (United States)

    Fischer, T; Brothers, K B; Erdmann, P; Langanke, M

    2016-05-21

    Systems medicine is the name for an assemblage of scientific strategies and practices that include bioinformatics approaches to human biology (especially systems biology); "big data" statistical analysis; and medical informatics tools. Whereas personalized and precision medicine involve similar analytical methods applied to genomic and medical record data, systems medicine draws on these as well as other sources of data. Given this distinction, the clinical translation of systems medicine poses a number of important ethical and epistemological challenges for researchers working to generate systems medicine knowledge and clinicians working to apply it. This article focuses on three key challenges: First, we will discuss the conflicts in decision-making that can arise when healthcare providers committed to principles of experimental medicine or evidence-based medicine encounter individualized recommendations derived from computer algorithms. We will explore in particular whether controlled experiments, such as comparative effectiveness trials, should mediate the translation of systems medicine, or if instead individualized findings generated through "big data" approaches can be applied directly in clinical decision-making. Second, we will examine the case of the Riyadh Intensive Care Program Mortality Prediction Algorithm, pejoratively referred to as the "death computer," to demonstrate the ethical challenges that can arise when big-data-driven scoring systems are applied in clinical contexts. We argue that the uncritical use of predictive clinical algorithms, including those envisioned for systems medicine, challenge basic understandings of the doctor-patient relationship. Third, we will build on the recent discourse on secondary findings in genomics and imaging to draw attention to the important implications of secondary findings derived from the joint analysis of data from diverse sources, including data recorded by patients in an attempt to realize their

  17. CAEP 2014 Academic Symposium: "How to make research succeed in your emergency department: How to develop and train career researchers in emergency medicine".

    Science.gov (United States)

    Perry, Jeffrey J; Snider, Carolyn E; Artz, Jennifer D; Stiell, Ian G; Shaeri, Sedigheh; McLeod, Shelley; Le Sage, Natalie; Hohl, Corinne; Calder, Lisa A; Vaillancourt, Christian; Holroyd, Brian; Hollander, Judd E; Morrison, Laurie J

    2015-05-01

    We sought to 1) identify best practices for training and mentoring clinician researchers, 2) characterize facilitators and barriers for Canadian emergency medicine researchers, and 3) develop pragmatic recommendations to improve and standardize emergency medicine postgraduate research training programs to build research capacity. We performed a systematic review of MEDLINE and Embase using search terms relevant to emergency medicine research fellowship/graduate training. We conducted an email survey of all Canadian emergency physician researchers. The Society for Academic Emergency Medicine (SAEM) research fellowship program was analysed, and other similar international programs were sought. An expert panel reviewed these data and presented recommendations at the Canadian Association of Emergency Physicians (CAEP) 2014 Academic Symposium. We refined our recommendations based on feedback received. Of 1,246 potentially relevant citations, we included 10 articles. We identified five key themes: 1) creating training opportunities; 2) ensuring adequate protected time; 3) salary support; 4) infrastructure; and 5) mentorship. Our survey achieved a 72% (67/93) response rate. From these responses, 42 (63%) consider themselves clinical researchers (i.e., spend a significant proportion of their career conducting research). The single largest constraint to conducting research was funding. Factors felt to be positive contributors to a clinical research career included salary support, research training (including an advanced graduate degree), mentorship, and infrastructure. The SAEM research fellowship was the only emergency medicine research fellowship program identified. This 2-year program requires approval of both the teaching centre and each applying fellow. This program requires training in 15 core competencies, manuscript preparation, and submission of a large grant to a national peer-review funding organization. We recommend that the CAEP Academic Section create a

  18. Pioneering small-group learning in Tanzanian emergency medicine: Investigating acceptability for physician learners

    Directory of Open Access Journals (Sweden)

    A G Lim

    2017-03-01

    Full Text Available Background. Emergency medicine (EM is a relatively new, but growing medical specialty in sub-Saharan Africa. African EM training programmes have used small-group learning (SGL modalities in their curricula. However, there is little knowledge of whether SGL modalities are perceived to be effective in these African EM training programmes. Objectives. To investigate the acceptability of SGL for physicians’ training in an academic Tanzanian emergency department using a novel EM curriculum. Methods. Using responses to a written questionnaire, we explored the perceived effectiveness of SGL compared with traditional didactic lectures among 38 emergency department physician learners in Dar es Salaam, Tanzania. Perceptions of SGL were identified from qualitative responses, and regression analyses were used to determine strength of association between quantitative outcomes. Results. Reported benefits of SGL included team building, simulation training, enhancement of procedural skills, and the opportunity to discuss opinions on clinical management. SGL scored more favourably with regard to improving clinical practice, enjoyment of learning, and building peer-to-peer relations. Lectures scored more favourably at improving medical knowledge. Preference towards SGL over lectures for overall training increased with years of clinical experience (95% confidence interval (CI 0.16 - 0.62, p=0.002, Spearman’s rho 0.51, and the perception that SGL reinforces learner-teacher relationships correlated with seniority within residency training (95% CI 0.14 - 0.86, p=0.007, Spearman’s rho 0.47. Conclusion. Techniques of SGL were perceived as effective at improving clinical practice in the emergency department setting. These modalities may be more favourably accepted by more experienced physician learners – therefore, new EM teaching programmes in Africa should consider these factors when targeting educational strategies for their respective regions and learner

  19. How alternative payment models in emergency medicine can benefit physicians, payers, and patients.

    Science.gov (United States)

    Harish, Nir J; Miller, Harold D; Pines, Jesse M; Zane, Richard D; Wiler, Jennifer L

    2017-06-01

    While there has been considerable effort devoted to developing alternative payment models (APMs) for primary care physicians and for episodes of care beginning with inpatient admissions, there has been relatively little attention by payers to developing APMs for specialty ambulatory care, and no efforts to develop APMs that explicitly focus on emergency care. In order to ensure that emergency care is appropriately integrated and valued in future payment models, emergency physicians (EPs) must engage with the stakeholders within the broader health care system. In this article, we describe a framework for the development of APMs for emergency medicine and present four examples of APMs that may be applicable in emergency medicine. A better understanding of how APMs can work in emergency medicine will help EPs develop new APMs that improve the cost and quality of care, and leverage the value that emergency care brings to the system. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Conference attendance does not correlate with emergency medicine residency in-training examination scores.

    Science.gov (United States)

    Gene Hern, H; Wills, Charlotte; Alter, Harrison; Bowman, Steven H; Katz, Eric; Shayne, Philip; Vahidnia, Farnaz

    2009-12-01

    The residency review committee for emergency medicine (EM) requires residents to have greater than 70% attendance of educational conferences during residency training, but it is unknown whether attendance improves clinical competence or scores on the American Board of Emergency Medicine (ABEM) in-training examination (ITE). This study examined the relationship between conference attendance and ITE scores. The hypothesis was that greater attendance would correlate to a higher examination score. This was a multi-center retrospective cohort study using conference attendance data and examination results from residents in four large county EM residency training programs. Longitudinal multi-level models, adjusting for training site, U.S. Medical Licensing Examination (USMLE) Step 1 score, and sex were used to explore the relationship between conference attendance and in-training examination scores according to year of training. Each year of training was studied, as well as the overall effect of mean attendance as it related to examination score. Four training sites reported data on 405 residents during 2002 to 2008; 386 residents had sufficient data to analyze. In the multi-level longitudinal models, attendance at conference was not a significant predictor of in-training percentile score (coefficient = 0.005, 95% confidence interval [CI] = -0.053 to 0.063, p = 0.87). Score on the USMLE Step 1 examination was a strong predictor of ITE score (coefficient = 0.186, 95% CI = 0.155 to 0.217; p ITE scores. Conference attendance may represent an important part of EM residency training but perhaps not of ITE performance. (c) 2009 by the Society for Academic Emergency Medicine.

  1. CIRM Alpha Stem Cell Clinics: Collaboratively Addressing Regenerative Medicine Challenges.

    Science.gov (United States)

    Jamieson, Catriona H M; Millan, Maria T; Creasey, Abla A; Lomax, Geoff; Donohoe, Mary E; Walters, Mark C; Abedi, Mehrdad; Bota, Daniela A; Zaia, John A; Adams, John S

    2018-06-01

    The California Institute for Regenerative Medicine (CIRM) Alpha Stem Cell Clinic (ASCC) Network was launched in 2015 to address a compelling unmet medical need for rigorous, FDA-regulated, stem cell-related clinical trials for patients with challenging, incurable diseases. Here, we describe our multi-center experiences addressing current and future challenges. Copyright © 2018 Elsevier Inc. All rights reserved.

  2. Radioactive isotopes in clinical medicine and research. Abstracts

    International Nuclear Information System (INIS)

    2007-01-01

    The review on the International Symposium on radioactive isotopes in clinical medicine and research in Bad Hofgastein, Austria, 9-12 January 2008, contains 42 papers and 29 poster contributions on the following topics: radiopharmaceutical sciences; radiopharmaceutical sciences in oncology and cardiology; therapy; endocrinology; molecular imaging; clinical PET; physics: image processing; instrumentation, neurology, psychiatry

  3. Radioactive isotopes in clinical medicine and research. Abstracts

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2007-07-01

    The review on the International Symposium on radioactive isotopes in clinical medicine and research in Bad Hofgastein, Austria, 9-12 January 2008, contains 42 papers and 29 poster contributions on the following topics: radiopharmaceutical sciences; radiopharmaceutical sciences in oncology and cardiology; therapy; endocrinology; molecular imaging; clinical PET; physics: image processing; instrumentation, neurology, psychiatry.

  4. Phronesis, clinical reasoning, and Pellegrino's philosophy of medicine.

    Science.gov (United States)

    Davis, F D

    1997-01-01

    In terms of Aristotle's intellectual virtues, the process of clinical reasoning and the discipline of clinical medicine are often construed as techne (art), as episteme (science), or as an amalgam or composite of techne and episteme. Although dimensions of process and discipline are appropriately described in these terms, I argue that phronesis (practical reasoning) provides the most compelling paradigm, particularly of the rationality of the physician's knowing and doing in the clinical encounter with the patient. I anchor this argument, moreover, in Pellegrino's philosophy of medicine as a healing relationship, oriented to the end of a right and good healing action for the individual patient.

  5. System for radiation emergency medicine. Activities of tertiary radiation emergency hospitals

    International Nuclear Information System (INIS)

    Kamiya, Kenji; Tanigawa, Koichi; Hosoi, Yoshio

    2011-01-01

    Japanese system for radiation emergency medicine is primarily built up by Cabinet Nuclear Safety Commission in 2001 based on previous Tokai JCO Accident (1999) and is composed from the primary, secondary and tertiary medical organizations. This paper describes mainly about roles and actions of the tertiary facilities at Fukushima Nuclear Power Plant Accident and tasks to be improved in future. The primary and secondary organizations in the system above are set up in the prefectures with or neighboring the nuclear facility, and tertiary ones, in two parts of western and eastern Japan. The western organization is in Hiroshima University having its cooperating 7 hospitals, and is responsible for such patients as exposed to high dose external radiation, having serious complication, and difficult to treat in the primary/secondary hospitals. The eastern is in National Institute of Radiological Sciences (NIRS) with 6 cooperating hospitals and responsible for patients with internal radiation exposure difficult to treat, with contaminated body surface with difficulty in decontamination and/or with causable of secondary contamination, and difficult to treat in the secondary hospitals. The tertiary organizations have made efforts for the education and training of medical staff, for network construction among the primary, secondary and other medicare facilities, for establishment of transferring system of patients, and for participation to the international network by global organizations like Response Assistance Network (RANET) in International Atomic Energy Agency (IAEA), and Radiation Emergency Preparedness and Network (REMPAN) in World Health Organization (WHO). At the Fukushima Accident, staffs of the two tertiary hospitals began to conduct medicare on site (Mar. 12-) and learned following tasks to be improved in future: the early definition of medicare and its network system, and Emergency Planning Zone (EPZ); urgent evacuation of residents weak to disaster like elderly

  6. Clinic and Emergency Room Evaluation and Testing of Headache.

    Science.gov (United States)

    Nye, Barbara L; Ward, Thomas N

    2015-10-01

    Evaluation of the headache patient in the outpatient clinic and emergency department (ED) has different focuses and goals. The focus of this paper is to review the evaluation of patients in both settings with mention of evaluation in the pediatric and pregnant patient population.  The patient's history should drive the practitioner's decision and evaluation choices. We review recommendations made by the American Board of Internal Medicine and American Headache Society through the Choosing Wisely Campaign, which has an emphasis on choosing the right imaging modality for the clinical situation and elimination/prevention of medication overuse headache, as well as the US Headache Consortium guidelines for migraine headache. We will also review focusing on ED evaluation of the pediatric patient and pregnant patient presenting with headache. At the end of the review we hope to have provided you with a framework to think about the headache patient and what is the appropriate test in the given clinical setting in order to ensure that the patient gets the right diagnosis and is set on a path to the appropriate management plan. © 2015 American Headache Society.

  7. Hippocrates of Kos, the father of clinical medicine, and Asclepiades of Bithynia, the father of molecular medicine. Review.

    Science.gov (United States)

    Yapijakis, Christos

    2009-01-01

    Hippocrates of Kos (460-377 Before Common Era, BCE) is universally recognized as the father of modern medicine, which is based on observation of clinical signs and rational conclusions, and does not rely on religious or magical beliefs. Hippocratic medicine was influenced by the Pythagorean theory that Nature was made of four elements (water, earth, wind and fire), and therefore, in an analogous way, the body consisted of four fluids or 'humors' (black bile, yellow bile, phlegm and blood). The physician had to reinstate the healthy balance of these humors by facilitating the healing work of 'benevolent Nature'. The Hippocratic Oath contains the Pythagorean duties of justice, secrecy, respect for teachers and solidarity with peers. The clinical and ethical basics of medical practice as well as most clinical terms used even today have their origins in Hippocrates. His contribution in clinical medicine is immense. Asclepiades of Bithynia (124-40 BCE) was the first physician who established Greek medicine in Rome. Influenced by the Epicurean philosophy, he adhered to atomic theory, chance and evolution, and did not accept the theory of a 'benevolent Nature'. He suggested that the human body is composed of molecules and void spaces, and that diseases are caused by alteration of form or position of a patient's molecules. Asclepiades favored naturalistic therapeutic methods such as a healthy diet, massage and physical exercise. Above all, he introduced the friendly, sympathetic, pleasing and painless treatment of patients into medical practice, influenced by the teachings of Epicurus on pleasure and friendship. He was the first who made the highly important division of diseases into acute and chronic ones and to perform an elective non-emergency tracheotomy. As the founder of the Methodic School, Asclepiades was the first known physician who spoke about what is known today as molecular medicine.

  8. Disaster Education: A Survey Study to Analyze Disaster Medicine Training in Emergency Medicine Residency Programs in the United States.

    Science.gov (United States)

    Sarin, Ritu R; Cattamanchi, Srihari; Alqahtani, Abdulrahman; Aljohani, Majed; Keim, Mark; Ciottone, Gregory R

    2017-08-01

    The increase in natural and man-made disasters occurring worldwide places Emergency Medicine (EM) physicians at the forefront of responding to these crises. Despite the growing interest in Disaster Medicine, it is unclear if resident training has been able to include these educational goals. Hypothesis This study surveys EM residencies in the United States to assess the level of education in Disaster Medicine, to identify competencies least and most addressed, and to highlight effective educational models already in place. The authors distributed an online survey of multiple-choice and free-response questions to EM residency Program Directors in the United States between February 7 and September 24, 2014. Questions assessed residency background and details on specific Disaster Medicine competencies addressed during training. Out of 183 programs, 75 (41%) responded to the survey and completed all required questions. Almost all programs reported having some level of Disaster Medicine training in their residency. The most common Disaster Medicine educational competencies taught were patient triage and decontamination. The least commonly taught competencies were volunteer management, working with response teams, and special needs populations. The most commonly identified methods to teach Disaster Medicine were drills and lectures/seminars. There are a variety of educational tools used to teach Disaster Medicine in EM residencies today, with a larger focus on the use of lectures and hospital drills. There is no indication of a uniform educational approach across all residencies. The results of this survey demonstrate an opportunity for the creation of a standardized model for resident education in Disaster Medicine. Sarin RR , Cattamanchi S , Alqahtani A , Aljohani M , Keim M , Ciottone GR . Disaster education: a survey study to analyze disaster medicine training in emergency medicine residency programs in the United States. Prehosp Disaster Med. 2017;32(4):368-373.

  9. Using Lean Management to Reduce Emergency Department Length of Stay for Medicine Admissions.

    Science.gov (United States)

    Allaudeen, Nazima; Vashi, Anita; Breckenridge, Julia S; Haji-Sheikhi, Farnoosh; Wagner, Sarah; Posley, Keith A; Asch, Steven M

    The practice of boarding admitted patients in the emergency department (ED) carries negative operational, clinical, and patient satisfaction consequences. Lean tools have been used to improve ED workflow. Interventions focused on reducing ED length of stay (LOS) for admitted patients are less explored. To evaluate a Lean-based initiative to reduce ED LOS for medicine admissions. Prospective quality improvement initiative performed at a single university-affiliated Department of Veterans Affairs (VA) medical center from February 2013 to February 2016. We performed a Lean-based multidisciplinary initiative beginning with a rapid process improvement workshop to evaluate current processes, identify root causes of delays, and develop countermeasures. Frontline staff developed standard work for each phase of the ED stay. Units developed a daily management system to reinforce, evaluate, and refine standard work. The primary outcome was the change in ED LOS for medicine admissions pre- and postintervention. ED LOS at the intervention site was compared with other similar VA facilities as controls over the same time period using a difference-in-differences approach. ED LOS for medicine admissions reduced 26.4%, from 8.7 to 6.4 hours. Difference-in-differences analysis showed that ED LOS for combined medicine and surgical admissions decreased from 6.7 to 6.0 hours (-0.7 hours, P = .003) at the intervention site compared with no change (5.6 hours, P = .2) at the control sites. We utilized Lean management to significantly reduce ED LOS for medicine admissions. Specifically, the development and management of standard work were key to sustaining these results.

  10. Knowledge translation studies in paediatric emergency medicine: A systematic review of the literature.

    Science.gov (United States)

    Wilson, Catherine L; Johnson, David; Oakley, Ed

    2016-02-01

    Systematic review of knowledge translation studies focused on paediatric emergency care to describe and assess the interventions used in emergency department settings. Electronic databases were searched for knowledge translation studies conducted in the emergency department that included the care of children. Two researchers independently reviewed the studies. From 1305 publications identified, 15 studies of varied design were included. Four were cluster-controlled trials, two patient-level randomised controlled trials, two interrupted time series, one descriptive study and six before and after intervention studies. Knowledge translation interventions were predominantly aimed at the treating clinician, with some targeting the organisation. Studies assessed effectiveness of interventions over 6-12 months in before and after studies, and 3-28 months in cluster or patient level controlled trials. Changes in clinical practice were variable, with studies on single disease and single treatments in a single site showing greater improvement. Evidence for effective methods to translate knowledge into practice in paediatric emergency medicine is fairly limited. More optimal study designs with more explicit descriptions of interventions are needed to facilitate other groups to effectively apply these procedures in their own setting. © 2016 The Authors Journal of Paediatrics and Child Health © 2016 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  11. Application and Exploration of Big Data Mining in Clinical Medicine.

    Science.gov (United States)

    Zhang, Yue; Guo, Shu-Li; Han, Li-Na; Li, Tie-Ling

    2016-03-20

    To review theories and technologies of big data mining and their application in clinical medicine. Literatures published in English or Chinese regarding theories and technologies of big data mining and the concrete applications of data mining technology in clinical medicine were obtained from PubMed and Chinese Hospital Knowledge Database from 1975 to 2015. Original articles regarding big data mining theory/technology and big data mining's application in the medical field were selected. This review characterized the basic theories and technologies of big data mining including fuzzy theory, rough set theory, cloud theory, Dempster-Shafer theory, artificial neural network, genetic algorithm, inductive learning theory, Bayesian network, decision tree, pattern recognition, high-performance computing, and statistical analysis. The application of big data mining in clinical medicine was analyzed in the fields of disease risk assessment, clinical decision support, prediction of disease development, guidance of rational use of drugs, medical management, and evidence-based medicine. Big data mining has the potential to play an important role in clinical medicine.

  12. Application and Exploration of Big Data Mining in Clinical Medicine

    Science.gov (United States)

    Zhang, Yue; Guo, Shu-Li; Han, Li-Na; Li, Tie-Ling

    2016-01-01

    Objective: To review theories and technologies of big data mining and their application in clinical medicine. Data Sources: Literatures published in English or Chinese regarding theories and technologies of big data mining and the concrete applications of data mining technology in clinical medicine were obtained from PubMed and Chinese Hospital Knowledge Database from 1975 to 2015. Study Selection: Original articles regarding big data mining theory/technology and big data mining's application in the medical field were selected. Results: This review characterized the basic theories and technologies of big data mining including fuzzy theory, rough set theory, cloud theory, Dempster–Shafer theory, artificial neural network, genetic algorithm, inductive learning theory, Bayesian network, decision tree, pattern recognition, high-performance computing, and statistical analysis. The application of big data mining in clinical medicine was analyzed in the fields of disease risk assessment, clinical decision support, prediction of disease development, guidance of rational use of drugs, medical management, and evidence-based medicine. Conclusion: Big data mining has the potential to play an important role in clinical medicine. PMID:26960378

  13. Full text publication rates of studies presented at an international emergency medicine scientific meeting.

    Science.gov (United States)

    Chan, Jannet W M; Graham, Colin A

    2011-09-01

    The publication rate of full text papers following an abstract presentation at a medical conference is variable, and few studies have examined the situation with respect to international emergency medicine conferences. This retrospective study aimed to identify the publication rate of abstracts presented at the 2006 International Conference on Emergency Medicine (ICEM) held in Halifax, Canada. The full text publication rate was 33.2%, similar to previous emergency medicine meetings. English language barriers may play a role in the low publication rate seen.

  14. The value of C-reactive protein in emergency medicine

    Directory of Open Access Journals (Sweden)

    Yu-Jang Su

    2014-01-01

    Full Text Available C-reactive protein (CRP is a commonly used tool in emergency department (ED, especially in febrile and infectious patients. It was identified in 1930 and was subsequently classified into an “acute phase protein”, an early indicator of infectious or inflammatory situations in the ED, CRP must be a diagnostic reference and no single value can be indicated to rule in or rule out a specific diagnosis or disease. CRP is a comprehensively assisted tool for evaluation and diagnosis of tissue damage (rheumatologic diseases, stroke, cancer, pancreatitis, burn injury, sepsis and gout and infection (urinary tract infection, pelvic inflammatory disease, meningitis and lung infection. It can be used for treatment monitoring and severity evaluation in pneumonia, pancreatitis, pelvic inflammatory disease (PID, and urinary tract infections (UTI. Otherwise, it also plays the role of prognostic indicator of acute coronary syndrome. C-reactive protein adds little to the diagnosis of pneumonia, urinary tract infections, and pancreatitis. A single CRP value should not straightly make the decision to treat these patients. That is, CRP has no role in diagnosing these clinical entities, and a normal CRP level should never delay antibiotic coverage in ED. Faster and more interpretable tools such as image studies (X-ray, sonography and computed tomography are available to help diagnose suspected cases of aortic dissection, appendicitis, cholecystitis, pancreatitis, pneumonia and stroke in ED.

  15. NMR clinical imaging and spectroscopy: Its impact on nuclear medicine

    International Nuclear Information System (INIS)

    1990-01-01

    This is a collection of four papers describing aspects of past and future use of nuclear magnetic resonance as a clinical diagnostic tool. The four papers are entitled (1) What Does NMR Offer that Nuclear Medicine Does Not? by Jerry W. Froelich, (2) Oncological Imaging: Now, Future and Impact Jerry W. Froelich, (3) Magnetic Resonance Spectroscopy/Spectroscopic Imaging and Nuclear Medicine: Past, Present and Future by H. Cecil Charles, and (4) MR Cardiology: Now, Future and Impact by Robert J. Herfkens

  16. Three-year emergency medicine training program in The Netherlands: first evaluation from the residents' perspective.

    Science.gov (United States)

    Koning, Salomon Willem; Gaakeer, Menno Iskander; Veugelers, Rebekka

    2013-07-26

    The Netherlands' 3-year training in Emergency Medicine (EM) was formally approved and introduced in November 2008. To identify areas for improvement, we conducted the first evaluation of this curriculum from the residents' perspective. A questionnaire was composed on ten aspects of the curriculum. It contained multiple-choice, open and opinion questions; answers to the latter were classified using the Likert scale. The questionnaires were mailed to all enrolled residents. We mailed questionnaires to all 189 enrolled residents, and 105 responded (55.6%). Although they were satisfied with their training overall, 96.2% thought it was currently too short: 18.3% desired extension to 4 years, 76.0% to 5 and 1.9% to 6 years. Nevertheless, residents expected that they would function effectively as emergency physicians (EPs) after finishing their 3-year training program. Bedside teaching was assessed positively by 35.2%. All rotations were assessed positively, with the general practice rotation seen as contributing the least to the program. According to 43.7%, supervising EPs were available for consultation; 40.7% thought that, in a clinical capacity, the EP was sufficiently present during residents' shifts. When EPs were present, 82.5% found them to be easily accessible, and 66.6% viewed them as role models. In the Emergency Medicine Departments (EDs) with a higher number of EPs employed, residents tended to perceive better supervision and were more likely to see their EPs as role models. While residents were stimulated to do research, actual support and assistance needed to be improved. Although overall, the current training program was evaluated positively, the residents identified four areas for improvement: (1) in training hospitals, trained EPs should be present more continuously for clinical supervision; (2) bedside teaching should be improved, (3) scientific research should be facilitated more and (4) the training program should be extended.

  17. [Contemplation on the application of big data in clinical medicine].

    Science.gov (United States)

    Lian, Lei

    2015-01-01

    Medicine is another area where big data is being used. The link between clinical treatment and outcome is the key step when applying big data in medicine. In the era of big data, it is critical to collect complete outcome data. Patient follow-up, comprehensive integration of data resources, quality control and standardized data management are the predominant approaches to avoid missing data and data island. Therefore, establishment of systemic patients follow-up protocol and prospective data management strategy are the important aspects of big data in medicine.

  18. Empowering Mayo Clinic Individualized Medicine with Genomic Data Warehousing

    Directory of Open Access Journals (Sweden)

    Iain Horton

    2017-08-01

    Full Text Available Individualized medicine enables better diagnoses and treatment decisions for patients and promotes research in understanding the molecular underpinnings of disease. Linking individual patient’s genomic and molecular information with their clinical phenotypes is crucial to these efforts. To address this need, the Center for Individualized Medicine at Mayo Clinic has implemented a genomic data warehouse and a workflow management system to bring data from institutional electronic health records and genomic sequencing data from both clinical and research bioinformatics sources into the warehouse. The system is the foundation for Mayo Clinic to build a suite of tools and interfaces to support various clinical and research use cases. The genomic data warehouse is positioned to play a key role in enhancing the research capabilities and advancing individualized patient care at Mayo Clinic.

  19. Empowering Mayo Clinic Individualized Medicine with Genomic Data Warehousing.

    Science.gov (United States)

    Horton, Iain; Lin, Yaxiong; Reed, Gay; Wiepert, Mathieu; Hart, Steven

    2017-08-22

    Individualized medicine enables better diagnoses and treatment decisions for patients and promotes research in understanding the molecular underpinnings of disease. Linking individual patient's genomic and molecular information with their clinical phenotypes is crucial to these efforts. To address this need, the Center for Individualized Medicine at Mayo Clinic has implemented a genomic data warehouse and a workflow management system to bring data from institutional electronic health records and genomic sequencing data from both clinical and research bioinformatics sources into the warehouse. The system is the foundation for Mayo Clinic to build a suite of tools and interfaces to support various clinical and research use cases. The genomic data warehouse is positioned to play a key role in enhancing the research capabilities and advancing individualized patient care at Mayo Clinic.

  20. Mechanisms of behavior modification in clinical behavioral medicine in China.

    Science.gov (United States)

    Yang, Zhiyin; Su, Zhonghua; Ji, Feng; Zhu, Min; Bai, Bo

    2014-08-01

    Behavior modification, as the core of clinical behavioral medicine, is often used in clinical settings. We seek to summarize behavior modification techniques that are commonly used in clinical practice of behavioral medicine in China and discuss possible biobehavioral mechanisms. We reviewed common behavior modification techniques in clinical settings in China, and we reviewed studies that explored possible biobehavioral mechanisms. Commonly used clinical approaches of behavior modification in China include behavior therapy, cognitive therapy, cognitive-behavioral therapy, health education, behavior management, behavioral relaxation training, stress management intervention, desensitization therapy, biofeedback therapy, and music therapy. These techniques have been applied in the clinical treatment of a variety of diseases, such as chronic diseases, psychosomatic diseases, and psychological disorders. The biobehavioral mechanisms of these techniques involve the autonomic nervous system, neuroendocrine system, neurobiochemistry, and neuroplasticity. Behavior modification techniques are commonly used in the treatment of a variety of somatic and psychological disorders in China. Multiple biobehavioral mechanisms are involved in successful behavior modification.

  1. Possibility of clinical applications of forest medicine.

    Science.gov (United States)

    Li, Qing; Kawada, Tomoyuki

    2014-01-01

    Since 2004, we have conducted a series of studies of the effect of forest therapy on human health and established forest therapy as a new preventive strategy. We have found that forest therapy has many beneficial effects on human health. However, there is almost no study dealing with the possibility of clinical applications of forest therapy. In this review, we discuss the possibility of clinical applications of forest therapy from the following viewpoints: 1. Forest therapy can decrease blood pressure, heart rate, sympathetic nerve activity, and levels of stress hormones, such as urinary adrenaline and noradrenaline, and can increase parasympathetic nerve activity, suggesting its preventive effect on hypertension. 2. Forest therapy can also decreace the scores for anxiety, depression, anger, fatigue, and confusion and increase the score for vigor in the Profile of Mood States (POMS) test, suggesting its preventive effect on mental depression. 3. Forest therapy can increase the activity and number of human natural killer (NK) cells and the intracellular levels of anticancer proteins, suggesting its preventive effect on cancers. 4. These findings suggest that forest therapy may have preventive effects on lifestyle-related diseases. However, the above preventive effects of forest therapy should be confirmed in clinical research.

  2. EVIDENCE-BASED MEDICINE – II. CLINICAL USE AND CRITICS

    Directory of Open Access Journals (Sweden)

    Angela Čuk

    2004-01-01

    Full Text Available Background. Evidence-based medicine employs systematic searching, evaluation and use of current research findings as the basis for clinical decision-making. However, there are some problems and uncertainties hindering introduction and spreading of the use of the method in clinical practice. Physicians often have no time for literature searching and for use of the method in practice. For certain questions in clinical practice there are no answers in medical literature. Most of the evidences in medical literature are only available in English. Introduction of the method is hampered also by the fact that clinical decision-making is complex and does not allow procedures prescribed in advance. Rigidity and universality of decisions resulting from the evidence may appear impersonal and may affect the relationship between the physician and the patient. Trends towards evidence based medicine are followed also by big multinational pharmaceutical corporations. They carry out large and expensive clinical trials using the results for promotional purposes. In this way, they get the competitive advantage and influence the objectivity of physicians’ clinical decision-making.Conclusions. With introduction of evidence based medicine into clinical practice physicians acquire new information and use a new form of continuing education by following new developments in their field. This way, new findings from medical literature get into clinical practice faster and more efficiently. In addition, physicians get more professional satisfaction and quality in clinical practice is higher.

  3. Clinical Holistic Medicine: Holistic Treatment of Children

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2004-01-01

    Full Text Available We believe a holistic approach to problems in childhood and adolescence will benefit the child, adolescent, and the whole family. As a rule, children have far less to say in the family than their parents. Therefore, it is the parents who set the agenda and decide how things are done at home and in relation to the child. Most often, it is also the parents who have a problem when the child is not thriving. The child thus acts as the thermometer of the family. When children are not feeling well or are sick, the parents are not doing well either. Most problems arising from dysfunctional patterns are almost impossible for the parents to solve on their own, but with help and support from the holistically oriented physician, we believe that many problems can be discovered and solved. Not only can health problems be addressed, but also problems of poor thriving in the family in general. With the physician in the role of a coach, the family can be provided with relevant exercises that will change the patterns of dysfunction. Consciousness-based medicine also seems to be efficient with children and adolescents, who are much more sensitive to the psychosocial dimensions than adults. Five needs seem to be essential for the thriving and health of the child: attention, respect, love, acceptance (touch, and acknowledgment. The physician should be able to see if the child lacks fulfillment in one or more of these needs, and he can then demonstrate to the parents how these needs should be handled. This should be followed by simple instructions and exercises for the parents in the spirit of coaching. This approach is especially relevant when the child is chronically ill.

  4. Clinical decision making-a functional medicine perspective.

    Science.gov (United States)

    Pizzorno, Joseph E

    2012-09-01

    As 21st century health care moves from a disease-based approach to a more patient-centric system that can address biochemical individuality to improve health and function, clinical decision making becomes more complex. Accentuating the problem is the lack of a clear standard for this more complex functional medicine approach. While there is relatively broad agreement in Western medicine for what constitutes competent assessment of disease and identification of related treatment approaches, the complex functional medicine model posits multiple and individualized diagnostic and therapeutic approaches, most or many of which have reasonable underlying science and principles, but which have not been rigorously tested in a research or clinical setting. This has led to non-rigorous thinking and sometimes to uncritical acceptance of both poorly documented diagnostic procedures and ineffective therapies, resulting in less than optimal clinical care.

  5. [Possible relation between clinical guidelines and legal standard of medicine].

    Science.gov (United States)

    Furukawa, Toshiharu; Kitagawa, Yuko

    2010-10-01

    Legal standard of medicine is not equal across the all kinds of medical institutions. Each medical institution is required its respective standard of medicine in which its doctors are expected to have studied medical informations, which have been spread among medical institutions with similar characteristics. Therefore, in principle, clinical guidelines for the treatment of a disease formed by public committees do not directly become the medical standards of respective disease treatment. However, doctors would be legally required to practice medicine with reference to the clinical guidelines because medical informations, mediated by internet or many kinds of media, have been spread very fast to all medical institutions these days. Moreover, doctors would be required to inform their patients of non-standardized new treatments, even if such treatments are not listed in clinical guidelines in case patients have special concern about new treat-

  6. Systematic Analysis of Theses in the Field of Emergency Medicine in Turkey

    Directory of Open Access Journals (Sweden)

    Erdem CEVIK

    2015-03-01

    Full Text Available SUMMARY: Objectives: The aim of this study is to systematically evaluate the theses in the field of emergency medicine in Turkey and to determine whether they were published as a scientific paper. Methods: This is a retrospective observational study. Theses in the field of emergency medicine between 1998 and 2013 were browsed from the internet database of National Thesis Center (Council of Higher Education. Study type, both if it was in the field of emergency, or if it was published and the journal's scope of published studies were assessed and recorded in the study chart. Results: 579 theses were included in the study. 27.1% of them were published and 14.9% of them were published in SCI/SCI-E journals. Advisors of theses were emergency medicine specialists in 67.6% of theses and 493 (85.1% of them were in the field of emergency medicine. 77.4% of theses were observational and 20.9% were experimental study. Most of the experimental studies (72.7%, n=88 were animal studies. Conclusions: It was concluded that very few theses in the field of emergency medicine were published in journals that were indexed in SCI/SCI-E. Key words: Emergency medicine, systematic analysis, theses

  7. Pediatric emergency medicine asynchronous e-learning: a multicenter randomized controlled Solomon four-group study.

    Science.gov (United States)

    Chang, Todd P; Pham, Phung K; Sobolewski, Brad; Doughty, Cara B; Jamal, Nazreen; Kwan, Karen Y; Little, Kim; Brenkert, Timothy E; Mathison, David J

    2014-08-01

    Asynchronous e-learning allows for targeted teaching, particularly advantageous when bedside and didactic education is insufficient. An asynchronous e-learning curriculum has not been studied across multiple centers in the context of a clinical rotation. We hypothesize that an asynchronous e-learning curriculum during the pediatric emergency medicine (EM) rotation improves medical knowledge among residents and students across multiple participating centers. Trainees on pediatric EM rotations at four large pediatric centers from 2012 to 2013 were randomized in a Solomon four-group design. The experimental arms received an asynchronous e-learning curriculum consisting of nine Web-based, interactive, peer-reviewed Flash/HTML5 modules. Postrotation testing and in-training examination (ITE) scores quantified improvements in knowledge. A 2 × 2 analysis of covariance (ANCOVA) tested interaction and main effects, and Pearson's correlation tested associations between module usage, scores, and ITE scores. A total of 256 of 458 participants completed all study elements; 104 had access to asynchronous e-learning modules, and 152 were controls who used the current education standards. No pretest sensitization was found (p = 0.75). Use of asynchronous e-learning modules was associated with an improvement in posttest scores (p effect (partial η(2) = 0.19). Posttest scores correlated with ITE scores (r(2) = 0.14, p e-learning is an effective educational tool to improve knowledge in a clinical rotation. Web-based asynchronous e-learning is a promising modality to standardize education among multiple institutions with common curricula, particularly in clinical rotations where scheduling difficulties, seasonality, and variable experiences limit in-hospital learning. © 2014 by the Society for Academic Emergency Medicine.

  8. Data processing systems for clinical nuclear medicine

    International Nuclear Information System (INIS)

    Winkler, C.; Knopp, R.

    1975-01-01

    The model studies on the above mentioned data processing demonstration systems have shown that the development of a modular process computer with an applicable operation system makes it possible to meet the special demands of any nuclear-medical clinical centre corresponding to its capacity and finances. The respective first draft of the compact system described was discussed by a major circle of competent specialists at the DP-meeting of the Rheinisch-Westfaelische Gesellschaft fuer Nuklearmedizin in 1974. The positive response which the draft was met with confirmes our opinion that in the future equipment of the nuclear-medical institutions with DP-systems the universal applicability of these systems in operation with several participants and the implementation of clinically tested user's software should have priority over all other things. The development of the compact system, which is being carried out with the help of the Federal Ministry for Research and Technology will be instrumental in creating the preconditions necessary. It will be fully available in 1977 and is even expected to be completed in its partial functions (such as camera scanning, renal clearance, evaluation of laboratory data) in 1976 already. (orig.) [de

  9. THE SPECIALTY OF EMERGENCY MEDICINE IN CHILE: 20 YEARS OF HISTORY

    Directory of Open Access Journals (Sweden)

    WK Mallon

    2017-03-01

    Full Text Available Chile is uniquely situated to be a leader in South American development of the specialty of Emergency Medicine. Chilean emergency medicine has successfully transitioned from a novelty training idea to a nationally and internationally recognized entity with serious public health goals. There are more residency training programs in Chile than in any other South American or Latin American country, and the specialty is formally recognized by the Ministry of Health. Chilean emergency medicine thought leaders have networked internationally with multiple groups, intelligently used outside resources, and created durable academic relationships. While focusing on locally important issues and patient care they have successfully advanced their agenda. Despite this, the specialty faces many new challenges and remains fragile but sustainable. Policy makers and the Chilean MOH need to be acutely aware of this fragility to preserve the progress achieved so far, and support ongoing maturation of the specialty of Emergency Medicine.

  10. Timing of Emergency Medicine Student Evaluation Does Not Affect Scoring.

    Science.gov (United States)

    Hiller, Katherine M; Waterbrook, Anna; Waters, Kristina

    2016-02-01

    Evaluation of medical students rotating through the emergency department (ED) is an important formative and summative assessment method. Intuitively, delaying evaluation should affect the reliability of this assessment method, however, the effect of evaluation timing on scoring is unknown. A quality-improvement project evaluating the timing of end-of-shift ED evaluations at the University of Arizona was performed to determine whether delay in evaluation affected the score. End-of-shift ED evaluations completed on behalf of fourth-year medical students from July 2012 to March 2013 were reviewed. Forty-seven students were evaluated 547 times by 46 residents and attendings. Evaluation scores were means of anchored Likert scales (1-5) for the domains of energy/interest, fund of knowledge, judgment/problem-solving ability, clinical skills, personal effectiveness, and systems-based practice. Date of shift, date of evaluation, and score were collected. Linear regression was performed to determine whether timing of the evaluation had an effect on evaluation score. Data were complete for 477 of 547 evaluations (87.2%). Mean evaluation score was 4.1 (range 2.3-5, standard deviation 0.62). Evaluations took a mean of 8.5 days (median 4 days, range 0-59 days, standard deviation 9.77 days) to complete. Delay in evaluation had no significant effect on score (p = 0.983). The evaluation score was not affected by timing of the evaluation. Variance in scores was similar for both immediate and delayed evaluations. Considerable amounts of time and energy are expended tracking down delayed evaluations. This activity does not impact a student's final grade. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Burnout among nursing staff in accident and emergency and acute medicine: a comparative study.

    Science.gov (United States)

    Gillespie, Mark; Melby, Vidar

    2003-11-01

    This study was designed to identify the prevalence of burnout among nurses working in Accident and Emergency (A & E) and acute medicine, to establish factors that contribute to stress and burnout, to determine the experiences of nurses affected by it and highlight its effects on patient care and to determine if stress and burnout have any effects on individuals outside the clinical setting. A triangulated research design was used incorporating quantitative and qualitative methods. Maslach Burnout Inventory was used. Nurses working in acute medicine experienced higher levels of emotional exhaustion than their A & E counterparts. The overall level of depersonalization was low. High levels of personal accomplishment were experienced less by junior members of staff. Stress and burnout have far reaching effects both for nurses in their clinical practice and personal lives. If nurses continue to work in their current environment without issues being tackled, then burnout will result. The science of nursing does not have to be painful, but by recognition of the existence of stress and burnout we can take the first steps towards their prevention.

  12. Emergence of a rehabilitation medicine model for low vision service delivery, policy, and funding.

    Science.gov (United States)

    Stelmack, Joan

    2005-05-01

    A rehabilitation medicine model for low vision rehabilitation is emerging. There have been many challenges to reaching consensus on the roles of each discipline (optometry, ophthalmology, occupational therapy, and vision rehabilitation professionals) in the service delivery model and finding a place in the reimbursement system for all the providers. The history of low vision, legislation associated with Centers for Medicare and Medicaid Services coverage for vision rehabilitation, and research on the effectiveness of low vision service delivery are reviewed. Vision rehabilitation is now covered by Medicare under Physical Medicine and Rehabilitation codes by some Medicare carriers, yet reimbursement is not available for low vision devices or refraction. Also, the role of vision rehabilitation professionals (rehabilitation teachers, orientation and mobility specialists, and low vision therapists) in the model needs to be determined. In a recent systematic review of the scientific literature on the effectiveness of low vision services contracted by the Agency for Health Care Quality Research, no clinical trials were found. The literature consists primarily of longitudinal case studies, which provide weak support for third-party funding for vision rehabilitative services. Providers need to reach consensus on medical necessity, treatment plans, and protocols. Research on low vision outcomes is needed to develop an evidence base to guide clinical practice, policy, and funding decisions.

  13. Supervision and feedback for junior medical staff in Australian emergency departments: findings from the emergency medicine capacity assessment study

    Directory of Open Access Journals (Sweden)

    Weiland Tracey J

    2010-11-01

    Full Text Available Abstract Background Clinical supervision and feedback are important for the development of competency in junior doctors. This study aimed to determine the adequacy of supervision of junior medical staff in Australian emergency departments (EDs and perceived feedback provided. Methods Semi-structured telephone surveys sought quantitative and qualitative data from ED Directors, Directors of Emergency Medicine Training, registrars and interns in 37 representative Australian hospitals; quantitative data were analysed with SPSS 15.0 and qualitative data subjected to content analysis identifying themes. Results Thirty six of 37 hospitals took part. Of 233 potential interviewees, 95 (40.1% granted interviews including 100% (36/36 of ED Directors, and 96.2% (25/26 of eligible DEMTs, 24% (19/81 of advanced trainee/registrars, and 17% (15/90 of interns. Most participants (61% felt the ED was adequately supervised in general and (64.2% that medical staff were adequately supervised. Consultants and registrars were felt to provide most intern supervision, but this varied depending on shift times, with registrars more likely to provide supervision on night shift and at weekends. Senior ED medical staff (64% and junior staff (79% agreed that interns received adequate clinical supervision. Qualitative analysis revealed that good processes were in place to ensure adequate supervision, but that service demands, particularly related to access block and overcrowding, had detrimental effects on both supervision and feedback. Conclusions Consultants appear to provide the majority of supervision of junior medical staff in Australian EDs. Supervision and feedback are generally felt to be adequate, but are threatened by service demands, particularly related to access block and ED overcrowding.

  14. [Biomarkers in emergency medicine and critical care patients: advances and pitfalls for news tools].

    Science.gov (United States)

    Claessens, Yann-Erick; Mallet-Coste, Thomas; Riqué, Thomas; Macchi, Marc-Alexis; Ray, Patrick; Chenevier-Gobeaux, Camille

    2014-01-01

    The use of biomarkers has changed approach of diagnosis and treatment procedures in emergency medicine, especially in the field of cardiovascular disorders. Effectiveness of new strategies that integrate biomarkers has precluded development and research in novel tools that may improve safety and efficiency at bedside. This mini-review presents current knowledge on utility of biomarkers in emergency medicine, including data that should be taken into account to avoid misleading utilization. Copyright © 2013. Published by Elsevier Masson SAS.

  15. Psychiatry and emergency medicine: medical student and physician attitudes toward homeless persons.

    Science.gov (United States)

    Morrison, Ann; Roman, Brenda; Borges, Nicole

    2012-05-01

    The purpose of the study was to explore changes in medical students' attitudes toward homeless persons during the Psychiatry and Emergency Medicine clerkships. Simultaneously, this study explored attitudes toward homeless persons held by Psychiatry and Emergency Medicine residents and faculty in an attempt to uncover the "hidden curriculum" in medical education, in which values are communicated from teacher to student outside of the formal instruction. A group of 79 students on Psychiatry and 66 on Emergency Medicine clerkships were surveyed at the beginning and end of their rotation regarding their attitudes toward homeless persons by use of the Health Professionals' Attitudes Toward the Homeless Inventory (HPATHI). The HPATHI was also administered to 31 Psychiatry residents and faculty and 41 Emergency Medicine residents and faculty one time during the course of this study. For Psychiatry clerks, t-tests showed significant differences pre- and post-clerkship experiences on 2 of the 23 items on the HPATHI. No statistically significant differences were noted for the Emergency Medicine students. An analysis of variance revealed statistically significant differences on 7 out of the 23 survey questions for residents and faculty in Psychiatry, as compared with those in Emergency Medicine. Results suggest that medical students showed small differences in their attitudes toward homeless people following clerkships in Psychiatry but not in Emergency Medicine. Regarding resident and faculty results, significant differences between specialties were noted, with Psychiatry residents and faculty exhibiting more favorable attitudes toward homeless persons than residents and faculty in Emergency Medicine. Given that medical student competencies should be addressing the broader social issues of homelessness, medical schools need to first understand the attitudes of medical students to such issues, and then develop curricula to overcome inaccurate or stigmatizing beliefs.

  16. An Emerging Role for Polystores in Precision Medicine

    Energy Technology Data Exchange (ETDEWEB)

    Begoli, Edmon [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Christian, J. Blair [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Gadepally, Vijay [Massachusetts Inst. of Technology (MIT), Cambridge, MA (United States); Papadopoulos, Stavros [TileDB, Inc., Cambridge, MA (United States)

    2017-08-26

    Medical data is organically heterogeneous, and it usually varies significantly in both size and composition. Yet, this data is also a key for the recent and promising field of precision medicine, which focuses on identifying and tailoring appropriate medical treatments for the needs of the individual patients, based on their specific conditions, their medical history, lifestyle, genetic, and other individual factors. As we, and a database community at large, recognize that a “one size does not fit all” solution is required to work with such data, we present in this paper our observations based on our experiences, and the applications in the field of precision medicine. Finally, we make the case for the use of polystore architecture; how it applies for precision medicine; we discuss the reference architecture; describe some of its critical components (array database); and discuss the specific types of analysis that directly benefit from this database architecture, and the ways it serves the data.

  17. Hormonal emergency contraception: a clinical primer.

    Science.gov (United States)

    Ziebarth, Angela; Hansen, Keith A

    2007-03-01

    Unintended and teenage pregnancies are major public health concerns in the United States. Emergency contraception is used to prevent pregnancy after failure of a contraceptive method or after unprotected intercourse. Expanded use of emergency contraception has the potential to reduce unintended pregnancy and induced abortions, while reducing state and federal healthcare expenditures. The recent approval of Plan B as an over-the-counter medication for individuals over 18 years of age should improve access to this medication. However, there are still widespread misconceptions about the mechanisms and implications of emergency contraception. Expanded access to emergency contraception is associated with increased use, but not associated with decreased efficacy, increased sexual risk-taking behavior, or less consistent use of traditional birth control methods. This review is designed to provide clinicians with information regarding the use of emergency contraception for reproductive age patients. It includes a brief description of methods of use, mechanisms of action, and side effect profiles of the most commonly used methods of emergency contraception, levonorgestrel and the Yuzpe method.

  18. Clinical need for nuclear medicine in paediatrics

    International Nuclear Information System (INIS)

    Gordon, I.

    2004-01-01

    Full text: Bone scans. Indications for bone scans Include Infection, avascular necrosis, trauma, back ache and malignancy (primary / secondary). High quality scans are essential, this requires minimal movement of the child, a high resolution collimator and the chid lying as close as possible to the camera if not on top of the collimator. Adequate images of the hips require pin hole images. Gut. Indications include bleeding usually rectal and painless, gastro-oesophageal reflux, gastric emptying, inflammatory bowel disease either suspected or known as well as jaundice in the infant. For painless bleeding Tc 99m 04 is used usually preceded by an H 2 antagonist the day before the scan and the morning of the scan. Dynamic images are acquired for 30 - 45 minutes in the anterior position. In suspected inflammatory bowel disease, Tc 99m HMPAO labelled to WBC are required. Images must be acquired between 60 - 90 minutes as normal bowel activity is seen at 3 hours. In the jaundiced infant premedication with phenobarbitone for 3 -5 days before the scan will reduce the cases with neonatal hepatitis that fail to show tracer in the bowel. The presence of tracer in the bowel will exclude the diagnosis of biliary artesia but the absence of activity simply demands further investigation I surgery. Lungs. Indications include investigation of the abnormal chest radiograph, children with chronic lung disease (e.g. cystic fibrosis) and following surgical intervention especially pulmonary artery surgery. When feasible both perfusion and ventilation images in the posterior, both posterior oblique projections and anterior views should be obtained. In the young, perfusion views alone may have to suffice. The interpretation of a V/Q scan should always be done in conjunction with a chest radiograph. Brain. The major clinical indication for regional cerebral blood flow (rCBF) is in epilepsy. Tc 99m labelled to either HMPAO is ECD are used. The aim of the study is to identify a focus that is

  19. The Role of Medicinal Cannabis in Clinical Therapy: Pharmacists' Perspectives.

    Science.gov (United States)

    Isaac, Sami; Saini, Bandana; Chaar, Betty B

    2016-01-01

    Medicinal cannabis has recently attracted much media attention in Australia and across the world. With the exception of a few countries, cannabinoids remain illegal-known for their adverse effects rather than their medicinal application and therapeutic benefit. However, there is mounting evidence demonstrating the therapeutic benefits of cannabis in alleviating neuropathic pain, improving multiple sclerosis spasticity, reducing chemotherapy induced nausea and vomiting, and many other chronic conditions. Many are calling for the legalisation of medicinal cannabis including consumers, physicians and politicians. Pharmacists are the gatekeepers of medicines and future administrators/dispensers of cannabis to the public, however very little has been heard about pharmacists' perspectives. Therefore the aim of this study was to explore pharmacists' views about medicinal cannabis; its legalisation and supply in pharmacy. Semi-structured interviews with 34 registered pharmacists in Australia were conducted. All interviews were audio-recorded, transcribed ad verbatim and thematically analysed using the NVivo software. Emergent themes included stigma, legislation, safety and collaboration. Overall the majority of pharmacists felt national legalisation of a standardised form of cannabis would be suitable, and indicated various factors and strategies to manage its supply. The majority of participants felt that the most suitable setting would be via a community pharmacy setting due to the importance of accessibility for patients. This study explored views of practicing pharmacists, revealing a number of previously undocumented views and barriers about medicinal cannabis from a supply perspective. There were several ethical and professional issues raised for consideration. These findings highlight the important role that pharmacists hold in the supply of medicinal cannabis. Additionally, this study identified important factors, which will help shape future policies for the

  20. The Role of Medicinal Cannabis in Clinical Therapy: Pharmacists' Perspectives.

    Directory of Open Access Journals (Sweden)

    Sami Isaac

    Full Text Available Medicinal cannabis has recently attracted much media attention in Australia and across the world. With the exception of a few countries, cannabinoids remain illegal-known for their adverse effects rather than their medicinal application and therapeutic benefit. However, there is mounting evidence demonstrating the therapeutic benefits of cannabis in alleviating neuropathic pain, improving multiple sclerosis spasticity, reducing chemotherapy induced nausea and vomiting, and many other chronic conditions. Many are calling for the legalisation of medicinal cannabis including consumers, physicians and politicians. Pharmacists are the gatekeepers of medicines and future administrators/dispensers of cannabis to the public, however very little has been heard about pharmacists' perspectives. Therefore the aim of this study was to explore pharmacists' views about medicinal cannabis; its legalisation and supply in pharmacy.Semi-structured interviews with 34 registered pharmacists in Australia were conducted. All interviews were audio-recorded, transcribed ad verbatim and thematically analysed using the NVivo software.Emergent themes included stigma, legislation, safety and collaboration. Overall the majority of pharmacists felt national legalisation of a standardised form of cannabis would be suitable, and indicated various factors and strategies to manage its supply. The majority of participants felt that the most suitable setting would be via a community pharmacy setting due to the importance of accessibility for patients.This study explored views of practicing pharmacists, revealing a number of previously undocumented views and barriers about medicinal cannabis from a supply perspective. There were several ethical and professional issues raised for consideration. These findings highlight the important role that pharmacists hold in the supply of medicinal cannabis. Additionally, this study identified important factors, which will help shape future

  1. Clinical implications of the recent homeopathic medicine and its application to oriental medicine

    Directory of Open Access Journals (Sweden)

    Ok-Byung,Choi

    2007-02-01

    Full Text Available Objectives : The purpose of this study is to analyze the practical implications of homeopathic medicines, their status, their preparation systems and registration rules, recognized by the European Union and other countries. Contents : This paper covers the background of homeopathic medical principle, homeopathy throughout the world, the medicine status and clinical research, increases of the drug potency, the practical regulation of treatment, preparation techniques of homeopathic drugs and registration rules and the clinical practice. Homeopathy has been currently practised in over eighty countries throughout the world, especially in Europe. It had attracted considerable attentions in South and North America (notably in USA, Brazil, and Argentina, India and Pakistan. Although it is not dominantly popular in North America, constant growth has been nevertheless noted. Over the last thirty years, homeopathy has also developed or appeared in South Africa, Tunisia, Morocco, Venezuela, Israel, and Australia, etc. Result & suggestion : As over 300 million patients have put their trust in homeopathy, the study of the integration of homeopathy to oriental medicine, its development and feasibility in Korea are urgently needed. The products, substances, compositions of Homeopathic drugs are very similar to those of oriental medicine theory. Therefore their preparations and applications should prescribed and practised exclusively by oriental doctors. Applying the homeopathic theory and its preparation techniques to oriental medicine, the herbal acupuncture preparation should be modernized and various oriental products are to be developed. To this end, government and herbal acupuncture society need to interact each other for the development of oriental medicine.

  2. Electronic strategies for information and research: cyberNephrology/cyberMedicine in the emerging world.

    Science.gov (United States)

    Solez, Kim; Hales, Michele; Katz, Sheila Moriber

    2005-09-01

    Communication and medicine have evolved together. Internet resources now provide an unprecedented opportunity to provide health assistance to the developing world. The International Society of Nephrology Informatics Commission and National Kidney Foundation cyberNephrology initiative (http://www.cybernephrology.org) have created e-mail discussion groups (e.g., NEPHROL, NEPHKIDS, and so forth) and online texts and web resources (e.g., the Schrier Atlas: http://www.kidneyatlas.org) that are, in many respects, ahead of other areas of medicine. On the other hand, nephrology is quite behind in its embrace of some specific communications initiatives that could benefit emerging nations: the Health InterNetwork Access to Research Initiative program, which provides free full-text access to medical journals and books in poorer countries; the Global Health Network Supercourse, which provides specially designed online lectures for the developing world; and Internet2/Abilene and similar research networks around the world, which provide reliable, guaranteed bandwidth for high-quality Internet videoconferencing as an alternative to face-to-face lectures and meetings. The intent of many educational ventures in nephrology, particularly in the clinical practice guideline realm (National Kidney Foundation Kidney Disease Outcomes Quality Initiative, Kidney Disease Improving Global Outcomes, and so forth), is not just to disseminate information but to change human behavior: physician practice and referral patterns, patient compliance, and so forth. Concepts from the worlds of marketing and entertainment, where the science of changing human behavior is highly evolved, can be used to create high-impact, educational offerings to promote health. They can also be highly beneficial to share Internet educational innovations and future vision across boundaries of medical specialties, which is part of the intent of the cyberMedicine joint venture (http://www.cyber-medicine.org).

  3. Clinical Mimics: An Emergency Medicine Focused Review of Anxiety Mimics: Journal of Emergency Medicine

    Science.gov (United States)

    2017-12-09

    was carried out, and that, if accepted, it will not be published elsewhere in the same form, in English or in any other language, including...thyroid May or may not have hormone via potassium iodide (5 prior diagnosis of drops PO every 6-8 hours) or hyperthyroidism Lugol’s solution (5-10 PO

  4. Law Enforcement and Emergency Medicine: An Ethical Analysis.

    Science.gov (United States)

    Baker, Eileen F; Moskop, John C; Geiderman, Joel M; Iserson, Kenneth V; Marco, Catherine A; Derse, Arthur R

    2016-11-01

    Emergency physicians frequently interact with law enforcement officers and patients in their custody. As always, the emergency physician's primary professional responsibility is to promote patient welfare, and his or her first duty is to the patient. Emergency physicians should treat criminals, suspects, and prisoners with the same respect and attention they afford other patients while ensuring the safety of staff, visitors, and other patients. Respect for patient privacy and protection of confidentiality are of paramount importance to the patient-physician relationship. Simultaneously, emergency physicians should attempt to accommodate law enforcement personnel in a professional manner, enlisting their aid when necessary. Often this relates to the emergency physician's socially imposed duties, governed by state laws, to report infectious diseases, suspicion of abuse or neglect, and threats of harm. It is the emergency physician's duty to maintain patient confidentiality while complying with Health Insurance Portability and Accountability Act regulations and state law. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  5. Reliability of a structured interview for admission to an emergency medicine residency program.

    Science.gov (United States)

    Blouin, Danielle

    2010-10-01

    Interviews are most important in resident selection. Structured interviews are more reliable than unstructured ones. We sought to measure the interrater reliability of a newly designed structured interview during the selection process to an Emergency Medicine residency program. The critical incident technique was used to extract the desired dimensions of performance. The interview tool consisted of 7 clinical scenarios and 1 global rating. Three trained interviewers marked each candidate on all scenarios without discussing candidates' responses. Interitem consistency and estimates of variance were computed. Twenty-eight candidates were interviewed. The generalizability coefficient was 0.67. Removing the central tendency ratings increased the coefficient to 0.74. Coefficients of interitem consistency ranged from 0.64 to 0.74. The structured interview tool provided good although suboptimal interrater reliability. Increasing the number of scenarios improves reliability as does applying differential weights to the rating scale anchors. The latter would also facilitate the identification of those candidates with extreme ratings.

  6. Narrowing the gap of personalized medicine in emerging countries: the case of multiple endocrine neoplasias in Brazil.

    Science.gov (United States)

    Toledo, Rodrigo A; Sekiya, Tomoko; Longuini, Viviane C; Coutinho, Flavia L; Lourenço, Delmar M; Toledo, Sergio P A

    2012-01-01

    The finished version of the human genome sequence was completed in 2003, and this event initiated a revolution in medical practice, which is usually referred to as the age of genomic or personalized medicine. Genomic medicine aims to be predictive, personalized, preventive, and also participative (4Ps). It offers a new approach to several pathological conditions, although its impact so far has been more evident in mendelian diseases. This article briefly reviews the potential advantages of this approach, and also some issues that may arise in the attempt to apply the accumulated knowledge from genomic medicine to clinical practice in emerging countries. The advantages of applying genomic medicine into clinical practice are obvious, enabling prediction, prevention, and early diagnosis and treatment of several genetic disorders. However, there are also some issues, such as those related to: (a) the need for approval of a law equivalent to the Genetic Information Nondiscrimination Act, which was approved in 2008 in the USA; (b) the need for private and public funding for genetics and genomics; (c) the need for development of innovative healthcare systems that may substantially cut costs (e.g. costs of periodic medical followup); (d) the need for new graduate and postgraduate curricula in which genomic medicine is emphasized; and (e) the need to adequately inform the population and possible consumers of genetic testing, with reference to the basic aspects of genomic medicine.

  7. Narrowing the gap of personalized medicine in emerging countries: the case of multiple endocrine neoplasias in Brazil

    Directory of Open Access Journals (Sweden)

    Rodrigo A. Toledo

    2012-01-01

    Full Text Available The finished version of the human genome sequence was completed in 2003, and this event initiated a revolution in medical practice, which is usually referred to as the age of genomic or personalized medicine. Genomic medicine aims to be predictive, personalized, preventive, and also participative (4Ps. It offers a new approach to several pathological conditions, although its impact so far has been more evident in mendelian diseases. This article briefly reviews the potential advantages of this approach, and also some issues that may arise in the attempt to apply the accumulated knowledge from genomic medicine to clinical practice in emerging countries. The advantages of applying genomic medicine into clinical practice are obvious, enabling prediction, prevention, and early diagnosis and treatment of several genetic disorders. However, there are also some issues, such as those related to: (a the need for approval of a law equivalent to the Genetic Information Nondiscrimination Act, which was approved in 2008 in the USA; (b the need for private and public funding for genetics and genomics; (c the need for development of innovative healthcare systems that may substantially cut costs (e.g. costs of periodic medical followup; (d the need for new graduate and postgraduate curricula in which genomic medicine is emphasized; and (e the need to adequately inform the population and possible consumers of genetic testing, with reference to the basic aspects of genomic medicine.

  8. Complementary and alternative medicine use in a pediatric neurology clinic.

    Science.gov (United States)

    Aburahma, Samah K; Khader, Yousef S; Alzoubi, Karem; Sawalha, Noor

    2010-08-01

    To evaluate the frequency and determinants of complementary and alternative medicine (CAM) use in children attending a pediatric neurology clinic in North Jordan, a parent completed questionnaire survey of children attending the pediatric neurology clinic at King Abdullah University Hospital from March to July 2008 was conducted. A review of 176 completed questionnaires showed that 99 parents (56%) had used CAM for their child's specific neurological illness. The most common modalities were prayer/reciting the Quran (77%), religious healers (30%), massage with olive oil (32%), and consumption of honey products (29%). The most common reason was religious beliefs in 68%. None reported lack of trust in conventional medicine as the reason behind seeking CAM. Factors significantly associated with CAM use were speech delay, belief in its usefulness, father's age more than 30 years, and mothers with education less than high school. CAM had a supplementary role in relation to traditional western medicine use. Copyright 2010 Elsevier Ltd. All rights reserved.

  9. The Practice of Medicine at a District Hospital Emergency Room ...

    African Journals Online (AJOL)

    To remain in touch with the changing environment of medicine, one has to keep on learning and sometimes attend refresher courses far away from the place of work. The rewarding part of the practice is that many junior doctors benefit from the experience of the senior colleagues, who teach them basic skills. A practitioner ...

  10. State of emergency medicine in Rwanda 2015: an innovative trainee and trainer model.

    Science.gov (United States)

    Mbanjumucyo, Gabin; DeVos, Elizabeth; Pulfrey, Simon; Epino, Henry M

    2015-01-01

    The 1994 Rwandan war and genocide left more than 1 million people dead; millions displaced; and the country's economic, social, and health infrastructure destroyed. Despite remaining one of the poorest countries in the world, Rwanda has made remarkable gains in health, social, and economic development over the last 20 years, but modern emergency care has been slow to progress. Rwanda has recently established the Human Resources for Health program to rapidly build capacity in multiple sectors of its healthcare delivery system, including emergency medicine. This project involves multiple medical and surgical residencies, nursing programs, allied health professional trainings, and hospital administrative support. A real strength of the program is that trainers work with international faculty at Rwanda's referral hospital, but also as emergency medicine specialty trainers when returning to their respective district hospitals. Rwanda's first emergency medicine trainees are playing a unique and important role in the implementation of emergency care systems and education in the country's district hospitals. While there has been early vital progress in building emergency medicine's foundations in Rwanda, there remains much work to be done. This will be accomplished with careful planning and strong commitment from the country's healthcare and emergency medicine leaders.

  11. Why Do Emergency Medicine Residents Experience Burn Out? A qualitative study

    Directory of Open Access Journals (Sweden)

    Atefe Kamaloo

    2017-06-01

    Full Text Available Objective: Emergency medicine residents are a high–risk group for burnout syndrome. This was a qualitative study with content analysis on emergency medical residents with 2 aims: evaluating the incidence of occupational burnout syndrome and identifying the points of view and attitudes of emergency medical residents about factors related to occupational burnout syndrome.Method: For this study, 2 sessions of focus group discussions were set up at Imam Khomeini hospital affiliated to Tehran University of Medical Sciences. Each session took 90 minutes, and 20 emergency medicine residents in their first or second year of emergency medicine residency participated in the sessions. Data were coded   by MAXQDA10 software.Results: Data were categorized in 4 themes as follow: (1 the characteristics of emergency medicine; (2 ambiguity in residents’ duties; (3 educational planning; and (4 careers.Data on the proposed solutions by residents were analyzed and coded in 3 groups including (1 changes in personal life; (2 arrangement in shifts; and  (3 educational issues.Conclusion: According to findings of this qualitative study, most of emergency medicine residents have experienced exhaustion sometime during the course of their residency. Psychological supports may help the residents to cope with their career difficulties and probable burn out.

  12. Project Title: Partnering to establish emergency medicine in Ethiopia ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2014-03-31

    Mar 31, 2014 ... current graduate working in. Ethiopia). Procedures ..... majority (62.6%) of deaths occurred within 48 hours of admission to the emergency department. ..... encourage graduates to pursue careers within Ethiopia. Conclusion: A ...

  13. Implementation and assessment of a training course for residents in neonatology and pediatric emergency medicine.

    Science.gov (United States)

    Brossier, D; Bellot, A; Villedieu, F; Fazilleau, L; Brouard, J; Guillois, B

    2017-05-01

    Residents must balance patient care and the ongoing acquisition of medical knowledge. With increasing clinical responsibilities and patient overload, medical training is often left aside. In 2010, we designed and implemented a training course in neonatology and pediatric emergency medicine for residents in pediatrics, in order to improve their medical education. The course was made of didactic sessions and several simulation-based seminars for each year of residency. We conducted this study to assess the impact of our program on residents' satisfaction and self-assessed clinical skills. A survey was conducted at the end of each seminar. The students were asked to complete a form on a five-point rating scale to evaluate the courses and their impact on their satisfaction and self-assessed clinical skills, following the French National Health Institute's adapted Kirkpatrick model. Sixty-four (84%) of the 76 residents who attended the courses completed the form. The mean satisfaction score for the entire course was 4.78±0.42. Over 80% of the students felt that their clinical skills had improved. Medical education is an important part of residency training. Our training course responded to the perceived needs of the students with consistently satisfactory evaluations. Before the evaluation of the impact of the course on patient care, further studies are needed to assess the acquisition of knowledge and skills through objective evaluations. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  14. Insurance Exchange Marketplace: Implications for Emergency Medicine Practice

    Directory of Open Access Journals (Sweden)

    David S. Rankey, MD, MPH

    2012-05-01

    Full Text Available The Patient Protection and Affordable Care Act of 2010 requires states to establish healthcareinsurance exchanges by 2014 to facilitate the purchase of qualified health plans. States are required toestablish exchanges for small businesses and individuals. A federally operated exchange will beestablished, and states failing to participate in any other exchanges will be mandated to join the federalexchange. Policymakers and health economists believe that exchanges will improve healthcare atlower cost by promoting competition among insurers and by reducing burdensome transaction costs.Consumers will no longer be isolated from monthly insurance premium costs. Exchanges will increasethe number of patients insured with more cost-conscious managed care and high-deductible plans.These insurance plan models have historically undervalued emergency medical services, while alsounderinsuring patients and limiting their healthcare system access to the emergency department. Thisparadoxically increases demand for emergency services while decreasing supply. The continualdevaluation of emergency medical services by insurance payers will result in inadequate distribution ofresources to emergency care, resulting in further emergency department closures, increases inemergency department crowding, and the demise of acute care services provided to families andcommunities.

  15. Clinical Trials in Veterinary Medicine: A New Era Brings New Challenges.

    Science.gov (United States)

    Oyama, M A; Ellenberg, S S; Shaw, P A

    2017-07-01

    Randomized clinical trials (RCTs) are among the most rigorous ways to determine the causal relationship between an intervention and important clinical outcome. Their use in veterinary medicine has become increasingly common, and as is often the case, with progress comes new challenges. Randomized clinical trials yield important answers, but results from these studies can be unhelpful or even misleading unless the study design and reporting are carried out with care. Herein, we offer some perspective on several emerging challenges associated with RCTs, including use of composite endpoints, the reporting of different forms of risk, analysis in the presence of missing data, and issues of reporting and safety assessment. These topics are explored in the context of previously reported veterinary internal medicine studies as well as through illustrative examples with hypothetical data sets. Moreover, many insights germane to RCTs in veterinary internal medicine can be drawn from the wealth of experience with RCTs in the human medical field. A better understanding of the issues presented here can help improve the design, interpretation, and reporting of veterinary RCTs. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

  16. Clinical Overview and Emergency-Department Whiteboards

    DEFF Research Database (Denmark)

    Hertzum, Morten; Simonsen, Jesper

    2010-01-01

    In Denmark emergency departments are newly established and still in a process of devising their procedures and technology support. Electronic whiteboards are a means of supporting clinicians in creating and maintaining the overview necessary to provide quality treatment of patients. The concrete ...

  17. A suggested emergency medicine boot camp curriculum for medical students based on the mapping of Core Entrustable Professional Activities to Emergency Medicine Level 1 milestones

    Directory of Open Access Journals (Sweden)

    Lamba S

    2016-03-01

    simulation cases assessed students’ skills. Results: Students (n=9 reported increased confidence in the following procedures: intubation (1.5–2.1, thoracostomy (1.1–1.9, and central venous catheterization (1.3–2 (a three-point Likert-type scale, with 1= not yet confident/able to perform with supervision to 3= confident/able to perform without supervision. Psychomotor skills testing showed on average, 26% of students required verbal prompting with performance errors, 48% with minor performance errors, and 26% worked independently without performance errors. All participants reported: 1 increased knowledge and confidence in covered topics and 2 overall satisfaction with simulation experience. Conclusion: Mapping the Core EPAs for Entering Residency to the EM milestones at Level 1 identifies educational gaps for graduating medical students seeking a career in EM. Educators designing EM boot camps for medical students should consider these identified gaps, procedures, and clinical conditions during the development of a core standardized curriculum. Keywords: emergency medicine, clerkship, medical education, competency, EPA 10, milestones

  18. A Lifestyle Medicine Clinic in a Community Pharmacy Setting

    Directory of Open Access Journals (Sweden)

    Thomas L. Lenz

    2010-06-01

    Full Text Available Chronic diseases continue to be a significant burden to the health care system. Pharmacists have been able to show that drug therapy for patients with chronic diseases can be improved through medication therapy management (MTM services but have yet to become significantly involved in implementing lifestyle modification programs to further control and prevent chronic conditions. A novel and innovative lifestyle medicine program was started by pharmacists in a community pharmacy in 2008 to more comprehensively prevent and manage chronic conditions. The lifestyle medicine program consists of designing seven personalized programs for patients to address physical activity, nutrition, alcohol consumption, weight control, stress management, sleep success, and tobacco cessation (if needed. The lifestyle medicine program complements existing MTM services for patients with hypertension, dyslipidemia, and/or diabetes. This program is innovative because pharmacists have developed and implemented a method to combine lifestyle medicine with MTM services to not only manage chronic conditions, but prevent the progression of those conditions and others. Several innovative tools have also been developed to enhance the effectiveness of a lifestyle medicine program. This manuscript describes the program's pharmacy setting, pharmacy personnel, participants and program details as well as the tools used to integrate a lifestyle medicine program with MTM services. Type: Clinical Experience

  19. The German emergency and disaster medicine and management system—history and present

    Directory of Open Access Journals (Sweden)

    Norman Hecker

    2018-04-01

    Full Text Available As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the “Golden Standard” of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach. Keywords: Emergency medical systems, Disaster medicine, Public health, Germany

  20. Systematic Analysis of Theses in the Field of Emergency Medicine in Turkey.

    Science.gov (United States)

    Cevik, Erdem; Karakus Yilmaz, Banu; Acar, Yahya Ayhan; Dokur, Mehmet

    2015-03-01

    The aim of this study is to systematically evaluate the theses in the field of emergency medicine in Turkey and to determine whether they were published as a scientific paper. This is a retrospective observational study. Theses in the field of emergency medicine between 1998 and 2013 were browsed from the internet database of National Thesis Center (Council of Higher Education). Study type, both if it was in the field of emergency, or if it was published and the journal's scope of published studies were assessed and recorded in the study chart. 579 theses were included in the study. 27.1% of them were published and 14.9% of them were published in SCI/SCI-E journals. Advisors of theses were emergency medicine specialists in 67.6% of theses and 493 (85.1%) of them were in the field of emergency medicine. 77.4% of theses were observational and 20.9% were experimental study. Most of the experimental studies (72.7%, n=88) were animal studies. It was concluded that very few theses in the field of emergency medicine were published in journals that were indexed in SCI/SCI-E.

  1. Authorship Trends of Emergency Medicine Publications over the Last Two Decades.

    Science.gov (United States)

    Lammers, Richard; Simunich, Thomas; Ashurst, John

    2016-05-01

    With the recent merger of the American Osteopathic Association (AOA) and the Accreditation Council for Graduate Medical Education (ACGME) a heightened pressure for publication may become evident. Our objective was to determine whether there was a gap in the type of both medical degree designation and advanced degree designation among authorship in three United States-based academic emergency medicine journals. We reviewed the Journal of Emergency Medicine, Academic Emergency Medicine and Annals of Emergency Medicine for the type of degree designation that the first and senior authors had obtained for the years 1995, 2000, 2005, 2010 and 2014. A total of 2.48% of all authors held a degree in osteopathic medicine. Osteopathic physician first authors contributed to 3.26% of all publications while osteopathic physician senior authors contributed 1.53%. No statistical trend could be established for the years studied for osteopathic physicians. However, we noted an overall trend for increased publication for allopathic senior authors (p=0.001), allopathic first authors with a dual degree (p=0.003) and allopathic senior authors with a dual degree (p=0.005). For each journal studied, no statistical trend could be established for osteopathic first or senior authors but a trend was noted for allopathic first and senior authors in the Journal of Emergency Medicine (p-value=0.020 and 0.006). Of those with dual degrees, osteopathic physicians were in the minority with 1.85% of osteopathic first authors and 0.60% of osteopathic senior authors attaining a dual degree. No statistical trend could be established for increased dual degree publications for osteopathic physicians over the study period, nor could a statistical trend be established for any of the journals studied. Very few osteopathic physicians have published in the Journal of Emergency Medicine, Academic Emergency Medicine or Annals of Emergency Medicine over the last two decades. Despite a trend for increased

  2. Technical Developments and Clinical Use of Telemedicine in Sleep Medicine

    Directory of Open Access Journals (Sweden)

    Marie Bruyneel

    2016-12-01

    Full Text Available The use of assistive technology and telemedicine is likely to continue to shape our medical practice in the future, notably in the field of sleep medicine, especially within developed countries. Currently, the number of people suffering from obstructive sleep apnea syndrome (OSAS is increasing. Telemedicine (TM can be used in a variety of ways in sleep medicine: telediagnostics, teleconsultation, teletherapy and telemonitoring of patients being treated with positive pressure devices. In this review, we aim to summarize the recent scientific progresses of these techniques and their potential clinical applications and give consideration to the remaining problems related to TM application.

  3. Clinical Holistic Medicine: Holistic Treatment of Mental Disorders

    OpenAIRE

    Ventegodt, Søren; Andersen, Niels Jørgen; Neikrug, Shimshon; Kandel, Isack; Merrick, Joav

    2005-01-01

    We believe that holistic medicine can be used for patient's with mental health disorders. With holistic psychiatry, it is possible to help the mentally ill patient to heal existentially. As in holistic medicine, the methods are love or intense care, winning the trust of the patient, getting permission to give support and holding, and daring to be fully at the patient's service. Our clinical experiences have led us to believe that mental health patient's can heal if only you can make him or he...

  4. Focus on the emerging new fields of network physiology and network medicine

    Science.gov (United States)

    Ivanov, Plamen Ch; Liu, Kang K. L.; Bartsch, Ronny P.

    2016-10-01

    Despite the vast progress and achievements in systems biology and integrative physiology in the last decades, there is still a significant gap in understanding the mechanisms through which (i) genomic, proteomic and metabolic factors and signaling pathways impact vertical processes across cells, tissues and organs leading to the expression of different disease phenotypes and influence the functional and clinical associations between diseases, and (ii) how diverse physiological systems and organs coordinate their functions over a broad range of space and time scales and horizontally integrate to generate distinct physiologic states at the organism level. Two emerging fields, network medicine and network physiology, aim to address these fundamental questions. Novel concepts and approaches derived from recent advances in network theory, coupled dynamical systems, statistical and computational physics show promise to provide new insights into the complexity of physiological structure and function in health and disease, bridging the genetic and sub-cellular level with inter-cellular interactions and communications among integrated organ systems and sub-systems. These advances form first building blocks in the methodological formalism and theoretical framework necessary to address fundamental problems and challenges in physiology and medicine. This ‘focus on’ issue contains 26 articles representing state-of-the-art contributions covering diverse systems from the sub-cellular to the organism level where physicists have key role in laying the foundations of these new fields.

  5. [Application of Delphi method in traditional Chinese medicine clinical research].

    Science.gov (United States)

    Bi, Ying-fei; Mao, Jing-yuan

    2012-03-01

    In recent years, Delphi method has been widely applied in traditional Chinese medicine (TCM) clinical research. This article analyzed the present application situation of Delphi method in TCM clinical research, and discussed some problems presented in the choice of evaluation method, classification of observation indexes and selection of survey items. On the basis of present application of Delphi method, the author analyzed the method on questionnaire making, selection of experts, evaluation of observation indexes and selection of survey items. Furthermore, the author summarized the steps of application of Delphi method in TCM clinical research.

  6. Emergency ultrasound and echocardiography in patients with infarct-related cardiogenic shock : A survey among members of the German Society of Medical Intensive Care and Emergency Medicine.

    Science.gov (United States)

    Michels, G; Hempel, D; Pfister, R; Janssens, U

    2018-04-09

    Current international and national guidelines promote the use of emergency echocardiography in patients with cardiogenic shock. We assessed whether these recommendations are followed in clinical practice of infarct-related cardiogenic shock patients. For this purpose we conducted a web-based survey among all members of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN); 40% of the DGIIN members completed the survey. Participants reported that in their department emergency echocardiography/ultrasound is performed on most patients in infarct-related cardiogenic shock presenting to the emergency department/chest pain unit or intensive care unit (58.6% versus 81.4%). Only 33% stated that on patients admitted directly to the catheterization laboratory emergency ultrasound/echocardiography is applied in their institution. Local availability of a standardized algorithm was lacking in the majority of departments (77.2%). A great proportion (38.3%) of participants stated that they personally had no formal training in emergency ultrasound. In order to meet the demands of the current guidelines, in addition to integration of ultrasound examinations into diagnostic algorithms, a structured training of all emergency and intensive care physicians is necessary.

  7. A Cognitive Apprenticeship-Based Faculty Development Intervention for Emergency Medicine Educators

    Directory of Open Access Journals (Sweden)

    Chris Merritt

    2017-12-01

    Full Text Available In just a few years of preparation, emergency medicine (EM trainees must achieve expertise across the broad spectrum of skills critical to the practice of the specialty. Though education occurs in many contexts, much learning occurs on the job, caring for patients under the guidance of clinical educators. The cognitive apprenticeship framework, originally described in primary and secondary education, has been applied to workplace-based medical training. The framework includes a variety of teaching methods: scaffolding, modeling, articulation, reflection, and exploration, applied in a safe learning environment. Without understanding these methods within a theoretical framework, faculty may not apply the methods optimally. Here we describe a faculty development intervention during which participants articulate, share, and practice their own applications of cognitive-apprenticeship methods to learners in EM. We summarize themes identified by workshop participants, and provide suggestions for tailoring the application of these methods to varying levels of EM learners. The cognitive-apprenticeship framework allows for a common understanding of the methods used in clinical teaching toward independence. Clinical educators should be encouraged to reflect critically on their methods, while being offered the opportunity to share and learn from others.

  8. Radioprotection in nuclear medicine department of 'Porto Alegre Clinical Hospital'

    International Nuclear Information System (INIS)

    Dias, T.M.; Pinto, A.L.; Bacelar, A.L.; Dytz, A.S.; Bernasiuk, M.E.; Baptista, I.S.

    1996-01-01

    The use of ionizing radiation in medicine allows great benefits. Nuclear Medicine uses ionizing radiation for medical diagnostic, such as: tumor, cancer, and dysfunctions location. However the use of ionizing radiation must be controlled in order to avoid likely biological effects in human beings. In order to extremely minimize that these effects appear, the Medical Physics Department of the Porto Alegre Clinical Hospital has implemented some procedures to assure that handling and use of radioactive material are in a safe way. This preoccupation is considered in all the places of nuclear medicine sector since the moment when the radioactive material is brought into including its manipulation and retirement, the exam process being accompanied. (authors). 4 refs

  9. Clinical Training of Medical Physicists Specializing in Nuclear Medicine

    International Nuclear Information System (INIS)

    2011-01-01

    The application of radiation in human health, for both diagnosis and treatment of disease, is an important component of the work of the IAEA. The responsibility for the increasingly technical aspects of this work is undertaken by the medical physicist. To ensure good practice in this vital area, structured clinical training programmes are required to complement academic learning. This publication is intended to be a guide to the practical implementation of such a programme for nuclear medicine. There is a general and growing awareness that radiation medicine is increasingly dependent on well trained medical physicists who are based in a clinical setting. However an analysis of the availability of medical physicists indicates a large shortfall of qualified and capable professionals. This is particularly evident in developing countries. While strategies to increase educational opportunities are critical to such countries, the need for guidance on structured clinical training was recognized by the members of the Regional Cooperative Agreement for Research, Development and Training related to Nuclear Science and Technology (RCA) for the Asia-Pacific region. Consequently, a technical cooperation regional project (RAS6038) under the RCA programme was formulated to address this need in this region by developing suitable material and establishing its viability. Development of a clinical training guide for medical physicists specialising in nuclear medicine was started in 2009 with the appointment of a core drafting committee of regional and international experts. The publication drew on the experience of clinical training in Australia, Croatia and Sweden and was moderated by physicists working in the Asian region. The present publication follows the approach of earlier IAEA publications in the Training Course Series, specifically Nos 37 and 47, Clinical Training of Medical Physicists Specializing in Radiation Oncology and Clinical Training of Medical Physicists

  10. Self vs. Other Focus: Predicting Professionalism Remediation of Emergency Medicine Residents.

    Science.gov (United States)

    Thaxton, Robert E; Jones, Woodson S; Hafferty, Fred W; April, Carolyn W; April, Michael D

    2018-01-01

    Unprofessionalism is a major reason for resident dismissal from training. Because of the high stakes involved, residents and educators alike would benefit from information predicting whether they might experience challenges related to this competency. Our objective was to correlate the outcome of professionalism-related remedial actions during residency with the predictor variable of resident response to a standardized interview question: "Why is Medicine important to you?" We conducted a professional development quality improvement (QI) initiative to improve resident education and mentorship by achieving a better understanding of each resident's reasons for valuing a career in medicine. This initiative entailed an interview administered to each resident beginning emergency medicine training at San Antonio Military Medical Center during 2006-2013. The interviews uniformly began with the standardized question "Why is Medicine important to you?" The residency program director documented a free-text summary of each response to this question, the accuracy of which was confirmed by the resident. We analyzed the text of each resident's response after a review of the QI data suggested an association between responses and professionalism actions (retrospective cohort design). Two associate investigators blinded to all interview data, remedial actions, and resident identities categorized each text response as either self-focused (e.g., "I enjoy the challenge") or other-focused (e.g., "I enjoy helping patients"). Additional de-identified data collected included demographics, and expressed personal importance of politics and religion. The primary outcome was a Clinical Competency Committee professionalism remedial action. Of 114 physicians starting residency during 2006-2013, 106 (93.0%) completed the interview. There was good inter-rater reliability in associate investigator categorization of resident responses as either self-focused or other-focused (kappa coefficient 0

  11. Self vs. Other Focus: Predicting Professionalism Remediation of Emergency Medicine Residents

    Directory of Open Access Journals (Sweden)

    Robert E. Thaxton

    2017-12-01

    Full Text Available Introduction Unprofessionalism is a major reason for resident dismissal from training. Because of the high stakes involved, residents and educators alike would benefit from information predicting whether they might experience challenges related to this competency. Our objective was to correlate the outcome of professionalism-related remedial actions during residency with the predictor variable of resident response to a standardized interview question: “Why is Medicine important to you?” Methods We conducted a professional development quality improvement (QI initiative to improve resident education and mentorship by achieving a better understanding of each resident’s reasons for valuing a career in medicine. This initiative entailed an interview administered to each resident beginning emergency medicine training at San Antonio Military Medical Center during 2006–2013. The interviews uniformly began with the standardized question “Why is Medicine important to you?” The residency program director documented a free-text summary of each response to this question, the accuracy of which was confirmed by the resident. We analyzed the text of each resident’s response after a review of the QI data suggested an association between responses and professionalism actions (retrospective cohort design. Two associate investigators blinded to all interview data, remedial actions, and resident identities categorized each text response as either self-focused (e.g., “I enjoy the challenge” or other-focused (e.g., “I enjoy helping patients”. Additional de-identified data collected included demographics, and expressed personal importance of politics and religion. The primary outcome was a Clinical Competency Committee professionalism remedial action. Results Of 114 physicians starting residency during 2006–2013, 106 (93.0% completed the interview. There was good inter-rater reliability in associate investigator categorization of resident

  12. Future enhanced clinical role of pharmacists in Emergency Departments in England: multi-site observational evaluation.

    Science.gov (United States)

    Hughes, Elizabeth; Terry, David; Huynh, Chi; Petridis, Konstantinos; Aiello, Matthew; Mazard, Louis; Ubhi, Hirminder; Terry, Alex; Wilson, Keith; Sinclair, Anthony

    2017-08-01

    Background There are concerns about maintaining appropriate clinical staffing levels in Emergency Departments. Pharmacists may be one possible solution. Objective To determine if Emergency Department attendees could be clinically managed by pharmacists with or without advanced clinical practice training. Setting Prospective 49 site cross-sectional observational study of patients attending Emergency Departments in England. Method Pharmacist data collectors identified patient attendance at their Emergency Department, recorded anonymized details of 400 cases and categorized each into one of four possible options: cases which could be managed by a community pharmacist; could be managed by a hospital pharmacist independent prescriber; could be managed by a hospital pharmacist independent prescriber with additional clinical training; or medical team only (unsuitable for pharmacists to manage). Impact indices sensitive to both workload and proportion of pharmacist manageable cases were calculated for each clinical group. Main outcome measure Proportion of cases which could be managed by a pharmacist. Results 18,613 cases were observed from 49 sites. 726 (3.9%) of cases were judged suitable for clinical management by community pharmacists, 719 (3.9%) by pharmacist prescribers, 5202 (27.9%) by pharmacist prescribers with further training, and 11,966 (64.3%) for medical team only. Impact Indices of the most frequent clinical groupings were general medicine (13.18) and orthopaedics (9.69). Conclusion The proportion of Emergency Department cases that could potentially be managed by a pharmacist was 36%. Greatest potential for pharmacist management was in general medicine and orthopaedics (usually minor trauma). Findings support the case for extending the clinical role of pharmacists.

  13. Workplace Violence and Harassment Against Emergency Medicine Residents

    OpenAIRE

    Schnapp, Benjamin H.; Slovis, Benjamin H.; Shah, Anar D.; Fant, Abra L.; Gisondi, Michael A.; Shah, Kaushal H.; Lech, Christie A.

    2016-01-01

    Introduction: Several studies have shown that workplace violence in the emergency department (ED) iscommon. Residents may be among the most vulnerable staff, as they have the least experience with thesevolatile encounters. The goal for this study was to quantify and describe acts of violence against emergencymedicine (EM) residents by patients and visitors and to identify perceived barriers to safety. Methods: This cross-sectional survey study queried EM residents at mul...

  14. Difficult airway equipment in departments of emergency medicine in Ireland: results of a national survey.

    LENUS (Irish Health Repository)

    Walsh, K

    2012-02-03

    BACKGROUND AND OBJECTIVE: Adverse effects associated with difficult airway management can be catastrophic and include death, brain injury and myocardial injury. Closed-malpractice claims have shown prolonged and persistent attempts at endotracheal intubation to be the most common situation leading to disastrous respiratory events. To date, there has been no evaluation of the types of difficult airway equipment currently available in Irish departments of emergency medicine. The objective of this survey was to identify the difficult airway equipment available in Irish departments of emergency medicine. METHODS: Departments of emergency medicine in the Republic of Ireland with at least one dedicated Emergency Medicine consultant were surveyed via telephone. RESULTS: All of the departments contacted held at least one alternative device on site for both ventilation and intubation. The most common alternative ventilation device was the laryngeal mask airway (89%). The most common alternative intubating device was the surgical airway device (100%). CONCLUSIONS: Irish departments of emergency medicine compare well with those in the UK and USA, when surveyed concerning difficult airway equipment. However, we believe that this situation could be further improved by training inexperienced healthcare providers in the use of the laryngeal mask airway and intubating laryngeal mask airway, by placing greater emphasis on the ready availability of capnography and by the increased use of portable difficult airway storage units.

  15. The Top 100 Cited Articles in Clinical Orthopedic Sports Medicine.

    Science.gov (United States)

    Nayar, Suresh K; Dein, Eric J; Spiker, Andrea M; Bernard, Johnathan A; Zikria, Bashir A

    2015-08-01

    Orthopedic sports medicine continues to evolve, owing much of its clinical management and practice to rigorous academic research. In this review, we identify and describe the top 100 cited articles in clinical sports medicine and recognize the authors and institutions driving the research. We collected articles (excluding basic science, animal, and cadaveric studies) from the 25 highest-impact sports medicine journals and analyzed them by number of citations, journal, publication date, institution, country, topic, and author. Mean number of citations was 408 (range, 229-1629). The articles were published in 7 journals, most in the 1980s to 2000s, and represented 15 countries. Thirty topics were addressed, with a heavy emphasis on anterior cruciate ligament injury and reconstruction, knee rating systems, rotator cuff reconstruction, and chondrocyte transplantation. The 3 most cited articles, by Insall and colleagues, Constant and Murley, and Tegner and Lysholm, addressed a knee, a shoulder, and another knee rating system, respectively. Several authors contributed multiple articles. The Hospital for Special Surgery and the University of Bern contributed the most articles (5 each). This study provides a comprehensive list of the past century's major academic contributions to sports medicine. Residents and fellows may use this list to guide their scholarly investigations.

  16. An internet-based teaching file on clinical nuclear medicine

    International Nuclear Information System (INIS)

    Jiang Zhong; Wu Jinchang

    2001-01-01

    Objective: The goal of this project was to develop an internet-based interactive digital teaching file on nuclide imaging in clinical nuclear medicine, with the capability of access to internet. Methods: On the basis of academic teaching contents in nuclear medicine textbook for undergraduates who major in nuclear medicine, Frontpage 2000, HTML language, and JavaScript language in some parts of the contents, were utilized in the internet-based teaching file developed in this study. Results: A practical and comprehensive teaching file was accomplished and may get access with acceptable speed to internet. Besides basic teaching contents of nuclide imagings, a large number of typical and rare clinical cases, questionnaire with answers and update data in the field of nuclear medicine were included in the file. Conclusion: This teaching file meets its goal of providing an easy-to-use and internet-based digital teaching file, characteristically with the contents instant and enriched, and with the modes diversified and colorful

  17. [Occupational aspects of emergency medicine practice in Catalonia: the OPENCAT opinion survey].

    Science.gov (United States)

    Jacob, Javier; Gené, Emili; Alonso, Gilberto; Rimbau, Pere; Zorrilla, José; Casarramona, Francesc; Netto, Cristina; Sánchez, Pere; Hernández, Ricard; Escalada, Xavier; Miró, Òscar

    2017-01-01

    To gather information on the contracting and training of members of the Catalan Society of Emergency Medicine (SoCMUE) who work in emergency medicine and services in Catalonia. To survey their opinions on certain aspects of resource availability and working conditions. Cross-sectional descriptive study based on a survey sent to SoCMUE members. We studied the opinions of 5 types of respondent: hospital physicians, out-of-hospital physicians, hospital nurses, out-of-hospital nurses, and emergency medical technicians. Responses were grouped to compare the opinions of physicians and nurses and workers in hospital and prehospital settings. We received 616 responses from 1273 members (48.4% response rate). More physicians than nurses come from outside Catalonia and have contracts specifically linked to emergency care; in addition, physicians have done less postgraduate training in emergency medicine. More hospital staff than prehospital staff have permanent contracts linked to the department where they work. More hospital physicians are specialized in internal medicine than in family and community medicine. The opinion that emergency services are inadequately staffed was widespread. Most respondents believed that patient transport is good or adequate. However, respondents working in prehospital services expressed a lower opinion of transport. Great difficulty in combining work with family (life achieving work-life balance) was expressed by 13.5% overall, and more often by hospital staff. Some type of aggression was experienced by 88.2%; 60% reported the event to superiors. Nurses reported aggression more often than physicians. A police report was filed by 10.1%. Emergency medicine working conditions can be improved in Catalonia according to members of SoCMUE. Relations between groups of professionals are not optimum in some aspects.

  18. Error identification, disclosure, and reporting: practice patterns of three emergency medicine provider types.

    Science.gov (United States)

    Hobgood, Cherri; Xie, Jipan; Weiner, Bryan; Hooker, James

    2004-02-01

    To gather preliminary data on how the three major types of emergency medicine (EM) providers, physicians, nurses (RNs), and out-of-hospital personnel (EMTs), differ in error identification, disclosure, and reporting. A convenience sample of emergency department (ED) providers completed a brief survey designed to evaluate error frequency, disclosure, and reporting practices as well as error-based discussion and educational activities. One hundred sixteen subjects participated: 41 EMTs (35%), 33 RNs (28%), and 42 physicians (36%). Forty-five percent of EMTs, 56% of RNs, and 21% of physicians identified no clinical errors during the preceding year. When errors were identified, physicians learned of them via dialogue with RNs (58%), patients (13%), pharmacy (35%), and attending physicians (35%). For known errors, all providers were equally unlikely to inform the team caring for the patient. Disclosure to patients was limited and varied by provider type (19% EMTs, 23% RNs, and 74% physicians). Disclosure education was rare, with error to a patient. Error discussions are widespread, with all providers indicating they discussed their own as well as the errors of others. This study suggests that error identification, disclosure, and reporting challenge all members of the ED care delivery team. Provider-specific education and enhanced teamwork training will be required to further the transformation of the ED into a high-reliability organization.

  19. Knowledge, Skills and Experience Managing Tracheostomy Emergencies: A Survey of Critical Care Medicine trainees

    LENUS (Irish Health Repository)

    Nizam, AA

    2016-10-01

    Since the development of percutaneous tracheostomy, the number of tracheostomy patients on hospital wards has increased. Problems associated with adequate tracheostomy care on the wards are well documented, particularly the management of tracheostomy-related emergencies. A survey was conducted among non-consultant hospital doctors (NCHDs) starting their Critical Care Medicine training rotation in a university affiliated teaching hospital to determine their basic knowledge and skills in dealing with tracheostomy emergencies. Trainees who had received specific tracheostomy training or who had previous experience of dealing with tracheostomy emergencies were more confident in dealing with such emergencies compared to trainees without such training or experience. Only a minority of trainees were aware of local hospital guidelines regarding tracheostomy care. Our results highlight the importance of increased awareness of tracheostomy emergencies and the importance of specific training for Anaesthesia and Critical Care Medicine trainees.

  20. Inappropriate emergency laboratory test ordering: defensive or peer evidence shared based medicine?

    Directory of Open Access Journals (Sweden)

    C. Descovich

    2013-05-01

    Full Text Available BACKGROUND The laboratory overuse is widely prevalent in hospital practice, mostly in the emergency care. Reasons for excessive and inappropriate test-ordering include defensive behaviour and fear or uncertainty, lack of experience, the misuse of protocols and guidelines, “routine” and local attitudes, inadequate educational feedback and clinician’s unawareness about the cost of examinations and their related implications. AIM OF THE STUDY AND METHODS The primary target of our working group was to reduce inappropriate ordering on a urgent basis test, implementing further examinations not yet previewed in the hospital panel of the available urgencies, according to the evidence based diagnosis concept. The secondary goal was to indicate strategies of re-engineering of the processes, improving turnaround time in the laboratory management of emergencies. After evaluating, as first intervention, the more reliable sources for practice guidelines, systematic reviews and RCTs, the committee further discussed main topics with in-hospital stakeholders, selected from Emergency, Internal Medicine and Surgery Depts. The working group, in many subsequent audits, tried to obtain a systematic feed back with all involved professionals. RESULTS After reviewing literature’s evidence, the board constrained testing options by defining the basic emergency laboratory panel tests (blood type, hemogram, blood urea nitrogen, plasma creatinine, glucose, sodium, potassium, chloride, osmolarity, CRP, bicarbonate, CPK, creatine phosphokinase-MB, myoglobin, troponin, BNP and NT-proBNP, PT-INR, PTT, D-dimer, beta- HCG, biochemical urinalysis etc.. As final result, the proposed tests reduced the overall number of inappropriate investigations and increased, with newer and updated tests, the available panel for critical patients. DISCUSSION A collegiate review of data reporting, in-hospital deepening of problems and the inter- professional discussion of the evidences

  1. Gender differences in acute and chronic pain in the emergency department: results of the 2014 Academic Emergency Medicine consensus conference pain section.

    Science.gov (United States)

    Musey, Paul I; Linnstaedt, Sarah D; Platts-Mills, Timothy F; Miner, James R; Bortsov, Andrey V; Safdar, Basmah; Bijur, Polly; Rosenau, Alex; Tsze, Daniel S; Chang, Andrew K; Dorai, Suprina; Engel, Kirsten G; Feldman, James A; Fusaro, Angela M; Lee, David C; Rosenberg, Mark; Keefe, Francis J; Peak, David A; Nam, Catherine S; Patel, Roma G; Fillingim, Roger B; McLean, Samuel A

    2014-12-01

    Pain is a leading public health problem in the United States, with an annual economic burden of more than $630 billion, and is one of the most common reasons that individuals seek emergency department (ED) care. There is a paucity of data regarding sex differences in the assessment and treatment of acute and chronic pain conditions in the ED. The Academic Emergency Medicine consensus conference convened in Dallas, Texas, in May 2014 to develop a research agenda to address this issue among others related to sex differences in the ED. Prior to the conference, experts and stakeholders from emergency medicine and the pain research field reviewed the current literature and identified eight candidate priority areas. At the conference, these eight areas were reviewed and all eight were ratified using a nominal group technique to build consensus. These priority areas were: 1) gender differences in the pharmacological and nonpharmacological interventions for pain, including differences in opioid tolerance, side effects, or misuse; 2) gender differences in pain severity perceptions, clinically meaningful differences in acute pain, and pain treatment preferences; 3) gender differences in pain outcomes of ED patients across the life span; 4) gender differences in the relationship between acute pain and acute psychological responses; 5) the influence of physician-patient gender differences and characteristics on the assessment and treatment of pain; 6) gender differences in the influence of acute stress and chronic stress on acute pain responses; 7) gender differences in biological mechanisms and molecular pathways mediating acute pain in ED populations; and 8) gender differences in biological mechanisms and molecular pathways mediating chronic pain development after trauma, stress, or acute illness exposure. These areas represent priority areas for future scientific inquiry, and gaining understanding in these will be essential to improving our understanding of sex and gender

  2. Gender- and sex-specific sports-related injury research in emergency medicine: a consensus on future research direction and focused application.

    Science.gov (United States)

    Raukar, Neha P; Zonfrillo, Mark R; Kane, Kathleen; Davenport, Moira; Espinoza, Tamara R; Weiland, Jessica; Franco, Vanessa; Vaca, Federico E

    2014-12-01

    Title IX, the commercialization of sports, the social change in sports participation, and the response to the obesity epidemic have contributed to the rapid proliferation of participation in both competitive organized sports and nontraditional athletic events. As a consequence, emergency physicians are regularly involved in the acute diagnosis, management, disposition, and counseling of a broad range of sports-related pathology. Three important and highly publicized mechanisms of injury in sports relevant to emergency medicine (EM) include concussion, heat illness, and sudden cardiac death. In conjunction with the 2014 Academic Emergency Medicine consensus conference "Gender-specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes," a consensus group consisting of experts in EM, emergency neurology, sports medicine, and public health convened to deliberate and develop research questions that could ultimately advance the field of sports medicine and allow for meaningful application in the emergency department (ED) clinical setting. Sex differences in injury risk, diagnosis, ED treatment, and counseling are identified in each of these themes. This article presents the consensus-based priority research agenda. © 2014 by the Society for Academic Emergency Medicine.

  3. Practical clinical applications of the computer in nuclear medicine

    International Nuclear Information System (INIS)

    Price, R.R.; Erickson, J.J.; Patton, J.A.; Jones, J.P.; Lagan, J.E.; Rollo, F.D.

    1978-01-01

    The impact of the computer on the practice of nuclear medicine has been felt primarily in the area of rapid dynamic studies. At this time it is difficult to find a clinic which routinely performs computer processing of static images. The general purpose digital computer is a sophisticated and flexible instrument. The number of applications for which one can use the computer to augment data acquisition, analysis, or display is essentially unlimited. In this light, the purpose of this exhibit is not to describe all possible applications of the computer in nuclear medicine but rather to illustrate those applications which have generally been accepted as practical in the routine clinical environment. Specifically, we have chosen examples of computer augmented cardiac, and renal function studies as well as examples of relative organ blood flow studies. In addition, a short description of basic computer components and terminology along with a few examples of non-imaging applications are presented

  4. Clinical uses of the medicinal leech: A practical review

    Directory of Open Access Journals (Sweden)

    B S Porshinsky

    2011-01-01

    Full Text Available The medicinal leech, Hirudo medicinalis, is an excellent example of the use of invertebrates in the treatment of human disease. Utilized for various medical indications since the ancient times, the medicinal leech is currently being used in a narrow range of well-defined and scientifically-grounded clinical applications. Hirudotherapy is most commonly used in the setting of venous congestion associated with soft tissue replantations and free flap-based reconstructive surgery. This is a comprehensive review of current clinical applications of hirudotherapy, featuring a comprehensive search of all major medical search engines (i.e. PubMed, Google Scholar, ScientificCommons and other cross-referenced sources. The authors focus on indications, contraindications, practical application/handling of the leech, and therapy-related complications.

  5. A national survey of terrorism preparedness training among pediatric, family practice, and emergency medicine programs.

    Science.gov (United States)

    Martin, Shelly D; Bush, Anneke C; Lynch, Julia A

    2006-09-01

    Domestic terrorism is a real threat focusing on a need to engage in effective emergency preparedness planning and training. Front-line physicians are an important component of any emergency preparedness plan. Potential victims of an attack include children who have unique physiologic and psychological vulnerabilities in disasters. Front-line providers need to have adequate training to effectively participate in local planning initiatives and to recognize and treat casualties including children. The goal of the survey was to assess the current state of terrorism preparedness training, including child victims, by emergency medicine, family practice, and pediatric residency programs in the United States and to assess methods of training and barriers to establishing effective training. A survey was e-mailed to a comprehensive list of all US pediatric, family practice, and emergency medicine residency programs 3 times between September 2003 and January 2004. The survey measured the perceived risk of terrorist attack, level of training by type of attack, level of training regarding children, method of training, and barriers to training. Overall, 21% of programs responded (46 of 182 pediatric, 75 of 400 family practice, and 29 of 125 emergency medicine programs). Across all of the event types, emergency medicine programs were more likely to report adequate/comprehensive training. However, terrorism preparedness funding, these data suggest that we are failing to provide adequate training to front-line providers who may care for children in a catastrophic domestic terrorist event.

  6. Preparing Emergency Medicine Residents to Disclose Medical Error Using Standardized Patients

    Directory of Open Access Journals (Sweden)

    Carmen N. Spalding

    2017-12-01

    Full Text Available Introduction Emergency Medicine (EM is a unique clinical learning environment. The American College of Graduate Medical Education Clinical Learning Environment Review Pathways to Excellence calls for “hands-on training” of disclosure of medical error (DME during residency. Training and practicing key elements of DME using standardized patients (SP may enhance preparedness among EM residents in performing this crucial skill in a clinical setting. Methods This training was developed to improve resident preparedness in DME in the clinical setting. Objectives included the following: the residents will be able to define a medical error; discuss ethical and professional standards of DME; recognize common barriers to DME; describe key elements in effective DME to patients and families; and apply key elements during a SP encounter. The four-hour course included didactic and experiential learning methods, and was created collaboratively by core EM faculty and subject matter experts in conflict resolution and healthcare simulation. Educational media included lecture, video exemplars of DME communication with discussion, small group case-study discussion, and SP encounters. We administered a survey assessing for preparedness in DME pre-and post-training. A critical action checklist was administered to assess individual performance of key elements of DME during the evaluated SP case. A total of 15 postgraduate-year 1 and 2 EM residents completed the training. Results After the course, residents reported increased comfort with and preparedness in performing several key elements in DME. They were able to demonstrate these elements in a simulated setting using SP. Residents valued the training, rating the didactic, SP sessions, and overall educational experience very high. Conclusion Experiential learning using SP is effective in improving resident knowledge of and preparedness in performing medical error disclosure. This educational module can be adapted

  7. Addressing the immediate need for emergency providers in resource-limited settings: the model of a six-month emergency medicine curriculum in Haiti.

    Science.gov (United States)

    Rouhani, Shada A; Israel, Kerling; Leandre, Fernet; Pierre, Sosthène; Bollman, Brennan; Marsh, Regan H

    2018-04-06

    In many resource-limited settings, emergency medicine (EM) is underdeveloped and formal EM training limited. Residencies and fellowships are an ideal long-term solution but cannot meet immediate needs for emergency providers, while short-term programs are often too limited in content. We describe a third method successfully implemented in Haiti: a medium-duration certificate program to meet the immediate need for emergency specialists. In conjunction with the Haitian Ministry of Health and National Medical School, we developed and implemented a novel, 6-month EM certificate program to build human resources for health and emergency care capacity. The program consisted of didactic and supervised clinical components, covering core content in EM. Didactics included lectures, simulations, hands-on skill-sessions, and journal clubs. Supervised clinical time reinforced concepts and taught an EM approach to patient care. Fourteen physicians from around Haiti successfully completed the program; all improved from their pre-test to post-test. At the end of the program and 9-month post-program evaluations, participants rated the program highly, and most felt they used their new knowledge daily. Participants found clinical supervision and simulation particularly useful. Key components to our program's success included collaboration with the Ministry of Health and National Medical School, supervised clinical time, and the continual presence of a course director. The program could be improved by a more flexible curriculum and by grouping participants by baseline knowledge levels. Medium-duration certificate programs offer a viable option for addressing immediate human resource gaps in emergency care, and our program offers a model for implementation in resource-limited settings. Similar options should be considered for other emerging specialties in resource-limited settings.

  8. Developing emergency medical dispatch systems in Africa – Recommendations of the African Federation for Emergency Medicine/International Academies of Emergency Dispatch Working Group

    Directory of Open Access Journals (Sweden)

    Nee-Kofi Mould-Millman

    2015-09-01

    To facilitate the development of EMD systems appropriate for the African setting, the African Federation for Emergency Medicine (AFEM and the International Academies of Emergency Dispatch (IAED convened a working group in November 2014 to provide conceptual, technical, and innovative recommendations for contextually appropriate EMD systems for African settings. It is hoped that these recommendations will augment efficiency, effectiveness, and standardisation within and among African EMD systems, thereby improving health outcomes for sufferers of acute illness or injury.

  9. Attitude of interns towards implementation and contribution of undergraduate Emergency Medicine training: Experience of an Ethiopian Medical School

    Directory of Open Access Journals (Sweden)

    Temesgen Beyene

    2017-09-01

    Conclusion: An Emergency Medicine rotation during the final year of medical school provides opportunities to learn about undifferentiated medical emergencies and it should be included for other medical schools in the country. Participants suggest that leadership aspects of Emergency Medicine need more emphasis as the curriculum is further developed in the future.

  10. Properties and clinical application of zirconia bioceramics in medicine

    Directory of Open Access Journals (Sweden)

    Čedomir Oblak

    2014-01-01

    Full Text Available Background: A group of inorganic non-metal biomaterials, that are commonly used in clinical medicine to replace or repair tissues, can be classified as a bioceramics. This group includes bioactive glasses, glass-ceramics, hydroxy-apatite and some other calcium phosphates. In addition, some bio-inert engineering ceramics materials have become increasingly utilised, aluminum oxide, zirconium oxide and their composites being the most popular. With the developement of yttria stabilized tetragonal zirconium oxide ceramics (Y-TZP medical community received a high strength biomaterial that is currently a material of choice for the manufacturing of medical devices. Y-TZP ceramics is becoming also increasingly used in dental medicine, where frameworks are manufactured by the use of computer-assisted technology.Conclusions: The article describes the basic properties of zirconia oxide ceramics important for the use in clinical medicine; high strength and fracture toughness, biocompatibility and negligible radiation. The ageing issue of this particular material, which is attributable to the thermo-dynamical instability of tetragonal zirconium oxide in hydrothermal conditions, is also discussed. When exposed to an aqueous environment over long periods of time, the surface of the Y-TZP ceramic will start transforming spontaneously into the monoclinic structure. The mechanism leading to the t-m transformation is temperature-dependent and is accompanied by extensive micro-cracking, which ultimately leads to strength degradation. The degradation might influence the clinical success rate of medical devices and therefore Y-TZP femoral heads are no longer made of pure zirconium oxide. Composites of zirconium and aluminium oxides are used instead, that are currently the strongest ceramic materials used in clinical medicine. In this work the clinical application of zirconia oxide ceramics in dental medicine is also presented. Conventional porcelain fused to metal

  11. Generational influences in academic emergency medicine: teaching and learning, mentoring, and technology (part I).

    Science.gov (United States)

    Mohr, Nicholas M; Moreno-Walton, Lisa; Mills, Angela M; Brunett, Patrick H; Promes, Susan B

    2011-02-01

    For the first time in history, four generations are working together-traditionalists, baby boomers, generation Xers (Gen Xers), and millennials. Members of each generation carry with them a unique perspective of the world and interact differently with those around them. Through a review of the literature and consensus by modified Delphi methodology of the Society for Academic Emergency Medicine Aging and Generational Issues Task Force, the authors have developed this two-part series to address generational issues present in academic emergency medicine (EM). Understanding generational characteristics and mitigating strategies can help address some common issues encountered in academic EM. Through recognition of the unique characteristics of each of the generations with respect to teaching and learning, mentoring, and technology, academicians have the opportunity to strategically optimize interactions with one another. © 2011 by the Society for Academic Emergency Medicine.

  12. An Innovative Clinical Skills “Boot Camp” for Dental Medicine Residents

    Directory of Open Access Journals (Sweden)

    Jenny Castillo

    2017-05-01

    Full Text Available During a 1-year hospital-based residency, dental residents are required to rotate through many departments including surgery, medicine, and emergency medicine. It became apparent that there was a gap between clinical skills knowledge taught in dental school curriculum and skills required for hospital-based patient care. In response, a simulation-based intensive clinical skill “boot camp” was created. The boot camp provided an intensive, interactive 3-day session for the dental residents. During the 3 days, residents were introduced to medical knowledge and skills that were necessary for their inpatient hospital rotations but were lacking in traditional dental school curriculum. Effectiveness of the boot camp was assessed in terms of knowledge base and comfort through presession and postsession surveys. According to resident feedback, this intensive introduction for the dental residents improved their readiness for their inpatient hospital-based residency.

  13. Project Title: Partnering to establish emergency medicine in Ethiopia ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2014-03-31

    Mar 31, 2014 ... The provision of a quality experience for U of T post-‐graduate and ...... The sum total of this experience cannot be reduced to a paragraph; ..... Topics included: ED management of DKA, incidence and clinical management of ...

  14. Project Title: Partnering to establish emergency medicine in Ethiopia ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Elayna Fremes

    2014-03-31

    Mar 31, 2014 ... To build capacity among Addis Ababa University faculty to design and execute .... To bridge the gap in qualified EM teachers in Ethiopia, TAAAC-EM delivers ... The curriculum spans the clinical competencies of EM and includes dedicated ..... application through disbursement was simple, and effective.

  15. Application of virtual reality technology in clinical medicine.

    Science.gov (United States)

    Li, Lan; Yu, Fei; Shi, Dongquan; Shi, Jianping; Tian, Zongjun; Yang, Jiquan; Wang, Xingsong; Jiang, Qing

    2017-01-01

    The present review discusses the application of virtual reality (VR) technology in clinical medicine, especially in surgical training, pain management and therapeutic treatment of mental illness. We introduce the common types of VR simulators and their operational principles in aforementioned fields. The clinical effects are also discussed. In almost every study that dealt with VR simulators, researchers have arrived at the same conclusion that both doctors and patients could benefit from this novel technology. Moreover, advantages and disadvantages of the utilization of VR technology in each field were discussed, and the future research directions were proposed.

  16. Regenerative Medicine for Epilepsy: From Basic Research to Clinical Application

    Directory of Open Access Journals (Sweden)

    Takao Yasuhara

    2013-11-01

    Full Text Available Epilepsy is a chronic neurological disorder, which presents with various forms of seizures. Traditional treatments, including medication using antiepileptic drugs, remain the treatment of choice for epilepsy. Recent development in surgical techniques and approaches has improved treatment outcomes. However, several epileptic patients still suffer from intractable seizures despite the advent of the multimodality of therapies. In this article, we initially provide an overview of clinical presentation of epilepsy then describe clinically relevant animal models of epilepsy. Subsequently, we discuss the concepts of regenerative medicine including cell therapy, neuroprotective agents, and electrical stimulation, which are reviewed within the context of our data.

  17. [Examples of the use of music in clinical medicine].

    Science.gov (United States)

    Myskja, A; Lindbaek, M

    2000-04-10

    Music has been an element in medical practice throughout history. There is growing interest in music as a therapeutic tool. Since there is no generally accepted standard for how, when and where music should be applied within a medical framework, this literature study endeavours to present an overview of central areas of application of music in medicine. It further attempts to find tentative conclusions that may be drawn from existing clinical research on the efficacy of music as a medical tool. Traditionally, music has been linked to the treatment of mental illness, and has been used successfully to treat anxiety and depression and improve function in schizophrenia and autism. In clinical medicine several studies have shown analgetic and anxiolytic properties that have been used in intensive care units, both in diagnostic procedures like gastroscopy and in larger operations, in preoperative as well as postoperative phases, reducing the need for medication in several studies. The combination of music with guided imagery and deep relaxation has shown reduction of symptoms and increased well-being in chronic pain syndromes, whether from cancer or rheumatic origin. Music has been used as support in pregnancy and gestation, in internal medicine, oncology, paediatrics and other related fields. The use of music with geriatric patients could prove to be especially fruitful, both in its receptive and its active aspect. Studies have shown that music can improve function and alleviate symptoms in stroke rehabilitation, Parkinson's disease, Alzheimer's disease and other forms of dementia. The role of music in medicine is primarily supportive and palliative. The supportive role of music has a natural field of application in palliative medicine and terminal care. Music is well tolerated, inexpensive, with good compliance and few side effects.

  18. Novel Emergency Medicine Curriculum Utilizing Self-Directed Learning and the Flipped Classroom Method: Genitourinary Emergencies Small Group Module

    Directory of Open Access Journals (Sweden)

    Andrew King

    2017-07-01

    Full Text Available Audience: This curriculum, created and implemented at The Ohio State University Wexner Medical Center, was designed to educate our emergency medicine (EM residents, PGY-1 to PGY-3, as well as medical students. Introduction: In 2013, there were over 6 million Emergency Department visits in the United States which resulted in a primary diagnosis of the genitourinary system. This represents 5.2% of all Emergency Department visits.1 Residents must be proficient in the differential diagnosis and management of the wide variety of genitourinary emergencies. This flipped classroom curricular model emphasizes self-directed learning activities completed by learners, followed by small group discussions pertaining to the topic reviewed. The active learning fostered by this curriculum increases faculty and learner engagement and interaction time typically absent in traditional lecture-based formats.2-4 Studies have revealed that the application of knowledge through case studies, personal interaction with content experts, and integrated questions are effective learning strategies for emergency medicine residents.4-6 The Ohio State University Wexner Medical Center EM Residency didactic curriculum recently transitioned to a “flipped classroom” approach.7-10 We created this innovative curriculum aimed to improve our residency education program and to share educational resources with other EM residency programs. Our curriculum utilizes an 18-month curricular cycle to cover the defined emergency medicine content. The flipped classroom curriculum maximizes didactic time and resident engagement, fosters intellectual curiosity and active learning, and meets the needs of today’s learners. 3,6,11 Objectives: We aim to teach the presentation and management of genitourinary emergencies through the creation of a flipped classroom design. This unique, innovative curriculum utilizes resources chosen by education faculty and resident learners, study questions, real

  19. Novel Emergency Medicine Curriculum Utilizing Self-Directed Learning and the Flipped Classroom Method: Psychiatric Emergencies Small Group Module

    Directory of Open Access Journals (Sweden)

    Andrew King

    2017-07-01

    Full Text Available Audience: This curriculum created and implemented at The Ohio State University Wexner Medical Center was designed to educate our emergency medicine (EM residents, PGY-1 to PGY-3, as well as medical students and attending physicians. Introduction: In 2007, there were 12 million adult Emergency Department visits for mental health and substance abuse complaints. This represents 12.5% of all adult emergency department visits.1 Residents must be proficient in the differential diagnosis and management of the wide variety of psychiatric emergencies. The flipped classroom curricular model emphasizes self-directed learning activities completed by learners, followed by small group discussions pertaining to the topic reviewed. The active learning fostered by this curriculum increases faculty and learner engagement and interaction time typically absent in traditional lecture-based formats.2-4 Studies have revealed that the application of knowledge through case studies, personal interaction with content experts, and integrated questions are effective learning strategies for emergency medicine residents.4-6 The Ohio State University EM Residency didactic curriculum recently transitioned to a “flipped classroom” approach.7-10 We created this innovative curriculum aimed to improve our residency education program and to share educational resources with other EM residency programs. Our curriculum utilizes an 18-month curricular cycle to cover the defined emergency medicine content. The flipped classroom curriculum maximizes didactic time and resident engagement, fosters intellectual curiosity and active learning, and meets the needs of today’s learners. 3,6,11 Objectives: We aim to teach the presentation and management of psychiatric emergencies through the creation of a flipped classroom design. This unique, innovative curriculum utilizes resources chosen by education faculty and resident learners, study questions, real-life experiences, and small group

  20. Working styles of medicine professionals in emergency medical service

    Directory of Open Access Journals (Sweden)

    Lazarević Marija

    2015-01-01

    Full Text Available Introduction: Transactional analysis is a personality and communication theory established by psychiatrist Eric Berne, at the end of the fifties. Counter script is the way of life in accordance with parental imperative. The person with a counter-script has a compulsion to fulfill the required task in order to avoid the disaster of ban. There are five drivers that are considered essential, and these are: 'Be perfect!', 'Be strong!', 'Hurry up!', 'Please others!' and 'Work hard!' Objective: a Determination of the most dominant driver in this medical service. b Because of the specifics of this job which requires speed and humanity, the emphasis will be on doublet: 'Hurry up!' and 'Please others!' Method: The study was conducted on a group of subjects employed in a general service with medical emergency. The instrument used in the study was Julie Hay's questionnaire for diagnosing the working styles. Results: Statistical research was conducted on a sample of 30 subjects employed in the emergency medical service. Availability of all afore mentioned drivers was tested. The research hypotheses were formulated as follows: H0: The driver is not present among the employees in this service; H1: The driver is present among the employees in this service. Calculated value of the t-statistics for the driver 'Hurry up!' is 1.398; for the driver 'Be perfect!' 3.616; for the driver 'Please others!' 11.693; for the driver 'Work hard!' -0.673; and for the driver 'Be strong!' 3.880. Since the realizable value of the t-statistics for the drivers: 'Be perfect!' and 'Please others!' and 'Be strong!' is bigger than the critical value 1.699, and p<0.05 we reject the null hypothesis and we accept the alternative hypothesis on the significance level of 95%. For the drivers 'Hurry up!' and 'Work hard!' the values of t-statistics are lower than the critical value 1.699 for significance level of 95%, so the alternative hypothesis are not acceptable. Conclusion: The results of

  1. Variation in Emergency Department vs Internal Medicine Excess Charges in the United States.

    Science.gov (United States)

    Xu, Tim; Park, Angela; Bai, Ge; Joo, Sarah; Hutfless, Susan M; Mehta, Ambar; Anderson, Gerard F; Makary, Martin A

    2017-08-01

    Uninsured and insured but out-of-network emergency department (ED) patients are often billed hospital chargemaster prices, which exceed amounts typically paid by insurers. To examine the variation in excess charges for services provided by emergency medicine and internal medicine physicians. Retrospective analysis was conducted of professional fee payment claims made by the Centers for Medicare & Medicaid Services for all services provided to Medicare Part B fee-for-service beneficiaries in calendar year 2013. Data analysis was conducted from January 1 to July 31, 2016. Markup ratios for ED and internal medicine professional services, defined as the charges submitted by the hospital divided by the Medicare allowable amount. Our analysis included 12 337 emergency medicine physicians from 2707 hospitals and 57 607 internal medicine physicians from 3669 hospitals in all 50 states. Services provided by emergency medicine physicians had an overall markup ratio of 4.4 (340% excess charges), which was greater than the markup ratio of 2.1 (110% excess charges) for all services performed by internal medicine physicians. Markup ratios for all ED services ranged by hospital from 1.0 to 12.6 (median, 4.2; interquartile range [IQR], 3.3-5.8); markup ratios for all internal medicine services ranged by hospital from 1.0 to 14.1 (median, 2.0; IQR, 1.7-2.5). The median markup ratio by hospital for ED evaluation and management procedure codes varied between 4.0 and 5.0. Among the most common ED services, laceration repair had the highest median markup ratio (7.0); emergency medicine physician review of a head computed tomographic scan had the greatest interhospital variation (range, 1.6-27.7). Across hospitals, markups in the ED were often substantially higher than those in the internal medicine department for the same services. Higher ED markup ratios were associated with hospital for-profit ownership (median, 5.7; IQR, 4.0-7.1), a greater percentage of uninsured patients seen

  2. Development of pediatric emergency medicine at Addis Ababa University/Tikuranbessa Specialized Hospital, Ethiopia.

    Science.gov (United States)

    Tefera, Muluwork; Bacha, Tigist; Butteris, Sabrina; Teshome, Getachew; Ross, Joshua; Hagen, Scott; Svenson, Jim; Busse, Heidi; Tefera, Girma

    2014-07-01

    In the world emergencies occur everywhere, and each day they consume ressources regardless of whether there are systems capable of achieving good outcomes. Low-income countries suffer the most highest rates of every category of injury--from traffic and the highest rates of acute complications of communicable diseases including tuberculosis, malaria and HIV. To describe the development of pediatrics emergency medicine at Tikur Anbesa Specialized Hospital A twinning partnership model was used in developing a pediatric emergency medicine training program helps in development of pediatrics emergency system. Strengthening the capacity of Addis Ababa University (AAU), Tikur Anbessa Hospital (TASH) to provide pediatric emergency medical services through improved organization of the pediatrics emergency department and strengthening of continuing education opportunities for faculty and staff capacity building by this improving quality of care in pediatrics patients in the country. The Addis Ababa University, University of Wiscosin and People to People partners intend to continue working together to strengthening and developing effetive systems to deliver quality pediatrics emergency medicine care troughout all regions of Ethiopia.

  3. Smartphones and Medical Apps in the Practice of Emergency Medicine in Iran

    Directory of Open Access Journals (Sweden)

    Amirhosein Jahanshir

    2017-01-01

    Full Text Available Introduction: Medical applications help physicians to make more rapid and evidence based decisions that may provide better patient care. This study aimed to determine the extent to which smart phones and medical applications are integrated in the emergency department daily practice.Method: In a cross sectional study, a modified standard questionnaire (Payne et al. consisting of demographic data and information regarding quality and quantity of smartphone and medical app utilization was sent to emergency-medicine residents and interns twice (two weeks apart, in January 2015. The questionnaire was put online using open access "Web-form Module" and the address of the web page was e-mailed along with a cover letter explaining the survey. Finally, responses were analyzed using descriptive statistics and SPSS 22 software.Results: 65 cases participated (response rate 86%. The mean age of interns and residents were 25.03 ± 1.13 and 30.27 ± 4.68 years, respectively (p < 0.001. There was no significant difference between interns and residents in owning a smartphone (p = 0.5. Android was more popular than IOS (67.7% against 25.8% and the most popular medical apps were Medscape and UpToDate, respectively. 38 (61.3% of the respondents were using their apps more than once a day and mostly for drug information. English (83.9%, Persian (12.9%, and other languages (3.2% were preferred languages for designing a medical software among the participants, respectively.Conclusion: The findings of present study showed that smartphones are very popular among Iranian interns and residents in emergency department and a substantial number of them own a smartphone and are using medical apps regularly in their clinical practice. 

  4. Effect of Educational Debt on Emergency Medicine Residents: A Qualitative Study Using Individual Interviews.

    Science.gov (United States)

    Young, Timothy P; Brown, Madison M; Reibling, Ellen T; Ghassemzadeh, Sassan; Gordon, Dawn M; Phan, Tammy H; Thomas, Tamara L; Brown, Lance

    2016-10-01

    In 2001, less than 20% of emergency medicine residents had more than $150,000 of educational debt. Our emergency medicine residents anecdotally reported much larger debt loads. Surveys have reported that debt affects career and life choices. Qualitative approaches are well suited to explore how and why such complex phenomena occur. We aim to gain a better understanding of how our emergency medicine residents experience debt. We conducted individual semistructured interviews with emergency medicine residents. We collected self-reported data related to educational debt and asked open-ended questions about debt influence on career choices, personal life, future plans, and financial decisions. We undertook a structured thematic analysis using a qualitative approach based in the grounded theory method. Median educational debt was $212,000. Six themes emerged from our analysis: (1) debt influenced career and life decisions by altering priorities; (2) residents experienced debt as a persistent source of background stress and felt powerless to change it; (3) residents made use of various techniques to negotiate debt in order to focus on day-to-day work; (4) personal debt philosophy, based on individual values and obtained from family, shaped how debt affected each individual; (5) debt had a normative effect and was acculturated in residency; and (6) residents reported a wide range of financial knowledge, but recognized its importance to career success. Our emergency medicine residents' debt experience is complex and involves multiple dimensions. Given our current understanding, simple solutions are unlikely to be effective in adequately addressing this issue. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  5. Social media in the emergency medicine residency curriculum: social media responses to the residents' perspective article.

    Science.gov (United States)

    Hayes, Bryan D; Kobner, Scott; Trueger, N Seth; Yiu, Stella; Lin, Michelle

    2015-05-01

    In July to August 2014, Annals of Emergency Medicine continued a collaboration with an academic Web site, Academic Life in Emergency Medicine (ALiEM), to host an online discussion session featuring the 2014 Annals Residents' Perspective article "Integration of Social Media in Emergency Medicine Residency Curriculum" by Scott et al. The objective was to describe a 14-day worldwide clinician dialogue about evidence, opinions, and early relevant innovations revolving around the featured article and made possible by the immediacy of social media technologies. Six online facilitators hosted the multimodal discussion on the ALiEM Web site, Twitter, and YouTube, which featured 3 preselected questions. Engagement was tracked through various Web analytic tools, and themes were identified by content curation. The dialogue resulted in 1,222 unique page views from 325 cities in 32 countries on the ALiEM Web site, 569,403 Twitter impressions, and 120 views of the video interview with the authors. Five major themes we identified in the discussion included curriculum design, pedagogy, and learning theory; digital curation skills of the 21st-century emergency medicine practitioner; engagement challenges; proposed solutions; and best practice examples. The immediacy of social media technologies provides clinicians the unique opportunity to engage a worldwide audience within a relatively short time frame. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  6. Trends in National Emergency Medicine Conference Didactic Lectures Over a 6-Year Period.

    Science.gov (United States)

    Gottlieb, Michael; Riddell, Jeff; Njie, Abdoulie

    2017-01-01

    National conference didactic lectures have traditionally featured hour-long lecture-based presentations. However, there is evidence that longer lectures can lead to both decreased attention and retention of information. The authors sought to identify trends in lecture duration, lecture types, and number of speakers at four national emergency medicine (EM) conferences over a 6-year period. The authors performed a retrospective analysis of the length, number of speakers, and format of didactic lectures at four different national EM conferences over 6 years. The authors abstracted data from the national academic assemblies for the four largest not-for-profit EM organizations in the United States: American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine. There was a significant yearly decrease in the mean lecture lengths for three of the four conferences. There was an increase in the percentage of rapid fire sessions over the preceding 2 years with a corresponding decrease in the percentage of general educational sessions. There was no significant difference in the mean number of speakers per lecture. An analysis of 4210 didactic lecture sessions from the annual meetings of four national EM organizations over a 6-year period showed significant decreases in mean lecture length. These findings can help to guide EM continuing medical education conference planning and research.

  7. Reflections on the consensus process: a leadership role for emergency medicine in educational scholarship and practice across health care.

    Science.gov (United States)

    Gordon, James A

    2012-12-01

    In just a few decades, emergency medicine (EM) has assumed a leadership role in medical education across many academic medical centers. This rapid evolution suggests medical education as a natural priority area for EM scholarship. This year's Academic Emergency Medicine consensus conference provides an ideal forum to focus on educational research as a core element of the specialty's academic portfolio. © 2012 by the Society for Academic Emergency Medicine.

  8. Dispatches from the front: emergency medicine teachers' perceptions of competency-based education.

    Science.gov (United States)

    Bandiera, Glen; Lendrum, David

    2011-05-01

    Controversy exists regarding the applicability of competency-based education during clinical rotations in emergency medicine (EM). Little has been written about the perceptions of front-line teachers regarding one such competency-based education paradigm, the CanMEDS framework. We undertook to determine 1) what perceptions exist among front-line teachers at two academic health science emergency departments (EDs) regarding the use of the CanMEDS roles to frame what residents should learn on ED rotations and 2) how those same teachers envision practically incorporating the CanMEDS roles into feedback provided to residents. Teachers at two sites volunteered for a semistructured focus group study. Focus groups were moderated by an experienced qualitative researcher, and verbatim transcriptions were coded by two independent reviewers. The codes were merged into final themes. The final focus group was used to further explore issues raised and test assumptions made in the preceding groups. In five focus groups involving 21 participants, the Medical Expert and Professional roles were seen as most relevant to an EM rotation, whereas the Health Advocate, Manager, Scholar, and Collaborator roles were least relevant. On further exploration, however, faculty identified highly relevant components of each role that they could envision teaching in an ED. Participants also felt that the framework helped highlight the breadth of physician competencies and provided structure for teaching and feedback. EM faculty find the CanMEDS framework helpful for structuring teaching and learning and that many elements of the roles, when defined, are feasible to integrate into a clinical rotation.

  9. Intern as Patient: A Patient Experience Simulation to Cultivate Empathy in Emergency Medicine Residents

    Directory of Open Access Journals (Sweden)

    Sara W. Nelson

    2017-12-01

    Full Text Available Introduction Prior work links empathy and positive physician-patient relationships to improved healthcare outcomes. The objective of this study was to analyze a patient experience simulation for emergency medicine (EM interns as a way to teach empathy and conscientious patient care. Methods We conducted a qualitative descriptive study on an in situ, patient experience simulation held during EM residency orientation. Half the interns were patients brought into the emergency department (ED by ambulance and half were family members. Interns then took part in focus groups that discussed the experience. Data collected during these focus groups were coded by two investigators using a grounded theory approach and constant comparative methodology. Results We identified 10 major themes and 28 subthemes in the resulting qualitative data. Themes were in three broad categories: the experience as a patient or family member in the ED; application to current clinical practice; and evaluation of the exercise itself. Interns experienced firsthand the physical discomfort, emotional stress and confusion patients and families endure during the ED care process. They reflected on lessons learned, including the importance of good communication skills, frequent updates on care and timing, and being responsive to the needs and concerns of patients and families. All interns felt this was a valuable orientation experience. Conclusion Conducting a patient experience simulation may be a practical and effective way to develop empathy in EM resident physicians. Additional research evaluating the effect of participation in the simulation over a longer time period and assessing the effects on residents’ actual clinical care is warranted.

  10. Problems associated with clinical trials of Ayurvedic medicines

    Directory of Open Access Journals (Sweden)

    Ashish K Sharma

    Full Text Available Herbal drugs have been used since ancient times as medicines for the treatment of various diseases. Especially in countries like India many of herbal drugs and formulations are used in different practices of treatment like Ayurveda, Siddha and Unani. It is estimated that about 25% of all modern medicines are directly or indirectly derived from plants sources. The contribution of developing countries in global herbal business is very poor due to lack of quality control and standardization measures. There is lack of common standards and appropriate methods for evaluating Traditional Medicine to ensure the safety, efficacy and quality control. This indicates the importance and necessity to develop a standard operational procedure for the standardization of herbal drugs and formulations. Benchmarking the evaluation protocols including both quality control and quality assurance of herbal drugs would play a major role in providing highly reliable and effective herbals drugs and to attract international trade, thus generating revenue. The article highlights various problems being faced by developing countries and suggests a unique approach for the preparation of SOP/guidelines for the standardization of all herbal based formulations, also there is a need for systematic clinical trials of traditional plant based medicines to enhance global acceptance

  11. Attitudes of Emergency Department Staff towards the Role of Clinical ...

    African Journals Online (AJOL)

    participation of future Pharm-D graduates in direct patient care in the Saudi health care system. Keywords: Clinical ... errors [3]. According to the findings of the. U.S. Institute of Medicine, ED has the highest ..... human: Building a safer health system. Washington, DC: ... department: A systems approach to minimizing risk.

  12. Definition of Specific Functions and Procedural Skills Required by Cuban Specialists in Intensive Care and Emergency Medicine.

    Science.gov (United States)

    Véliz, Pedro L; Berra, Esperanza M; Jorna, Ana R

    2015-07-01

    INTRODUCTION Medical specialties' core curricula should take into account functions to be carried out, positions to be filled and populations to be served. The functions in the professional profile for specialty training of Cuban intensive care and emergency medicine specialists do not include all the activities that they actually perform in professional practice. OBJECTIVE Define the specific functions and procedural skills required of Cuban specialists in intensive care and emergency medicine. METHODS The study was conducted from April 2011 to September 2013. A three-stage methodological strategy was designed using qualitative techniques. By purposive maximum variation sampling, 82 professionals were selected. Documentary analysis and key informant criteria were used in the first stage. Two expert groups were formed in the second stage: one used various group techniques (focus group, oral and written brainstorming) and the second used a three-round Delphi method. In the final stage, a third group of experts was questioned in semistructured in-depth interviews, and a two-round Delphi method was employed to assess priorities. RESULTS Ultimately, 78 specific functions were defined: 47 (60.3%) patient care, 16 (20.5%) managerial, 6 (7.7%) teaching, and 9 (11.5%) research. Thirty-one procedural skills were identified. The specific functions and procedural skills defined relate to the profession's requirements in clinical care of the critically ill, management of patient services, teaching and research at the specialist's different occupational levels. CONCLUSIONS The specific functions and procedural skills required of intensive care and emergency medicine specialists were precisely identified by a scientific method. This product is key to improving the quality of teaching, research, administration and patient care in this specialty in Cuba. The specific functions and procedural skills identified are theoretical, practical, methodological and social contributions to

  13. Compassion Fatigue is Similar in Emergency Medicine Residents Compared to other Medical and Surgical Specialties

    Directory of Open Access Journals (Sweden)

    M. Fernanda Bellolio

    2014-09-01

    Full Text Available Introduction: Compassion fatigue (CF is the emotional and physical burden felt by those helping others in distress, leading to a reduced capacity and interest in being empathetic towards future suffering. Emergency care providers are at an increased risk of CF secondary to their first responder roles and exposure to traumatic events. We aimed to investigate the current state of compassion fatigue among emergency medicine (EM resident physicians, including an assessment of contributing factors. Methods: We distributed a validated electronic questionnaire consisting of the Professional Quality of Life Scale with subscales for the three components of CF (compassion satisfaction, burnout and secondary traumatic stress, with each category scored independently. We collected data pertaining to day- versus night-shift distribution, hourly workload and child dependents. We included residents in EM, neurology, orthopedics, family medicine, pediatrics, obstetrics, and general surgery. Results: We surveyed 255 residents, with a response rate of 75%. Of the 188 resident respondents, 18% worked a majority of their clinical shifts overnight, and 32% had child dependents. Burnout scores for residents who worked greater than 80 hours per week, or primarily worked overnight shifts, were higher than residents who worked less than 80 hours (mean score 25.0 vs 21.5; p=0.013, or did not work overnight (mean score 23.5 vs 21.3; p=0.022. EM residents had similar scores in all three components of CF when compared to other specialties. Secondary traumatic stress scores for residents who worked greater than 80 hours were higher than residents who worked less than 80 hours (mean score 22.2 vs 19.5; p=0.048, and those with child dependents had higher secondary traumatic stress than those without children (mean score 21.0 vs 19.1; p=0.012. Conclusion: CF scores in EM residents are similar to residents in other surgical and medical specialties. Residents working primarily

  14. Does Spanish instruction for emergency medicine resident physicians improve patient satisfaction in the emergency department and adherence to medical recommendations?

    Directory of Open Access Journals (Sweden)

    Stoneking LR

    2016-08-01

    Full Text Available LR Stoneking,1 AL Waterbrook,1 J Garst Orozco,2 D Johnston,1 A Bellafiore,1 C Davies,3 T Nuño,1 J Fatás-Cabeza,4 O Beita,5 V Ng,1 KH Grall,6 W Adamas-Rappaport7 1Department of Emergency Medicine, University of Arizona, Tucson, AZ, 2Department of Emergency Medicine, Sinai Health System, Chicago, IL, 3Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ, 4Department of Spanish and Portuguese, University of Arizona, Tucson, AZ, 5Department of Family and Community Medicine, University of Arizona, Tucson, AZ, 6Department of Emergency Medicine, Regions Hospital, St Paul, MN, 7Department of Surgery, University of Arizona, Tucson, AZ, USA Background: After emergency department (ED discharge, Spanish-speaking patients with limited English proficiency are less likely than English-proficient patients to be adherent to medical recommendations and are more likely to be dissatisfied with their visit.Objectives: To determine if integrating a longitudinal medical Spanish and cultural competency curriculum into emergency medicine residency didactics improves patient satisfaction and adherence to medical recommendations in Spanish-speaking patients with limited English proficiency.Methods: Our ED has two Emergency Medicine Residency Programs, University Campus (UC and South Campus (SC. SC program incorporates a medical Spanish and cultural competency curriculum into their didactics. Real-time Spanish surveys were collected at SC ED on patients who self-identified as primarily Spanish-speaking during registration and who were treated by resident physicians from both residency programs. Surveys assessed whether the treating resident physician communicated in the patient’s native Spanish language. Follow-up phone calls assessed patient satisfaction and adherence to discharge instructions.Results: Sixty-three patients self-identified as primarily Spanish-speaking from August 2014 to July 2015 and were initially included in this pilot study

  15. Understanding Emergency Medicine Physicians Multitasking Behaviors Around Interruptions.

    Science.gov (United States)

    Fong, Allan; Ratwani, Raj M

    2018-06-11

    Interruptions can adversely impact human performance, particularly in fast-paced and high-risk environments such as the emergency department (ED). Understanding physician behaviors before, during, and after interruptions is important to the design and promotion of safe and effective workflow solutions. However, traditional human factors based interruption models do not accurately reflect the complexities of real-world environments like the ED and may not capture multiple interruptions and multitasking. We present a more comprehensive framework for understanding interruptions that is composed of three phases, each with multiple levels: Interruption Start Transition, Interruption Engagement, and Interruption End Transition. This three-phase framework is not constrained to discrete task transitions, providing a robust method to categorize multitasking behaviors around interruptions. We apply this framework in categorizing 457 interruption episodes. 457 interruption episodes were captured during 36 hours of observation. The interrupted task was immediately suspended 348 (76.1%) times. Participants engaged in new self-initiated tasks during the interrupting task 164 (35.9%) times and did not directly resume the interrupted task in 284 (62.1%) interruption episodes. Using this framework provides a more detailed description of the types of physician behaviors in complex environments. Understanding the different types of interruption and resumption patterns, which may have a different impact on performance, can support the design of interruption mitigation strategies. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  16. Booklet of the Research Institute of Clinical Medicine

    International Nuclear Information System (INIS)

    Todua, F.; Jgamadze, N.; Todua, N.; Beriashvili, Z.; Chelishvili, M.; Todua, I.; Chovelidze, Sh. et al.

    2012-01-01

    Research Institute of Clinical Medicine is one of the biggest university diagnostic and treatment centre in Georgia with unique modern diagnostic and treatment apparatus. The institute is acknowledged as a leader in various trends of radiology and surgery. The Research Institute of Clinical Medicine was founded in 1991. It is the leading scientific establishment in the field of medicine. The scientific-research work of the Institute is coordinated by the National Academy of Sciences of Georgia. The main scientific trend of the Institute is the Early Complex Diagnostics and Treatment. The scientific activity of the Institute is led by the Scientific Council. Institute achieved remarkable success since its foundation: It has been defended 56 theses for Candidate of Medical Sciences and 16 for Doctor of Medical Sciences; About 30 post-graduate students and more than 200 radiologists have taken training courses in radiology. Nowadays they work in different regions of Georgia, 21 inventions took out patents. It has been published 2000 scientific works and 9 monographs. (authors)

  17. Clinical Holistic Medicine: Chronic Pain in Internal Organs

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2005-01-01

    Full Text Available Holistic medicine seems to be efficient in the treatment of chronic pain in internal organs, especially when the pain has no known cause. It is quite surprising that while chronic pain can be one of the toughest challenges in the biomedical clinic, it is often one of the simplest things to alleviate in the holistic clinic. These pains are regarded as being caused by repressed emotions and are explained as psychosomatic reactions. Using holistic medicine, the patients can often be cured of their suffering when they assume responsibility for the repressed feelings. The holistic process theory of healing states that the return to the natural (pain free state of being is possible whenever the person obtains the resources needed for existential healing. This shift is explained by the related quality of life and life mission theories. The resources needed are “holding” or genuine care in the dimensions of awareness, respect, care, acknowledgment, and acceptance with support and processing in the dimensions of feeling, understanding, and letting go of negative attitudes and beliefs. The preconditions for the holistic healing to take place are “love” and trust. Obtaining the full trust of the patient, therefore, seems to be the biggest challenge of holistic medicine, especially when dealing with a patient in pain.

  18. Clinical research of traditional Chinese medicine in big data era.

    Science.gov (United States)

    Zhang, Junhua; Zhang, Boli

    2014-09-01

    With the advent of big data era, our thinking, technology and methodology are being transformed. Data-intensive scientific discovery based on big data, named "The Fourth Paradigm," has become a new paradigm of scientific research. Along with the development and application of the Internet information technology in the field of healthcare, individual health records, clinical data of diagnosis and treatment, and genomic data have been accumulated dramatically, which generates big data in medical field for clinical research and assessment. With the support of big data, the defects and weakness may be overcome in the methodology of the conventional clinical evaluation based on sampling. Our research target shifts from the "causality inference" to "correlativity analysis." This not only facilitates the evaluation of individualized treatment, disease prediction, prevention and prognosis, but also is suitable for the practice of preventive healthcare and symptom pattern differentiation for treatment in terms of traditional Chinese medicine (TCM), and for the post-marketing evaluation of Chinese patent medicines. To conduct clinical studies involved in big data in TCM domain, top level design is needed and should be performed orderly. The fundamental construction and innovation studies should be strengthened in the sections of data platform creation, data analysis technology and big-data professionals fostering and training.

  19. Education scholarship in emergency medicine part 1: innovating and improving teaching and learning.

    Science.gov (United States)

    Sherbino, Jonathan; Van Melle, Elaine; Bandiera, Glen; McEwen, Jill; Leblanc, Constance; Bhanji, Farhan; Frank, Jason R; Regehr, Glenn; Snell, Linda

    2014-05-01

    As emergency medicine (EM) education evolves, a more advanced understanding of education scholarship is required. This article is the first in a series of three articles that reports the recommendations of the 2013 education scholarship consensus conference of the Academic Section of the Canadian Association of Emergency Physicians. Adopting the Canadian Association for Medical Education's definition, education scholarship (including both research and innovation) is defined. A rationale for why education scholarship should be a priority for EM is discussed.

  20. Biopharmaceutical industry-sponsored global clinical trials in emerging countries.

    Science.gov (United States)

    Alvarenga, Lenio Souza; Martins, Elisabeth Nogueira

    2010-01-01

    To evaluate biopharmaceutical industry-sponsored clinical trials placed in countries previously described as emerging regions for clinical research, and potential differences for those placed in Brazil. Data regarding recruitment of subjects for clinical trials were retrieved from www.clinicaltrials.gov on February 2nd 2009. Proportions of sites in each country were compared among emerging countries. Multiple logistic regressions were performed to evaluate whether trial placement in Brazil could be predicted by trial location in other countries and/or by trial features. A total of 8,501 trials were then active and 1,170 (13.8%) included sites in emerging countries (i.e., Argentina, Brazil, China, Czech Republic, Hungary, India, Mexico, Poland, Russia, South Korea, and South Africa). South Korea and China presented a significantly higher proportion of sites when compared to other countries (pattractiveness for biopharmaceutical industry-sponsored clinical trials.

  1. The economic role of the Emergency Department in the health care continuum: applying Michael Porter's five forces model to Emergency Medicine.

    Science.gov (United States)

    Pines, Jesse M

    2006-05-01

    Emergency Medicine plays a vital role in the health care continuum in the United States. Michael Porters' five forces model of industry analysis provides an insight into the economics of emergency care by showing how the forces of supplier power, buyer power, threat of substitution, barriers to entry, and internal rivalry affect Emergency Medicine. Illustrating these relationships provides a view into the complexities of the emergency care industry and offers opportunities for Emergency Departments, groups of physicians, and the individual emergency physician to maximize the relationship with other market players.

  2. Short Sleep Times Predict Obesity in Internal Medicine Clinic Patients

    Science.gov (United States)

    Buscemi, Dolores; Kumar, Ashwani; Nugent, Rebecca; Nugent, Kenneth

    2007-01-01

    Study Objectives: Epidemiological studies have demonstrated an association between short sleep times and obesity as defined by body mass index (BMI). We wanted to determine whether this association occurs in patients with chronic medical diagnoses since the number of confounding factors is likely higher in patients than the general population. Methods: Two hundred patients attending internal medicine clinics completed a survey regarding sleep habits, lifestyle characteristics, and medical diagnoses. An independent surveyor collected the information on the questionnaires and reviewed the medical records. Height and weight were measured by clinic personnel. Data were analyzed with multivariate logistic regression. Results: Subjects with short sleep times (< 7 hours) had an increased likelihood of obesity as defined by a BMI ≥ 30 kg/m2 when compared to the reference group of (8, 9] hours (odds ratio 2.93; 95% confidence interval, 1.06–8.09). There was a U-shaped relationship between obesity and sleep time in women but not in men. Young age (18 to 49 years), not smoking, drinking alcohol, hypertension, diabetes, and sleep apnea were also associated with obesity in the overall model. Conclusions: This study demonstrates an association between short sleep times and obesity in undifferentiated patients attending an internal medicine clinic using models adjusting for age, lifestyle characteristics, and some medical diagnoses. The U-shaped relationship in women suggests that sleep patterns may have gender specific associations. These observations provide the background for therapeutic trials in weight loss in patients with established medical problems. Citation: Buscemi D; Kumar A; Nugent R; Nugent K. Short sleep times predict obesity in internal medicine clinic patients. J Clin Sleep Med 2007;3(7):681–688. PMID:18198800

  3. Advanced Bayesian processing of clinical data in nuclear medicine

    International Nuclear Information System (INIS)

    Jirsa, L.

    1999-11-01

    The Bayesian methodology was applied with a view to improving the quality of thyroid gland disease treatment at a nuclear medicine department. The specific tasks included: formulation of the estimation tasks from the theoretical point of view; elaborating algorithms to estimate various physical, medical and dosimetric quantities used in radiodiagnosis and radiotherapy of thyroid gland diseases; testing their numerical precision; testing their numerical stability on a large set of clinical data; implementation of the algorithms at a level applicable in routine conditions of the nuclear medicine department and replace by them the data processing methods used there so far; exploring and testing the quality improvement of the estimates; and in dependence on the results, proposing hints where improvement of the data measurement methodology is necessary

  4. Clinical Mass Spectrometry: Achieving Prominence in Laboratory Medicine

    Energy Technology Data Exchange (ETDEWEB)

    Annesley, Thomas M.; Cooks, Robert G.; Herold, David A.; Hoofnagle, Andrew N.

    2016-01-04

    Each year the journal Clinical Chemistry publishes a January special issue on a topic that is relevant to the laboratory medicine community. In January 2016 the topic is mass spectrometry, and the issue is entitled “Clinical Mass Spectrometry: Achieving Prominence in Laboratory Medicine”. One popular feature in our issues is a Q&A on a topic, clearly in this case mass spectrometry. The journal is assembling a panel of 5-6 experts from various areas of mass spectrometry ranging from instrument manufacturing to practicing clinical chemists. Dick Smith is one of the scientist requested to participate in this special issue Q&A on Mass Spectrometry. The Q&A Transcript is attached

  5. Enhancing clinical skills education: University of Virginia School of Medicine's Clerkship Clinical Skills Workshop Program.

    Science.gov (United States)

    Corbett, Eugene C; Payne, Nancy J; Bradley, Elizabeth B; Maughan, Karen L; Heald, Evan B; Wang, Xin Qun

    2007-07-01

    In 1993, the University of Virginia School of Medicine began a clinical skills workshop program in an effort to improve the preparation of all clerkship students to participate in clinical care. This program involved the teaching of selected basic clinical skills by interested faculty to small groups of third-year medical students. Over the past 14 years, the number of workshops has increased from 11 to 31, and they now involve clerkship faculty from family medicine, internal medicine, and pediatrics. Workshops include a variety of common skills from the communication, physical examination, and clinical test and procedure domains such as pediatric phone triage, shoulder examination, ECG interpretation, and suturing. Workshop sessions allow students to practice skills on each other, with standardized patients, or with models, with the goal of improving competence and confidence in the performance of basic clinical skills. Students receive direct feedback from faculty on their skill performance. The style and content of these workshops are guided by an explicit set of educational criteria.A formal evaluation process ensures that faculty receive regular feedback from student evaluation comments so that adherence to workshop criteria is continuously reinforced. Student evaluations confirm that these workshops meet their skill-learning needs. Preliminary outcome measures suggest that workshop teaching can be linked to student assessment data and may improve students' skill performance. This program represents a work-in-progress toward the goal of providing a more comprehensive and developmental clinical skills curriculum in the school of medicine.

  6. Emergency supply of prescription-only medicines to patients by community pharmacists: a mixed methods evaluation incorporating patient, pharmacist and GP perspectives.

    Science.gov (United States)

    Morecroft, Charles W; Mackridge, Adam J; Stokes, Elizabeth C; Gray, Nicola J; Wilson, Sarah E; Ashcroft, Darren M; Mensah, Noah; Pickup, Graham B

    2015-07-10

    To evaluate and inform emergency supply of prescription-only medicines by community pharmacists (CPs), including how the service could form an integral component of established healthcare provision to maximise adherence. Mixed methods. 4 phases: prospective audit of emergency supply requests for prescribed medicines (October-November 2012 and April 2013); interviews with CPs (February-April 2013); follow-up interviews with patients (April-May 2013); interactive feedback sessions with general practice teams (October-November 2013). 22 community pharmacies and 6 general practices in Northwest England. 27 CPs with experience of dealing with requests for emergency supplies; 25 patients who received an emergency supply of a prescribed medicine; 58 staff at 6 general practices. Clinical audit in 22 pharmacies over two 4-week periods reported that 526 medicines were requested by 450 patients. Requests peaked over a bank holiday and around weekends. A significant number of supplies were made during practice opening hours. Most requests were for older patients and for medicines used in long-term conditions. Difficulty in renewing repeat medication (forgetting to order, or prescription delays) was the major reason for requests. The majority of medicines were 'loaned' in advance of a National Health Service (NHS) prescription. Interviews with CPs and patients indicated that continuous supply had a positive impact on medicines adherence, removing the need to access urgent care. General practice staff were surprised and concerned by the extent of emergency supply episodes. CPs regularly provide emergency supplies to patients who run out of their repeat medication, including during practice opening hours. This may aid adherence. There is currently no feedback loop, however, to general practice. Patient care and interprofessional communication may be better served by the introduction of a formally structured and funded NHS emergency supply service from community pharmacies, with

  7. Emergency medicine clerkship curriculum in a high-income developing country: methods for development and application.

    Science.gov (United States)

    Cevik, Arif Alper; Cakal, Elif Dilek; Abu-Zidan, Fikri M

    2018-06-07

    The published recommendations for international emergency medicine curricula cover the content, but exclude teaching and learning methods, assessment, and evaluation. We aim to provide an overview on available emergency medicine clerkship curricula and report the development and application experience of our own curriculum. Our curriculum is an outcome-based education, enriched by e-learning and various up-to-date pedagogic principles. Teaching and learning methods, assessment, and evaluation are described. The theory behind our practice in the light of recent literature is discussed aiming to help other colleagues from developing countries to have a clear map for developing and tailoring their own curricula depending on their needs. The details of our emergency medicine clerkship will serve as an example for developing and developed countries having immature undergraduate emergency medicine clerkship curricula. However, these recommendations will differ in various settings depending on available resources. The main concept of curriculum development is to create a curriculum having learning outcomes and content relevant to the local context, and then align the teaching and learning activities, assessments, and evaluations to be in harmony. This may assure favorable educational outcome even in resource limited settings.

  8. Assessing the New Competencies for Resident Education: A Model from an Emergency Medicine Program.

    Science.gov (United States)

    Reisdorff, Earl J.; Hayes, Oliver W.; Carlson, Dale J.; Walker, Gregory L.

    2001-01-01

    Based on the experience of Michigan State University's emergency medicine residency program, proposes a practical method for modifying an existing student evaluation format. The model provides a template other programs could use in assessing residents' acquisition of the knowledge, skills, and attitudes reflected in the six general competencies…

  9. Critical Emergency Medicine Procedural Skills: A Comparative Study of Methods for Teaching and Assessment.

    Science.gov (United States)

    Chapman, Dane M.; And Others

    Three critical procedural skills in emergency medicine were evaluated using three assessment modalities--written, computer, and animal model. The effects of computer practice and previous procedure experience on skill competence were also examined in an experimental sequential assessment design. Subjects were six medical students, six residents,…

  10. The imperative for emergency medicine to create its own alternative payment model.

    Science.gov (United States)

    Medford-Davis, Laura N

    2017-06-01

    Seven years after the Affordable Care Act legislated Alternative Payment Models, it is time for Emergency Medicine to find its place within this value-based trend by developing its own Alternative Payment Model. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Gender-specific research for emergency diagnosis and management of ischemic heart disease: proceedings from the 2014 Academic Emergency Medicine Consensus Conference Cardiovascular Research Workgroup.

    Science.gov (United States)

    Safdar, Basmah; Nagurney, John T; Anise, Ayodola; DeVon, Holli A; D'Onofrio, Gail; Hess, Erik P; Hollander, Judd E; Legato, Mariane J; McGregor, Alyson J; Scott, Jane; Tewelde, Semhar; Diercks, Deborah B

    2014-12-01

    -provider communication; and 5) the changing definitions of pathophysiology call for looking beyond conventionally defined cardiovascular outcomes to patient-centered outcomes. These emergency care priorities should guide future clinical and basic science research and extramural funding in an area that greatly influences patient outcomes. © 2014 by the Society for Academic Emergency Medicine.

  12. Utility of the CORD ECG Database in Evaluating ECG Interpretation by Emergency Medicine Residents

    Directory of Open Access Journals (Sweden)

    Wong, Hubert E

    2002-10-01

    Full Text Available OBJECTIVES: Electrocardiograph (ECG interpretation is a vital component of Emergency Medicine (EM resident education, but few studies have formally examined ECG teaching methods used in residency training. Recently, the Council of EM Residency Directors (CORD developed an Internet database of 395 ECGs that have been extensively peer-reviewed to incorporate all findings and abnormalities. We examined the efficacy of this database in assessing EM residents' skills in ECG interpretation. METHODS: We used the CORD ECG database to evaluate residents at our academic three-year EM residency. Thirteen residents participated, including four first-year, four second-year, and five third-year residents. Twenty ECGs were selected using 14 search criteria representing a broad range of abnormalities, including infarction, rhythm, and conduction abnormalities. Exams were scored based on all abnormalities and findings listed in the teaching points accompanying each ECG. We assigned points to each abnormal finding based on clinical relevance. RESULTS: Out of a total of 183 points in our clinically weighted scoring system, first-year residents scored an average of 99 points (54.1% [9 1- 1191, second-year residents 11 1 points (60.4% [97-1261, and third-year residents 130 points (7 1.0% [94- 1501, p = 0.12. Clinically relevant abnormalities, including anterior and inferior myocardial infarctions, were most frequently diagnosed correctly, while posterior infarction was more frequently missed. Rhythm abnormalities including ventricular and supraventricular tachycardias were most frequently diagnosed correctly, while conduction abnormalities including left bundle branch block and atrioventricular (AV block were more frequently missed. CONCLUSION: The CORD database represents a valuable resource in the assessment and teaching of ECG skills, allowing more precise identification of areas upon which instruction should be further focused or individually tailored. Our

  13. Clinical laboratory analytics: Challenges and promise for an emerging discipline

    Directory of Open Access Journals (Sweden)

    Brian H Shirts

    2015-01-01

    Full Text Available The clinical laboratory is a major source of health care data. Increasingly these data are being integrated with other data to inform health system-wide actions meant to improve diagnostic test utilization, service efficiency, and "meaningful use." The Academy of Clinical Laboratory Physicians and Scientists hosted a satellite meeting on clinical laboratory analytics in conjunction with their annual meeting on May 29, 2014 in San Francisco. There were 80 registrants for the clinical laboratory analytics meeting. The meeting featured short presentations on current trends in clinical laboratory analytics and several panel discussions on data science in laboratory medicine, laboratory data and its role in the larger healthcare system, integrating laboratory analytics, and data sharing for collaborative analytics. One main goal of meeting was to have an open forum of leaders that work with the "big data" clinical laboratories produce. This article summarizes the proceedings of the meeting and content discussed.

  14. An innovative longitudinal curriculum to increase emergency medicine residents’ exposure to rarely encountered and technically challenging procedures

    Directory of Open Access Journals (Sweden)

    Grall KH

    2014-07-01

    Full Text Available Kristi H Grall,1 Lisa R Stoneking,1 Lawrence A DeLuca,1 Anna L Waterbrook,1 T Gail Pritchard,2,3 Kurt R Denninghoff1 1Department of Emergency Medicine, The College of Medicine, The University of Arizona, 2Office Medical Student Education, 3Office of Graduate Medical Education, The College of Medicine, The University of Arizona, Tucson, AZ, USA Background: Procedural skills have historically been taught at the bedside. In this study, we aimed to increase resident knowledge of uncommon emergency medical procedures to increase residents’ procedural skills in common and uncommon emergency medical procedures and to integrate cognitive training with hands-on procedural instruction using high- and low-fidelity simulation. Methods: We developed 13 anatomically/physiologically-based procedure modules focusing on uncommon clinical procedures and/or those requiring higher levels of technical skills. A departmental expert directed each session with collaboration from colleagues in related subspecialties. Sessions were developed based on Manthey and Fitch’s stages of procedural competency including 1 knowledge acquisition, 2 experience/technical skill development, and 3 competency evaluation. We then distributed a brief, 10-question, online survey to our residents in order to solicit feedback regarding their perceptions of increased knowledge and ability in uncommon and common emergency medical procedures, and their perception of the effectiveness of integrated cognitive training with hands-on instruction through high- and low-fidelity simulation. Results: Fifty percent of our residents (11/22 responded to our survey. Responses indicated the procedure series helped with understanding of both uncommon (65% strongly agreed [SA], 35% agreed [A] and common (55% SA, 45% A emergency medicine procedures and increased residents’ ability to perform uncommon (55% SA, 45% A and common (45% SA, 55% A emergency medical procedures. In addition, survey results

  15. Novel Emergency Medicine Curriculum Utilizing Self-Directed Learning and the Flipped Classroom Method: Gastrointestinal Emergencies Small Group Module

    Directory of Open Access Journals (Sweden)

    Andrew King

    2017-01-01

    Full Text Available Audience and type of curriculum: This curriculum created and implemented at The Ohio State University Wexner Medical Center was designed to educate our emergency medicine (EM residents, PGY-1 to PGY-3, as well as medical students and attending physicians. Introduction/Background: Gastrointestinal (GI emergencies comprise approximately 12% of emergency department (ED visits.1 Residents must be proficient in the differential diagnosis and management of the wide variety of GI emergencies. The flipped classroom curricular model emphasizes self-directed learning activities completed by learners, followed by small group discussions pertaining to the topic reviewed. The active learning fostered by this curriculum increases faculty and learner engagement and interaction time typically absent in traditional lecture-based formats.2-4 Studies have revealed that the application of knowledge through case studies, personal interaction with content experts, and integrated questions are effective learning strategies for emergency medicine residents.4-6 The Ohio State University EM Residency didactic curriculum recently transitioned to a “flipped classroom” approach.7-10 We created this innovative curriculum aimed to improve our residency education program and to share educational resources with other EM residency programs. This proposed curriculum utilizes an 18-month curricular cycle. The flipped classroom curriculum maximizes didactic time and resident engagement, fosters intellectual curiosity and active learning, and meets the needs of today’s learners. 3,6,11 Objectives: We aim to teach the presentation and management of GI emergencies through the creation of a flipped classroom design. This unique, innovative curriculum utilizes resources chosen by education faculty and resident learners, study questions, real-life experiences, and small group discussions in place of traditional lectures. In doing so, a goal of the curriculum is to encourage self

  16. Off-label prescription of genetically modified organism medicines in europe: emerging conflicts of interest?

    Science.gov (United States)

    Schagen, Frederik H E; Hoeben, Rob C; Hospers, Geke A P

    2014-10-01

    Recently, the first human medicine containing a genetically modified organism (GMO medicine) was authorized for use in the European market. Just as any medicinal product, the market authorization for a GMO medicine contains a precise description of the therapeutic use for which the medicinal product is intended. Within this use, the application of the GMO medicine is permitted, without the need for the institution to obtain a specific permit. In practice, however, medicinal products are also frequently prescribed for treatment outside the registered therapeutic use, a practice that is referred to as "off-label use." While off-label use of conventional medicines is permitted and has been very useful, the off-label use of GMO medicines is not covered in the European Union (EU) legislation or guidelines and falls under each member state's national environmental legislation. This implies that in the Netherlands and most other EU member states, an environmental permit will be required for any institution that uses the GMO medicine outside the registered application(s). In the Netherlands, this permit is identical to the permits required for the execution of clinical trials involving nonregistered GMOs. The application procedure for such permit is time-consuming. This process can therefore limit the therapeutic options for medical professionals. As a consequence, desired treatment regimens could be withheld for certain patient (groups). To make future off-label use of GMO medicines permissible in a way that is acceptable for all stakeholders, regulators should adopt a proactive attitude and formulate transparent legislative procedures for this. Only then the field can maintain the public acceptance of GMO medicines, while maintaining the freedom to operate of medical professionals.

  17. Emergency medicine resident crisis resource management ability: a simulation-based longitudinal study

    Directory of Open Access Journals (Sweden)

    Samuel Clarke

    2014-12-01

    Full Text Available Background: Simulation has been identified as a means of assessing resident physicians’ mastery of technical skills, but there is a lack of evidence for its utility in longitudinal assessments of residents’ non-technical clinical abilities. We evaluated the growth of crisis resource management (CRM skills in the simulation setting using a validated tool, the Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS. We hypothesized that the Ottawa GRS would reflect progressive growth of CRM ability throughout residency. Methods: Forty-five emergency medicine residents were tracked with annual simulation assessments between 2006 and 2011. We used mixed-methods repeated-measures regression analyses to evaluate elements of the Ottawa GRS by level of training to predict performance growth throughout a 3-year residency. Results: Ottawa GRS scores increased over time, and the domains of leadership, problem solving, and resource utilization, in particular, were predictive of overall performance. There was a significant gain in all Ottawa GRS components between postgraduate years 1 and 2, but no significant difference in GRS performance between years 2 and 3. Conclusions: In summary, CRM skills are progressive abilities, and simulation is a useful modality for tracking their development. Modification of this tool may be needed to assess advanced learners’ gains in performance.

  18. Competency Assessment in Senior Emergency Medicine Residents for Core Ultrasound Skills.

    Science.gov (United States)

    Schmidt, Jessica N; Kendall, John; Smalley, Courtney

    2015-11-01

    Quality resident education in point-of-care ultrasound (POC US) is becoming increasingly important in emergency medicine (EM); however, the best methods to evaluate competency in graduating residents has not been established. We sought to design and implement a rigorous assessment of image acquisition and interpretation in POC US in a cohort of graduating residents at our institution. We evaluated nine senior residents in both image acquisition and image interpretation for five core US skills (focused assessment with sonography for trauma (FAST), aorta, echocardiogram (ECHO), pelvic, central line placement). Image acquisition, using an observed clinical skills exam (OSCE) directed assessment with a standardized patient model. Image interpretation was measured with a multiple-choice exam including normal and pathologic images. Residents performed well on image acquisition for core skills with an average score of 85.7% for core skills and 74% including advanced skills (ovaries, advanced ECHO, advanced aorta). Residents scored well but slightly lower on image interpretation with an average score of 76%. Senior residents performed well on core POC US skills as evaluated with a rigorous assessment tool. This tool may be developed further for other EM programs to use for graduating resident evaluation.

  19. Blended learning in paediatric emergency medicine: preliminary analysis of a virtual learning environment.

    Science.gov (United States)

    Spedding, Ruth; Jenner, Rachel; Potier, Katherine; Mackway-Jones, Kevin; Carley, Simon

    2013-04-01

    Paediatric emergency medicine (PEM) currently faces many competing educational challenges. Recent changes to the working patterns have made the delivery of effective teaching to trainees extremely difficult. We developed a virtual learning environment, on the basis of socioconstructivist principles, which allows learning to take place regardless of time or location. The aim was to evaluate the effectiveness of a blended e-learning approach for PEM training. We evaluated the experiences of ST3 trainees in PEM using a multimodal approach. We classified and analysed message board discussions over a 6-month period to look for evidence of practice change and learning. We conducted semistructured qualitative interviews with trainees approximately 5 months after they completed the course. Trainees embraced the virtual learning environment and had positive experiences of the blended approach to learning. Socioconstructivist learning did take place through the use of message boards on the virtual learning environment. Despite their initial unfamiliarity with the online learning system, the participants found it easy to access and use. The participants found the learning relevant and there was an overlap between shop floor learning and the online content. Clinical discussion was often led by trainees on the forums and these were described as enjoyable and informative. A blended approach to e-learning in basic PEM is effective and enjoyable to trainees.

  20. Online research article discussion board to increase knowledge translation during emergency medicine residency.

    Science.gov (United States)

    Stoneking, Lisa R; Grall, Kristi H; Min, Alice A; Panchal, Ashish R

    2013-01-01

    Many clinicians have difficulties reading current best practice journal articles on a regular basis. Discussion boards are one method of online asynchronous learning that facilitates active learning and participation. We hypothesized that an online repository of best practice articles with a discussion board would increase journal article reading by emergency medicine residents. PARTICIPANTS ANSWERED THREE QUESTIONS WEEKLY ON A DISCUSSION BOARD: What question does this study address? What does this study add to our knowledge? How might this change clinical practice? A survey regarding perceived barriers to participating was then distributed. Most participants completed an article summary once or twice in total (23/32, 71.9%). Only three were involved most weeks (3/32, 9.4%) whereas 5/32 (15.6%) participated monthly. The most common barriers were lack of time (20/32, 62.5%), difficulty logging on (7/32, 21.9%), and forgetting (6/32, 18.8%). Although subjects were provided weekly with an article link, email, and feedback, journal article reading frequency did not increase.

  1. Strategies to overcome clinical, regulatory, and financial challenges in the implementation of personalized medicine.

    Science.gov (United States)

    Tsimberidou, Apostolia M; Ringborg, Ulrik; Schilsky, Richard L

    2013-01-01

    This article highlights major developments over the last decade in personalized medicine in cancer. Emerging data from clinical studies demonstrate that the use of targeted agents in patients with targetable molecular aberrations improves clinical outcomes. Despite a surge of studies, however, significant gaps in knowledge remain, especially in identifying driver molecular aberrations in patients with multiple aberrations, understanding molecular networks that control carcinogenesis and metastasis, and most importantly, discovering effective targeted agents. Implementation of personalized medicine requires continued scientific and technological breakthroughs; standardization of tumor tissue acquisition and molecular testing; changes in oncology practice and regulatory standards for drug and device access and approval; modification of reimbursement policies by health care payers; and innovative ways to collect and analyze electronic patient information that are linked to prospective clinical registries and rapid learning systems. Informatics systems that integrate clinical, laboratory, radiologic, molecular, and economic data will improve clinical care and will provide infrastructure to enable clinical research. The initiative of the EurocanPlatform aims to overcome the challenges of implementing personalized medicine in Europe by sharing patients, biologic materials, and technological resources across borders. The EurocanPlatform establishes a complete translational cancer research program covering the drug development process and strengthening collaborations among academic centers, pharmaceutical companies, regulatory authorities, health technology assessment organizations, and health care systems. The CancerLinQ rapid learning system being developed by ASCO has the potential to revolutionize how all stakeholders in the cancer community assemble and use information obtained from patients treated in real-world settings to guide clinical practice, regulatory

  2. Emergency medicine resident physicians' perceptions of electronic documentation and workflow: a mixed methods study.

    Science.gov (United States)

    Neri, P M; Redden, L; Poole, S; Pozner, C N; Horsky, J; Raja, A S; Poon, E; Schiff, G; Landman, A

    2015-01-01

    To understand emergency department (ED) physicians' use of electronic documentation in order to identify usability and workflow considerations for the design of future ED information system (EDIS) physician documentation modules. We invited emergency medicine resident physicians to participate in a mixed methods study using task analysis and qualitative interviews. Participants completed a simulated, standardized patient encounter in a medical simulation center while documenting in the test environment of a currently used EDIS. We recorded the time on task, type and sequence of tasks performed by the participants (including tasks performed in parallel). We then conducted semi-structured interviews with each participant. We analyzed these qualitative data using the constant comparative method to generate themes. Eight resident physicians participated. The simulation session averaged 17 minutes and participants spent 11 minutes on average on tasks that included electronic documentation. Participants performed tasks in parallel, such as history taking and electronic documentation. Five of the 8 participants performed a similar workflow sequence during the first part of the session while the remaining three used different workflows. Three themes characterize electronic documentation: (1) physicians report that location and timing of documentation varies based on patient acuity and workload, (2) physicians report a need for features that support improved efficiency; and (3) physicians like viewing available patient data but struggle with integration of the EDIS with other information sources. We confirmed that physicians spend much of their time on documentation (65%) during an ED patient visit. Further, we found that resident physicians did not all use the same workflow and approach even when presented with an identical standardized patient scenario. Future EHR design should consider these varied workflows while trying to optimize efficiency, such as improving

  3. Organization, execution and evaluation of the 2014 Academic Emergency Medicine consensus conference on Gender-Specific Research in Emergency Care - an executive summary.

    Science.gov (United States)

    Safdar, Basmah; Greenberg, Marna R

    2014-12-01

    With the goal of reducing inequalities in patient care, the 2014 Academic Emergency Medicine (AEM) consensus conference, "Gender-Specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes," convened a diverse group of researchers, clinicians, health care providers, patients, and representatives of federal agencies and policy-makers in Dallas, Texas, in May 2014. The executive and steering committees identified seven clinical domains as key to gender-specific emergency care: cardiovascular, neurological, trauma/injury, substance abuse, pain, mental health, and diagnostic imaging. The main aims of the conference were to: 1) summarize and consolidate current data related to sex- and gender-specific research for acute care and identify critical gender-related gaps in knowledge to inform an EM research agenda; 2) create a consensus-driven research agenda that advances sex- and gender-specific research in the prevention, diagnosis, and management of acute diseases and identify strategies to investigate them; and 3) build a multinational interdisciplinary consortium to disseminate and study the sex and gender medicine of acute conditions. Over a 2-year period, this collaborative network of stakeholders identified key areas where sex- and gender-specific research is most likely to improve clinical care and ultimately patient outcomes. The iterative consensus process culminated in a daylong conference on May 13, 2014, with a total of 133 registrants, with the majority being between ages 31 and 50 years (57%), females (71%), and whites (79%). Content experts led the consensus-building workshops at the conference and used the nominal group technique to consolidate consensus recommendations for priority research. In addition, panel sessions addressed funding mechanisms for gender-specific research as well as gender-specific regulatory challenges to product development and approval. This special issue of AEM reports the

  4. Creating a contemporary clerkship curriculum: the flipped classroom model in emergency medicine.

    Science.gov (United States)

    Lew, Edward K

    2016-12-01

    The teaching modality of "flipping the classroom" has garnered recent attention in medical education. In this model, the lecture and homework components are reversed. The flipped classroom lends itself to more interaction in "class" and theoretically improved clinical decision-making. Data is lacking for this model for students in emergency medicine clerkships. We trialed the flipped classroom in our fourth-year student clerkship. Our aim was to learn student and faculty facilitator perceptions of the experience, as it has not been done previously in this setting. We evaluated this in two ways: (1) participant perception of the experience and (2) facilitator (EM physician educator) perception of student preparation, participation, and knowledge synthesis. With permission from its creators, we utilized an online video series derived from the Clerkship Directors in Emergency Medicine. Students were provided the link to these 1 week prior to the classroom experience as the "homework." We developed patient cases generated from the videos that we discussed during class in small-group format. Afterward, students were surveyed about the experience using four-point Likert items and free-text comments and also were evaluated by the facilitator on a nine-point scale. Forty-six clerkship students participated. Students deemed the online modules useful at 2.9 (95 % CI 2.7-3.2). Further, they reported the in-class discussion to be of high value at 3.9 (95 % CI 3.8-4.0), much preferred the flipped classroom to traditional lecturing at 3.8 (95 % CI 3.6-3.9), and rated the overall experience highly at 3.8 (95 % CI 3.7-3.9). Based on preparation, participation, and knowledge synthesis, the facilitator judged participants favorably at 7.4 (95 % CI 7.0-7.8). Students commented that the interactivity, discussion, and medical decision-making were advantages of this format. Students found high value in the flipped classroom and prefer it to traditional lecturing, citing

  5. The current status and reinforcement plan for radiation emergency medicine in Korea

    International Nuclear Information System (INIS)

    Kim, Hyun Ki; Lee, Youngmin; Lee, Jai Ki

    2011-01-01

    Korea operating twenty nuclear power plants was ranked 6th in nuclear power generation in the world. The potential risk for radiological emergency also increases along with the growing use of radiation and radioisotopes and a constant expansion of the nuclear industry in neighboring countries, Japan and China. This paper is intended for finding ways to strengthen medical planning and response preparedness from achievements in radiation emergency medicine over the years. 'Integrated Medical Preparedness System' for a radiological disaster is proposed as a practical way to enhance mobilization of existing human and material resources in the health care. It is based on the collaborative response among the related medical institutes : radiation emergency medical institutes around the Korean Institute of Radiological and Medical Sciences, emergency medical centers around the National Emergency Medical Center and other hospitals available. (author)

  6. The German emergency and disaster medicine and management system-history and present.

    Science.gov (United States)

    Hecker, Norman; Domres, Bernd Dieter

    2018-04-01

    As well for optimized emergency management in individual cases as for optimized mass medicine in disaster management, the principle of the medical doctors approaching the patient directly and timely, even close to the site of the incident, is a long-standing marker for quality of care and patient survival in Germany. Professional rescue and emergency forces, including medical services, are the "Golden Standard" of emergency management systems. Regulative laws, proper organization of resources, equipment, training and adequate delivery of medical measures are key factors in systematic approaches to manage emergencies and disasters alike and thus save lives. During disasters command, communication, coordination and cooperation are essential to cope with extreme situations, even more so in a globalized world. In this article, we describe the major historical milestones, the current state of the German system in emergency and disaster management and its integration into the broader European approach. Copyright © 2018. Production and hosting by Elsevier B.V.

  7. Video-Based Learning vs Traditional Lecture for Instructing Emergency Medicine Residents in Disaster Medicine Principles of Mass Triage, Decontamination, and Personal Protective Equipment.

    Science.gov (United States)

    Curtis, Henry A; Trang, Karen; Chason, Kevin W; Biddinger, Paul D

    2018-02-01

    Introduction Great demands have been placed on disaster medicine educators. There is a need to develop innovative methods to educate Emergency Physicians in the ever-expanding body of disaster medicine knowledge. The authors sought to demonstrate that video-based learning (VBL) could be a promising alternative to traditional learning methods for teaching disaster medicine core competencies. Hypothesis/Problem The objective was to compare VBL to traditional lecture (TL) for instructing Emergency Medicine residents in the American College of Emergency Physicians (ACEP; Irving, Texas USA) disaster medicine core competencies of patient triage and decontamination. A randomized, controlled pilot study compared two methods of instruction for mass triage, decontamination, and personal protective equipment (PPE). Emergency Medicine resident learning was measured with a knowledge quiz, a Likert scale measuring comfort, and a practical exercise. An independent samples t-test compared the scoring of the VBL with the TL group. Twenty-six residents were randomized to VBL (n=13) or TL (n=13). Knowledge score improvement following video (14.9%) versus lecture (14.1%) did not differ significantly between the groups (P=.74). Comfort score improvement also did not differ (P=.64) between video (18.3%) and lecture groups (15.8%). In the practical skills assessment, the VBL group outperformed the TL group overall (70.4% vs 55.5%; Plearning vs traditional lecture for instructing emergency medicine residents in disaster medicine principles of mass triage, decontamination, and personal protective equipment. Prehosp Disaster Med. 2018;33(1):7-12.

  8. Establishing research priorities for patient safety in emergency medicine: a multidisciplinary consensus panel.

    Science.gov (United States)

    Plint, Amy C; Stang, Antonia S; Calder, Lisa A

    2015-01-01

    Patient safety in the context of emergency medicine is a relatively new field of study. To date, no broad research agenda for patient safety in emergency medicine has been established. The objective of this study was to establish patient safety-related research priorities for emergency medicine. These priorities would provide a foundation for high-quality research, important direction to both researchers and health-care funders, and an essential step in improving health-care safety and patient outcomes in the high-risk emergency department (ED) setting. A four-phase consensus procedure with a multidisciplinary expert panel was organized to identify, assess, and agree on research priorities for patient safety in emergency medicine. The 19-member panel consisted of clinicians, administrators, and researchers from adult and pediatric emergency medicine, patient safety, pharmacy, and mental health; as well as representatives from patient safety organizations. In phase 1, we developed an initial list of potential research priorities by electronically surveying a purposeful and convenience sample of patient safety experts, ED clinicians, administrators, and researchers from across North America using contact lists from multiple organizations. We used simple content analysis to remove duplication and categorize the research priorities identified by survey respondents. Our expert panel reached consensus on a final list of research priorities through an in-person meeting (phase 3) and two rounds of a modified Delphi process (phases 2 and 4). After phases 1 and 2, 66 unique research priorities were identified for expert panel review. At the end of phase 4, consensus was reached for 15 research priorities. These priorities represent four themes: (1) methods to identify patient safety issues (five priorities), (2) understanding human and environmental factors related to patient safety (four priorities), (3) the patient perspective (one priority), and (4) interventions for

  9. MD-CTS: An integrated terminology reference of clinical and translational medicine

    Directory of Open Access Journals (Sweden)

    Will Ray

    2016-01-01

    Full Text Available New vocabularies are rapidly evolving in the literature relative to the practice of clinical medicine and translational research. To provide integrated access to new terms, we developed a mobile and desktop online reference—Marshfield Dictionary of Clinical and Translational Science (MD-CTS. It is the first public resource that comprehensively integrates Wiktionary (word definition, BioPortal (ontology, Wiki (image reference, and Medline abstract (word usage information. MD-CTS is accessible at http://spellchecker.mfldclin.edu/. The website provides a broadened capacity for the wider clinical and translational science community to keep pace with newly emerging scientific vocabulary. An initial evaluation using 63 randomly selected biomedical words suggests that online references generally provided better coverage (73%-95% than paper-based dictionaries (57–71%.

  10. Ethical Diversity and the Role of Conscience in Clinical Medicine

    Science.gov (United States)

    Genuis, Stephen J.; Lipp, Chris

    2013-01-01

    In a climate of plurality about the concept of what is “good,” one of the most daunting challenges facing contemporary medicine is the provision of medical care within the mosaic of ethical diversity. Juxtaposed with escalating scientific knowledge and clinical prowess has been the concomitant erosion of unity of thought in medical ethics. With innumerable technologies now available in the armamentarium of healthcare, combined with escalating realities of financial constraints, cultural differences, moral divergence, and ideological divides among stakeholders, medical professionals and their patients are increasingly faced with ethical quandaries when making medical decisions. Amidst the plurality of values, ethical collision arises when the values of individual health professionals are dissonant with the expressed requests of patients, the common practice amongst colleagues, or the directives from regulatory and political authorities. In addition, concern is increasing among some medical practitioners due to mounting attempts by certain groups to curtail freedom of independent conscience—by preventing medical professionals from doing what to them is apparently good, or by compelling practitioners to do what they, in conscience, deem to be evil. This paper and the case study presented will explore issues related to freedom of conscience and consider practical approaches to ethical collision in clinical medicine. PMID:24455248

  11. Nano medicine in Action: An Overview of Cancer Nano medicine on the Market and in Clinical Trials

    International Nuclear Information System (INIS)

    Wang, R.; Billone, P.S.; Mullett, W.M.

    2013-01-01

    Nano medicine, defined as the application of nano technology in the medical field, has the potential to significantly change the course of diagnostics and treatment of life-threatening diseases, such as cancer. In comparison with traditional cancer diagnostics and therapy, cancer nano medicine provides sensitive cancer detection and/or enhances treatment efficacy with significantly minimized adverse effects associated with standard therapeutics. Cancer nano medicine has been increasingly applied in areas including nano drug delivery systems, nano pharmaceuticals, and nano analytical contrast reagents in laboratory and animal model research. In recent years, the successful introduction of several novel nano medicine products into clinical trials and even onto the commercial market has shown successful outcomes of fundamental research into clinics. This paper is intended to examine several nano medicines for cancer therapeutics and/or diagnostics-related applications, to analyze the trend of nano medicine development, future opportunities, and challenges of this fast-growing area.

  12. [Perceptions of students and teachers about clinical medicine learning].

    Science.gov (United States)

    Bitran, Marcela; Zúñiga, Denisse; Leiva, Isabel; Calderón, Maribel; Tomicic, Alemka; Padilla, Oslando; Riquelme, Arnoldo

    2014-06-01

    The transition to the clinical courses represents a major challenge for medical students who are expected to become experiential learners, able to integrate theory and practice in the context of patient care. There are questions about how students face this challenge. To understand and compare the perceptions of students and clinical tutors on how medical students learn during the transition to the clinical levels of the curriculum. We performed eight focus group discussions with 54 students enrolled in years three to seven and we interviewed eight clinical tutors. Both students' focus group discussions and tutors' interviews were audio recorded, transcribed and analyzed according to the Grounded Theory. Nine main themes emerged from the analysis of students' opinions and six from the tutors' views. The following themes were common to both students and educators: educational activities, actors, clinical settings, learning strategies, transition markers and tutor's role. Educators emphasized the importance of curricular courses' design and students, that of emotions, adaptation and self-care strategies, and threats to learning. There is a common core of students' and clinical tutors' perceptions about the relevance of practical activities, social interactions and context in the development of students' learning and adaptation strategies during the transition to the clinical levels of the curriculum. These results are related to social and cultural theories of learning. Thus we propose a model for early clinical learning that might help to stimulate the reflection of students and medical educators regarding clinical learning and contribute to the development of interventions that improve the clinical learning and teaching practices.

  13. Child Rights and Clinical Bioethics: Historical Reflections on Modern Medicine and Ethics.

    Science.gov (United States)

    Brosco, Jeffrey P

    2016-01-01

    Why might pediatric bioethicists in the United States reject the U.N. Convention on the Rights of the Child (CRC) as a framework for resolving ethical issues? The essays in this issue present arguments and counterarguments regarding the usefulness of the CRC in various clinical and research cases. But underlying this debate are two historical factors that help explain the seeming paradox of pediatric bioethicists' arguing against child's rights. First, the profession of clinical bioethics emerged in the 1970s as one component of modern medicine's focus on improving health through the application of technologically sophisticated treatments. The everyday work of U.S. bioethicists thus usually involves emerging technologies or practices in clinical or laboratory settings; the articles of the CRC, in contrast, seem better suited to addressing broad policy issues that affect the social determinants of health. Second, U.S. child health policy veered away from a more communitarian approach in the early 20th century for reasons of demography that were reinforced by ideology and concerns about immigration. The divide between clinical medicine and public health in the United States, as well as the relatively meager social safety net, are not based on a failure to recognize the rights of children. Indeed, there is some historical evidence to suggest that "rights language" has hindered progress on child health and well-being in the United States. In today's political climate, efforts to ensure that governments pledge to treat children in accordance with their status as human beings (a child right's perspective) are less likely to improve child health than robust advocacy on behalf of children's unique needs, especially as novel models of health-care financing emerge.

  14. Comparison of Patient Health History Questionnaires Used in General Internal and Family Medicine, Integrative Medicine, and Complementary and Alternative Medicine Clinics.

    Science.gov (United States)

    Laube, Justin G R; Shapiro, Martin F

    2017-05-01

    Health history questionnaires (HHQs) are a set of self-administered questions completed by patients prior to a clinical encounter. Despite widespread use, minimal research has evaluated the content of HHQs used in general internal medicine and family medicine (GIM/FM), integrative medicine, and complementary and alternative medicine (CAM; chiropractic, naturopathic, and Traditional Chinese Medicine [TCM]) clinics. Integrative medicine and CAM claim greater emphasis on well-being than does GIM/FM. This study investigated whether integrative medicine and CAM clinics' HHQs include more well-being content and otherwise differ from GIM/FM HHQs. HHQs were obtained from GIM/FM (n = 9), integrative medicine (n = 11), naturopathic medicine (n = 5), chiropractic (n = 4), and TCM (n = 7) clinics in California. HHQs were coded for presence of medical history (chief complaint, past medical history, social history, family history, surgeries, hospitalizations, medications, allergies, review of systems), health maintenance procedures (immunization, screenings), and well-being components (nutrition, exercise, stress, sleep, spirituality). In HHQs of GIM/FM clinics, the average number of well-being components was 1.4 (standard deviation [SD], 1.4) compared with 4.0 (SD, 1.1) for integrative medicine (p medicine (p = 0.04), 2.0 (SD, 1.4) for chiropractic (p = 0.54), and 2.0 (SD, 1.5) for TCM (p = 0.47). In HHQs of GIM/FM clinics, the average number of medical history components was 6.4 (SD, 1.9) compared with 8.3 (SD, 1.2) for integrative medicine (p = 0.01), 9.0 (SD, 0) for naturopathic medicine (p = 0.01), 7.1 (SD, 2.8) for chiropractic (p = 0.58), and 7.1 (SD, 1.7) for TCM (p = 0.41). Integrative and naturopathic medicine HHQs included significantly more well-being and medical history components than did GIM/FM HHQs. Further investigation is warranted to determine the optimal HHQ content to support the clinical and preventive

  15. Executive Summary from the 2017 Emergency Medicine Resident Wellness Consensus Summit.

    Science.gov (United States)

    Battaglioli, Nicole; Ankel, Felix; Doty, Christopher I; Chung, Arlene; Lin, Michelle

    2018-03-01

    Physician wellness has recently become a popular topic of conversation and publication within the house of medicine and specifically within emergency medicine (EM). Through a joint collaboration involving Academic Life in Emergency Medicine's (ALiEM) Wellness Think Tank, Essentials of Emergency Medicine (EEM), and the Emergency Medicine Residents' Association (EMRA), a one-day Resident Wellness Consensus Summit (RWCS) was organized. The RWCS was held on May 15, 2017, as a pre-day event prior to the 2017 EEM conference in Las Vegas, Nevada. Seven months before the RWCS event, pre-work began in the ALiEM Wellness Think Tank, which was launched in October 2016. The Wellness Think Tank is a virtual community of practice involving EM residents from the U.S. and Canada, hosted on the Slack digital-messaging platform. A working group was formed for each of the four predetermined themes: wellness curriculum development; educator toolkit resources for specific wellness topics; programmatic innovations; and wellness-targeted technologies. Pre-work for RWCS included 142 residents from 100 different training programs in the Wellness Think Tank. Participants in the actual RWCS event included 44 EM residents, five EM attendings who participated as facilitators, and three EM attendings who acted as participants. The four working groups ultimately reached a consensus on their specific objectives to improve resident wellness on both the individual and program level. The Resident Wellness Consensus Summit was a unique and novel consensus meeting, involving residents as the primary stakeholders. The summit demonstrated that it is possible to galvanize a large group of stakeholders in a relatively short time by creating robust trust, communication, and online learning networks to create resources that support resident wellness.

  16. Investigation on legal problems encountered by emergency medicine physicians in Turkey.

    Science.gov (United States)

    Kayipmaz, Afsin Emre; Kavalci, Cemil; Gulalp, Betul; Kocalar, Ummu Gulsum; Giray, Tufan Akin; Yesilagac, Hasan; Ozel, Betul Akbuga; Celikel, Elif; Karagun, Ozlem

    2015-01-01

    Medicine is a profession that carries certain risks. One risky area of practice is the emergency department. Emergency physicians diagnose and treat a high volume of patients, and are also responsible for preparing reports for forensic cases. In this study, we aim to investigate emergency physicians' legal-administrative problems and reveal their level of understanding on forensic cases. An electronic questionnaire form was prepared after the approval of an ethical committee. This form was sent to the residents, specialists and academicians of emergency medicine by e-mail. The physicians were asked to fill out the form online. All the gathered data was analyzed. Descriptive statistics were presented as frequency percentages with mean and standard deviation. Chi-square tests were used to compare the groups. Correlation between number of complaint cases and age, sex, career, institution, and duration of service in emergency department were investigated. pmedicine and age. There was a significant difference between number of complaint reports and career (p<0.05). The physicians' level of awareness on forensic cases was found to be insufficient. Lack of legislation knowledge may be an important cause of complaint reports concerning emergency physicians, who have a high load of patients. Thus, we think that increasing the frequency of post-graduate education sessions and periodical reviews might be beneficial.

  17. Investigation on legal problems encountered by emergency medicine physicians in Turkey.

    Directory of Open Access Journals (Sweden)

    Afsin Emre Kayipmaz

    Full Text Available Medicine is a profession that carries certain risks. One risky area of practice is the emergency department. Emergency physicians diagnose and treat a high volume of patients, and are also responsible for preparing reports for forensic cases. In this study, we aim to investigate emergency physicians' legal-administrative problems and reveal their level of understanding on forensic cases.An electronic questionnaire form was prepared after the approval of an ethical committee. This form was sent to the residents, specialists and academicians of emergency medicine by e-mail. The physicians were asked to fill out the form online. All the gathered data was analyzed. Descriptive statistics were presented as frequency percentages with mean and standard deviation. Chi-square tests were used to compare the groups. Correlation between number of complaint cases and age, sex, career, institution, and duration of service in emergency department were investigated. p<0.05 was considered statistically significant.294 physicians participated in the questionnaire. According to the questionnaire, 170 of the physicians were reported to the patient communication units due to medical malpractice. Mean number of compliant reports was 3.20±3.5. 29 of the physicians received administrative penalties. 42 of the physicians were judged in the court for medical malpractice. 1 physician was fined 5000 Turkish Liras as a result of these judgments.We found that the number of complaint reports is negatively correlated with duration of service in emergency medicine and age. There was a significant difference between number of complaint reports and career (p<0.05. The physicians' level of awareness on forensic cases was found to be insufficient. Lack of legislation knowledge may be an important cause of complaint reports concerning emergency physicians, who have a high load of patients. Thus, we think that increasing the frequency of post-graduate education sessions and

  18. Examining the relationship between critical-thinking skills and decision-making ability of emergency medicine students.

    Science.gov (United States)

    Heidari, Mohammad; Ebrahimi, Parvin

    2016-10-01

    Critical-thinking ability would enable students to think creatively and make better decisions and makes them make a greater effort to concentrate on situations related to clinical matters and emergencies. This can bridge the gap between the clinical and theoretical training. Therefore, the aim of the present study is to examine the relationship between critical-thinking ability and decision-making skills of the students of Emergency Medicine. This descriptive and analytical research was conducted on all the students of medical emergency students ( n = 86) in Shahrekord, Iran. The demographic information questionnaire, the California Critical Thinking Skills Test, and a decision-making researcher-made questionnaire were used to collect data. The data were analyzed by SPSS software version 16 using descriptive and analytical statistical tests and Pearson's correlation coefficient. The results of the present study indicate that the total mean score for the critical thinking was 8.32 ± 2.03 and for decision making 8.66 ± 1.89. There is a significant statistical relationship between the critical-thinking score and decision-making score ( P critical-thinking skills and decision-making ability are essential for medical emergency professional competence, the results of this study show that these skills are poor among the students.

  19. Clinical trials in "emerging markets": regulatory considerations and other factors.

    Science.gov (United States)

    Singh, Romi; Wang, Ouhong

    2013-11-01

    Clinical studies are being placed in emerging markets as part of global drug development programs to access large pool of eligible patients and to benefit from a cost effective structure. However, over the last few years, the definition of "emerging markets" is being revisited, especially from a regulatory perspective. For purposes of this article, countries outside US, EU and the traditional "western countries" are discussed. Multiple factors are considered for placement of clinical studies such as adherence to Good Clinical Practice (GCP), medical infrastructure & standard of care, number of eligible patients, etc. This article also discusses other quantitative factors such as country's GDP, patent applications, healthcare expenditure, healthcare infrastructure, corruption, innovation, etc. These different factors and indexes are correlated to the number of clinical studies ongoing in the "emerging markets". R&D, healthcare expenditure, technology infrastructure, transparency, and level of innovation, show a significant correlation with the number of clinical trials being conducted in these countries. This is the first analysis of its kind to evaluate and correlate the various other factors to the number of clinical studies in a country. © 2013.

  20. Travel medicine physician adherence to guidelines for the emergency self treatment of malaria.

    Science.gov (United States)

    Flaherty, Gerard T; Walden, Lucas M; Townend, Michael

    2016-05-01

    Few studies have examined emergency self treatment (EST) antimalarial prescribing patterns. 110 physician-members of the Travel Medicine Society of Ireland and British Global and Travel Health Association participated in this study. There was a trend towards the prescription of EST for travel to remote low-risk malaria areas; for long-term residents living in low-risk areas; and for frequent travellers to low-risk areas. This study provides insights into the use of EST in travellers' malaria. © International Society of Travel Medicine, 2016. All rights reserved. Published by Oxford University Press. For permissions, please e-mail: journals.permissions@oup.com.

  1. Clinical features of emergency department patients with depression ...

    African Journals Online (AJOL)

    Clinical features of emergency department patients with depression who had attempted to commit suicide by poisoning. ... MDD patients. Conclusion: In poisoning patients with MDD, physicians in the ED must consider that they have a higher tendency to show suicidal behavior and to have ingested multiple types of drugs.

  2. Alcoholics and the emergency ward. Part I. Clinical characteristics.

    Science.gov (United States)

    Fialkov, M J

    1977-10-01

    A study of White and Black (Black, Cape Coloured and Asiatic) male alcoholics who attended the psychiatric emergency service unit at Groote Schuur Hospital, Cape Town, is presented. The psychosocial and clinical characteristics are described and compared. In addition, the associated physical and psychiatric morbidity is tabulated.

  3. Clinical Performance of Emergency Surgical Officers in Southern ...

    African Journals Online (AJOL)

    GB

    The proportion of cesarean and instrumental deliveries over the total deliveries were 13% and 0.7%, respectively. Explorative laparotomies and appendectomies were the majority of the non-obstetric emergency operations. Interviewed staff in the respective hospitals stated that ESOs' clinical decision making, surgical skill ...

  4. Quality of natural product clinical trials: a comparison of those published in alternative medicine versus conventional medicine journals.

    Science.gov (United States)

    Cochrane, Zara Risoldi; Gregory, Philip; Wilson, Amy

    2011-06-01

    To compare the quality of natural product clinical trials published in alternative medicine journals versus those published in conventional medicine journals. Systematic search and review of the literature. Randomized controlled trials of natural products were included if they were published in English between 2003 and 2008. Articles were categorized by their journal of publication (alternative medicine versus conventional medicine). Two independent reviewers evaluated study quality using guidelines from the Cochrane Collaboration. The results with respect to the primary outcome (positive or negative) were also assessed. Thirty articles were evaluated, 15 published in alternative medicine journals and 15 in conventional medicine journals. Of articles published in alternative medicine journals, 33.33% (n = 5) were considered low quality, and none were considered high quality. Of articles published in conventional medicine journals, 26.67% (n = 4) were considered low quality and 6.67% (n = 1) were considered high quality. Two thirds of all trials reviewed were of unclear quality, due to inadequate reporting of information relating to the study's methodology. Similar proportions of positive and negative primary outcomes were found in alternative and conventional medicine journals, and low-quality articles were not more likely to report a positive primary outcome (Fisher's exact test, two-tailed p = .287). The quality of natural product randomized controlled trials was similar among alternative and conventional medicine journals. Efforts should be made to improve the reporting of natural product clinical trials for accurate determinations of study quality to be possible.

  5. The Importance of Medicinal Chemistry Knowledge in the Clinical Pharmacist's Education.

    Science.gov (United States)

    Fernandes, João Paulo S

    2018-03-01

    Objective. To show why medicinal chemistry must be a key component of the education of pharmacy students, as well as in the pharmacist's practice. Findings. Five case reports were selected by their clinically relevant elements of medicinal chemistry and were explained using structure-activity relationship data of the drugs involved in the case easily obtained from primary literature and in medicinal chemistry textbooks. Summary. This paper demonstrates how critical clinical decisions can be addressed using medicinal chemistry knowledge. While such knowledge may not explain all clinical decisions, medicinal chemistry concepts are essential for the education of pharmacy students to explain drug action in general and clinical decisions.

  6. The Frontlines of Medicine Project: a proposal for the standardized communication of emergency department data for public health uses including syndromic surveillance for biological and chemical terrorism.

    Science.gov (United States)

    Barthell, Edward N; Cordell, William H; Moorhead, John C; Handler, Jonathan; Feied, Craig; Smith, Mark S; Cochrane, Dennis G; Felton, Christopher W; Collins, Michael A

    2002-04-01

    The Frontlines of Medicine Project is a collaborative effort of emergency medicine (including emergency medical services and clinical toxicology), public health, emergency government, law enforcement, and informatics. This collaboration proposes to develop a nonproprietary, "open systems" approach for reporting emergency department patient data. The common element is a standard approach to sending messages from individual EDs to regional oversight entities that could then analyze the data received. ED encounter data could be used for various public health initiatives, including syndromic surveillance for chemical and biological terrorism. The interlinking of these regional systems could also permit public health surveillance at a national level based on ED patient encounter data. Advancements in the Internet and Web-based technologies could allow the deployment of these standardized tools in a rapid time frame.

  7. Clinical intuition versus statistics: different modes of tacit knowledge in clinical epidemiology and evidence-based medicine.

    Science.gov (United States)

    Braude, Hillel D

    2009-01-01

    Despite its phenomenal success since its inception in the early nineteen-nineties, the evidence-based medicine movement has not succeeded in shaking off an epistemological critique derived from the experiential or tacit dimensions of clinical reasoning about particular individuals. This critique claims that the evidence-based medicine model does not take account of tacit knowing as developed by the philosopher Michael Polanyi. However, the epistemology of evidence-based medicine is premised on the elimination of the tacit dimension from clinical judgment. This is demonstrated through analyzing the dichotomy between clinical and statistical intuition in evidence-based medicine's epistemology of clinical reasoning. I argue that clinical epidemiology presents a more nuanced epistemological model for the application of statistical epidemiology to the clinical context. Polanyi's theory of tacit knowing is compatible with the model of clinical reasoning associated with clinical epidemiology, but not evidence-based medicine.

  8. [Second victim : Critical incident stress management in clinical medicine].

    Science.gov (United States)

    Schiechtl, B; Hunger, M S; Schwappach, D L; Schmidt, C E; Padosch, S A

    2013-09-01

    Critical incidents in clinical medicine can have far-reaching consequences on patient health. In cases of severe medical errors they can seriously harm the patient or even lead to death. The involvement in such an event can result in a stress reaction, a so-called acute posttraumatic stress disorder in the healthcare provider, the so-called second victim of an adverse event. Psychological distress may not only have a long lasting impact on quality of life of the physician or caregiver involved but it may also affect the ability to provide safe patient care in the aftermath of adverse events. A literature review was performed to obtain information on care giver responses to medical errors and to determine possible supportive strategies to mitigate negative consequences of an adverse event on the second victim. An internet search and a search in Medline/Pubmed for scientific studies were conducted using the key words "second victim, "medical error", "critical incident stress management" (CISM) and "critical incident stress reporting system" (CIRS). Sources from academic medical societies and public institutions which offer crisis management programs where analyzed. The data were sorted by main categories and relevance for hospitals. Analysis was carried out using descriptive measures. In disaster medicine and aviation navigation services the implementation of a CISM program is an efficient intervention to help staff to recover after a traumatic event and to return to normal functioning and behavior. Several other concepts for a clinical crisis management plan were identified. The integration of CISM and CISM-related programs in a clinical setting may provide efficient support in an acute crisis and may help the caregiver to deal effectively with future error events and employee safety.

  9. The MedSeq Project: a randomized trial of integrating whole genome sequencing into clinical medicine.

    Science.gov (United States)

    Vassy, Jason L; Lautenbach, Denise M; McLaughlin, Heather M; Kong, Sek Won; Christensen, Kurt D; Krier, Joel; Kohane, Isaac S; Feuerman, Lindsay Z; Blumenthal-Barby, Jennifer; Roberts, J Scott; Lehmann, Lisa Soleymani; Ho, Carolyn Y; Ubel, Peter A; MacRae, Calum A; Seidman, Christine E; Murray, Michael F; McGuire, Amy L; Rehm, Heidi L; Green, Robert C

    2014-03-20

    Whole genome sequencing (WGS) is already being used in certain clinical and research settings, but its impact on patient well-being, health-care utilization, and clinical decision-making remains largely unstudied. It is also unknown how best to communicate sequencing results to physicians and patients to improve health. We describe the design of the MedSeq Project: the first randomized trials of WGS in clinical care. This pair of randomized controlled trials compares WGS to standard of care in two clinical contexts: (a) disease-specific genomic medicine in a cardiomyopathy clinic and (b) general genomic medicine in primary care. We are recruiting 8 to 12 cardiologists, 8 to 12 primary care physicians, and approximately 200 of their patients. Patient participants in both the cardiology and primary care trials are randomly assigned to receive a family history assessment with or without WGS. Our laboratory delivers a genome report to physician participants that balances the needs to enhance understandability of genomic information and to convey its complexity. We provide an educational curriculum for physician participants and offer them a hotline to genetics professionals for guidance in interpreting and managing their patients' genome reports. Using varied data sources, including surveys, semi-structured interviews, and review of clinical data, we measure the attitudes, behaviors and outcomes of physician and patient participants at multiple time points before and after the disclosure of these results. The impact of emerging sequencing technologies on patient care is unclear. We have designed a process of interpreting WGS results and delivering them to physicians in a way that anticipates how we envision genomic medicine will evolve in the near future. That is, our WGS report provides clinically relevant information while communicating the complexity and uncertainty of WGS results to physicians and, through physicians, to their patients. This project will not only

  10. Evaluation of the physicians‘ of n hospital opinion on clinical trials of medicinal products

    OpenAIRE

    Videikaitė, Lina

    2014-01-01

    Aim of the research. To evaluate the physicians‘ of N Hospital opinion on clinical trials of medicinal products. Objectives. To evaluate the factors affecting physicians' motivation to perform clinical trials of medicinal products as well as those that prevent the physicians getting involved in the trials. To assess physicians' attitude towards clinical trials of medicinal products. To compare the opinions of physicians who have and have’nt participated in clinical trials. Methods of...

  11. The American Board of Emergency Medicine ConCert Examination: Emergency Physicians' Perceptions of Learning and Career Benefits.

    Science.gov (United States)

    Marco, Catherine A; Wahl, Robert P; Counselman, Francis L; Heller, Barry N; Harvey, Anne L; Joldersma, Kevin B; Kowalenko, Terry; Coombs, Andrea B; Reisdorff, Earl J

    2016-09-01

    As part of the American Board of Emergency Medicine (ABEM) Maintenance of Certification (MOC) program, ABEM-certified physicians are required to pass the Continuous Certification (ConCert) examination at least every 10 years. With the 2015 ConCert examination, ABEM sought to better understand emergency physicians' perceptions of the benefits of preparing for and taking the examination and the career benefits of staying ABEM-certified. This was a prospective survey study. A voluntary postexamination survey was administered at the end of the 2015 ABEM ConCert examination (September 21-26, 2015). Physicians were asked about the benefits of preparing for the examination and maintaining ABEM certification. Examination performance was compared to perceptions of learning and career benefits. Of the 2,601 on-time test takers, 2,511 respondents participated (96.5% participation rate). The majority of participants (92.0%) identified a benefit to preparing for the ConCert examination, which included reinforced medical knowledge (73.9%), increased knowledge (66.8%), and making them a better clinician (39.4%). The majority of respondents (90.8%) identified a career benefit of maintaining ABEM certification, which included more employment options (73.8%), more positively viewed by other physicians (56.8%), and better financial outcomes (29.8%). There was a statistically significant association between the perception of knowledge reinforcement and examination performance (p Medicine.

  12. Frequency of Burnout, Sleepiness and Depression in Emergency Medicine Residents with Medical Errors in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Alireza Aala

    2014-07-01

    Full Text Available Aims: Medical error is a great concern of the patients and physicians. It usually occurs due to physicians’ exhaustion, distress and fatigue. In this study, we aimed to evaluate frequency of distress and fatigue among emergency medicine residents reporting a medical error. Materials and Methods: The study population consisted of emergency medicine residents who completed an emailed questionnaire including self-assessment of medical errors, the Epworth Sleepiness Scale (ESS score, the Maslach Burnout Inventory, and PRIME-MD validated depression screening tool.   Results: In this survey, 100 medical errors were reported including diagnostic errors in 53, therapeutic errors in 24 and following errors in 23 subjects. Most errors were reported by males and third year residents. Residents had no signs of depression, but all had some degrees of sleepiness and burnout. There were significant differences between errors subtypes and age, residency year, depression, sleepiness and burnout scores (p<0.0001.   Conclusion: In conclusion, residents committing a medical error usually experience burnout and have some grades of sleepiness that makes them less motivated increasing the probability of medical errors. However, as none of the residents had depression, it could be concluded that depression has no significant role in medical error occurrence and perhaps it is a possible consequence of medical error.    Keywords: Residents; Medical error; Burnout; Sleepiness; Depression

  13. Minor emergency clinic: key to the future of successful hospitals.

    Science.gov (United States)

    Chawla, S; Kathawala, Y; Elmuti, D

    1992-01-01

    This project set out to determine whether there is a relationship between the minor emergency facility an individual uses and their choice of a hospital for in-patient care. In studying this relationship, the factors that are important to persons choosing a clinic or hospital facility, as well as the influence of a physician, were also identified. A structured, undisguised telephone survey was used for interviewing a randomly selected sample population of 189 San Angelo residents. Analysis of the survey data indicated that dependency does exist between minor emergency clinic use and the hospital chosen for in-patient care. The results of this study also suggested that hospitals' marketing strategy should shift the emphasis of their advertising from the hospital itself to their physician association and clinics. In addition, a number of other interesting observations concerning the relative importance of various medical factors to the participants was also explored.

  14. EM Talk: communication skills training for emergency medicine patients with serious illness.

    Science.gov (United States)

    Grudzen, Corita R; Emlet, Lillian L; Kuntz, Joanne; Shreves, Ashley; Zimny, Erin; Gang, Maureen; Schaulis, Monique; Schmidt, Scott; Isaacs, Eric; Arnold, Robert

    2016-06-01

    The emergency department visit for a patient with serious illness represents a sentinel event, signalling a change in the illness trajectory. By better understanding patient and family wishes, emergency physicians can reinforce advance care plans and ensure the hospital care provided matches the patient's values. Despite their importance in care at the end of life, emergency physicians have received little training on how to talk to seriously ill patients and their families about goals of care. To expand communication skills training to emergency medicine, we developed a programme to give emergency medicine physicians the ability to empathically deliver serious news and to talk about goals of care. We have built on lessons from prior studies to design an intervention employing the most effective pedagogical techniques, including the use of simulated patients/families, role-playing and small group learning with constructive feedback from master clinicians. Here, we describe our evidence-based communication skills training course EM Talk using simulation, reflective feedback and deliberate practice. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  15. On a Work Expected to the Department of Emergency and Critical Care Medicine and the Emergency Unit of the Niigata University Hospital

    OpenAIRE

    小山, 真; Koyama, Shin

    2001-01-01

    The author would like to celebrate the start of the Department of emergency and critical care medicine and the Emergency unit of the Niigata University Hospital. The author also wishes to express his opinion, which is mentioned below, on preparing the Department and the Emergency unit for their future activity. 1 . The stuff members of the Department are expected to instruct undergraduate students in the knowledge and technique of Triage and the first aid in emergency exactly. 2 . The Emergen...

  16. Opinion: redefining the role of the physician in laboratory medicine in the context of emerging technologies, personalised medicine and patient autonomy ('4P medicine').

    Science.gov (United States)

    Orth, Matthias; Averina, Maria; Chatzipanagiotou, Stylianos; Faure, Gilbert; Haushofer, Alexander; Kusec, Vesna; Machado, Augusto; Misbah, Siraj A; Oosterhuis, Wytze; Pulkki, Kari; Twomey, Patrick J; Wieland, Eberhard

    2017-12-22

    The role of clinical pathologists or laboratory-based physicians is being challenged on several fronts-exponential advances in technology, increasing patient autonomy exercised in the right to directly request tests and the use of non-medical specialists as substitutes. In response, clinical pathologists have focused their energies on the pre-analytical and postanalytical phases of Laboratory Medicine thus emphasising their essential role in individualised medical interpretation of complex laboratory results. Across the European Union, the role of medical doctors is enshrined in the Medical Act. This paper highlights the relevance of this act to patient welfare and the need to strengthen training programmes to prevent an erosion in the quality of Laboratory Medicine provided to patients and their physicians. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  17. The clinical application of mobile technology to disaster medicine.

    Science.gov (United States)

    Case, Timothy; Morrison, Cecily; Vuylsteke, Alain

    2012-10-01

    Mobile health care technology (mHealth) has the potential to improve communication and clinical information management in disasters. This study reviews the literature on health care and computing published in the past five years to determine the types and efficacy of mobile applications available to disaster medicine, along with lessons learned. Five types of applications are identified: (1) disaster scene management; (2) remote monitoring of casualties; (3) medical image transmission (teleradiology); (4) decision support applications; and (5) field hospital information technology (IT) systems. Most projects have not yet reached the deployment stage, but evaluation exercises show that mHealth should allow faster processing and transport of patients, improved accuracy of triage and better monitoring of unattended patients at a disaster scene. Deployments of teleradiology and field hospital IT systems to disaster zones suggest that mHealth can improve resource allocation and patient care. The key problems include suitability of equipment for use in disaster zones and providing sufficient training to ensure staff familiarity with complex equipment. Future research should focus on providing unbiased observations of the use of mHealth in disaster medicine.

  18. Clinical nuclear medicine applications in Turkey and specific renal studies

    International Nuclear Information System (INIS)

    Erbas, B.

    2004-01-01

    Full text: Nuclear cardiology, nuclear oncology, pediatric nuclear medicine and nuclear endocrinology are the main application areas of clinical nuclear medicine in Turkey. Not only imaging studies, but also therapeutic application of radiopharmaceuticals is also performed at many institutes, such as hyperthyroidism treatment with radioiodine, thyroid cancer ablation and metastases treatment with radioiodine, radio synovectomy, metastatic pain therapy, and recently radioimmunotherapy of lymphomas. Almost all radionuclides and radiopharmaceuticals are obtained commercially from European countries, except 18-FDG which is obtained from two cyclotrons in Turkey. More than 30.000 renal procedures are performed at the University hospitals in a year. Pediatric age groups is approximately % 55 of patients. 99mTc-DTPA (%44), 99mTc-DMSA (%37), 99mTc-MAG3 (%17) and 99mTc-EC (%2) are the most commonly used radiopharmaceuticals for renal imaging. More than 6.000 vials of several pharmaceuticals are used for renal cortical scintigraphy (%35), dynamic renal imaging (%34), renal scintigraphy with diuretic (%27) and captopril scintigraphy (%4). Most common indication for renal cortical scintigraphy is detection of cortical scarring (%53). In addition, using single plasma sample method or gamma-camera method renal clearance measurements with 99mTc-MAG3 99mTc-DTPA have been used at some institutions

  19. Clinical nuclear medicine applications in Turkey and specific renal studies

    International Nuclear Information System (INIS)

    Erbas, B.

    2004-01-01

    Nuclear cardiology, nuclear oncology, pediatric nuclear medicine and nuclear endocrinology are the main application areas of clinical nuclear medicine in Turkey. Not only imaging studies, but also therapeutic application of radiopharmaceuticals is also performed at many institutes, such as hyperthyroidism treatment with radioiodine, thyroid cancer ablation and metastases treatment with radioiodine, radio synovectomy, metastatic pain therapy, and recently radioimmunotherapy of lymphomas. Almost all radionuclides and radiopharmaceuticals are obtained commercially from European countries, except 18-FDG which is obtained from two cyclotrons in Turkey. More than 30.000 renal procedures are performed at the University hospitals in a year. Pediatric age groups is approximately % 55 of patients. 99m Tc-DTPA (%44), 99m Tc-DMSA (%37), 99m Tc-MAG3 (%17) and 99m Tc-EC (%2) are the most commonly used radiopharmaceuticals for renal imaging. More than 6.000 vials of several pharmaceuticals are used for renal cortical scintigraphy (%35), dynamic renal imaging (%34), renal scintigraphy with diuretic (%27) and captopril scintigraphy (%4). Most common indication for renal cortical scintigraphy is detection of cortical scarring (%53). In addition, using single plasma sample method or gamma-camera method renal clearance measurements with 99m Tc-MAG3 99m Tc-DTPA have been used at some institutions. (author)

  20. Sleep apps: what role do they play in clinical medicine?

    Science.gov (United States)

    Lorenz, Christopher P; Williams, Adrian J

    2017-11-01

    Today's smartphones boast more computing power than the Apollo Guidance Computer. Given the ubiquity and popularity of smartphones, are we already carrying around miniaturized sleep labs in our pockets? There is still a lack of validation studies for consumer sleep technologies in general and apps for monitoring sleep in particular. To overcome this gap, multidisciplinary teams are needed that focus on feasibility work at the intersection of software engineering, data science and clinical sleep medicine. To date, no smartphone app for monitoring sleep through movement sensors has been successfully validated against polysomnography, despite the role and validity of actigraphy in sleep medicine having been well established. Missing separation of concerns, not methodology, poses the key limiting factor: The two essential steps in the monitoring process, data collection and scoring, are chained together inside a black box due to the closed nature of consumer devices. This leaves researchers with little room for influence nor can they access raw data. Multidisciplinary teams that wield complete power over the sleep monitoring process are sorely needed.

  1. Generational Influences in Academic Emergency Medicine: Teaching and Learning, Mentoring, and Technology (Part I)

    Science.gov (United States)

    Mohr, Nicholas M.; Moreno-Walton, Lisa; Mills, Angela M.; Brunett, Patrick H.; Promes, Susan B.

    2010-01-01

    For the first time in history, four generations are working together – Traditionalists, Baby Boomers, Generation Xers, and Millennials. Members of each generation carry with them a unique perspective of the world and interact differently with those around them. Through a review of the literature and consensus by modified Delphi methodology of the Society for Academic Emergency Medicine (SAEM) Aging and Generational Issues Task Force, the authors have developed this two-part series to address generational issues present in academic emergency medicine (EM). Understanding generational characteristics and mitigating strategies can help address some common issues encountered in academic EM. Through recognition of the unique characteristics of each of the generations with respect to teaching and learning, mentoring, and technology, academicians have the opportunity to strategically optimize interactions with one another. PMID:21314779

  2. Artificial Intelligence to Assist Clinical Diagnosis in Medicine

    Directory of Open Access Journals (Sweden)

    Saúl Oswaldo Lugo-Reyes

    2014-03-01

    Full Text Available Medicine is one of the elds of knowledge that would most bene t from a closer interaction with Computer studies and Mathematics by optimizing complex, imperfect processes such as differential diagnosis; this is the domain of Machine Learning, a branch of Arti cial Intelligence that builds and studies systems capable of learning from a set of training data, in order to optimize classi cation and prediction processes. In Mexico during the last few years, progress has been made on the implementation of electronic clinical records, so that the National Institutes of Health already have accumulated a wealth of stored data. For those data to become knowledge, they need to be processed and analyzed through complex statistical methods, as it is already being done in other countries, employing: case-based reasoning, artificial neural networks, Bayesian classi ers, multivariate logistic regression, or support vector machines, among other methodologies; to assist the clinical diagnosis of acute appendicitis, breast cancer and chronic liver disease, among a wide array of maladies. In this review we sift through concepts, antecedents, current examples and methodologies of machine learning-assisted clinical diagnosis.

  3. [Artificial intelligence to assist clinical diagnosis in medicine].

    Science.gov (United States)

    Lugo-Reyes, Saúl Oswaldo; Maldonado-Colín, Guadalupe; Murata, Chiharu

    2014-01-01

    Medicine is one of the fields of knowledge that would most benefit from a closer interaction with Computer studies and Mathematics by optimizing complex, imperfect processes such as differential diagnosis; this is the domain of Machine Learning, a branch of Artificial Intelligence that builds and studies systems capable of learning from a set of training data, in order to optimize classification and prediction processes. In Mexico during the last few years, progress has been made on the implementation of electronic clinical records, so that the National Institutes of Health already have accumulated a wealth of stored data. For those data to become knowledge, they need to be processed and analyzed through complex statistical methods, as it is already being done in other countries, employing: case-based reasoning, artificial neural networks, Bayesian classifiers, multivariate logistic regression, or support vector machines, among other methodologies; to assist the clinical diagnosis of acute appendicitis, breast cancer and chronic liver disease, among a wide array of maladies. In this review we shift through concepts, antecedents, current examples and methodologies of machine learning-assisted clinical diagnosis.

  4. Monitoring medicines use: the role of the clinical pharmacologist.

    LENUS (Irish Health Repository)

    Williams, David

    2012-10-01

    Appreciation of the potential of newly marketed medicines to produce both benefit and harm has increased the role of the clinical pharmacologist. Pharmacoepidemiology applies epidemiological reasoning, methods and knowledge to the study of the uses and effects of drugs in human populations. Pharmacovigilence identifies and then responds to safety issues about marketed drugs. Whilst adverse drug reaction (ADR) reporting systems can identify potential problems with drugs, determination of causation requires population-based studies of adverse events (including information from large clinical trials), which attempt to link unequivocally the adverse outcome to the drug in question. Pharmacovigilance is closely linked to postmarketing surveillance and is important for determining issues such as the long-term effects of drugs, identification of low-frequency ADRs, the effectiveness of drugs for their licensed indications or in new indications and other factors which may modify the efficacy and effectiveness of the drug in question. The related field of drug utilization developed in parallel with the study of adverse drug reactions, in recognition of the dramatic increase in the marketing of new drugs, the wide variations in the patterns and extent of drug prescribing, the growing concern about ADRs and the increasing costs of drugs. With the ever increasing number of recognized adverse effects of drugs, prescribing errors, patients\\' expectations concerning drug safety and the need for appropriate new drug appraisal, the clinical pharmacologist will play an important role both in the introduction of new drugs and in improving the safe and effective use of established drugs.

  5. Laboratory hemostasis: milestones in Clinical Chemistry and Laboratory Medicine.

    Science.gov (United States)

    Lippi, Giuseppe; Favaloro, Emmanuel J

    2013-01-01

    Hemostasis is a delicate, dynamic and intricate system, in which pro- and anti-coagulant forces cooperate for either maintaining blood fluidity under normal conditions, or else will prompt blood clot generation to limit the bleeding when the integrity of blood vessels is jeopardized. Excessive prevalence of anticoagulant forces leads to hemorrhage, whereas excessive activation of procoagulant forces triggers excessive coagulation and thrombosis. The hemostasis laboratory performs a variety of first, second and third line tests, and plays a pivotal role in diagnostic and monitoring of most hemostasis disturbances. Since the leading targets of Clinical Chemistry and Laboratory Medicine include promotion of progress in fundamental and applied research, along with publication of guidelines and recommendations in laboratory diagnostics, this journal is an ideal source of information on current developments in the laboratory technology of hemostasis, and this article is aimed to celebrate some of the most important and popular articles ever published by the journal in the filed of laboratory hemostasis.

  6. Clinical Application of Induced Pluripotent Stem Cells in Cardiovascular Medicine.

    Science.gov (United States)

    Chi, Hong-jie; Gao, Song; Yang, Xin-chun; Cai, Jun; Zhao, Wen-shu; Sun, Hao; Geng, Yong-Jian

    2015-01-01

    Induced pluripotent stem cells (iPSCs) are generated by reprogramming human somatic cells through the overexpression of four transcription factors: Oct4, Sox2, Klf4 and c-Myc. iPSCs are capable of indefinite self-renewal, and they can differentiate into almost any type of cell in the body. These cells therefore offer a highly valuable therapeutic strategy for tissue repair and regeneration. Recent experimental and preclinical research has revealed their potential for cardiovascular disease diagnosis, drug screening and cellular replacement therapy. Nevertheless, significant challenges remain in terms of the development and clinical application of human iPSCs. Here, we review current progress in research related to patient-specific iPSCs for ex vivo modeling of cardiovascular disorders and drug screening, and explore the potential of human iPSCs for use in the field of cardiovascular regenerative medicine. © 2015 S. Karger AG, Basel.

  7. Executive Summary from the 2017 Emergency Medicine Resident Wellness Consensus Summit

    Directory of Open Access Journals (Sweden)

    Felix Ankel

    2018-02-01

    Full Text Available Introduction: Physician wellness has recently become a popular topic of conversation and publication within the house of medicine and specifically within emergency medicine (EM. Through a joint collaboration involving Academic Life in Emergency Medicine’s (ALiEM Wellness Think Tank, Essentials of Emergency Medicine (EEM, and the Emergency Medicine Residents’ Association (EMRA, a one-day Resident Wellness Consensus Summit (RWCS was organized. Methods: The RWCS was held on May 15, 2017, as a pre-day event prior to the 2017 EEM conference in Las Vegas, Nevada. Seven months before the RWCS event, pre-work began in the ALiEM Wellness Think Tank, which was launched in October 2016. The Wellness Think Tank is a virtual community of practice involving EM residents from the U.S. and Canada, hosted on the Slack digital-messaging platform. A working group was formed for each of the four predetermined themes: wellness curriculum development; educator toolkit resources for specific wellness topics; programmatic innovations; and wellness-targeted technologies. Results: Pre-work for RWCS included 142 residents from 100 different training programs in the Wellness Think Tank. Participants in the actual RWCS event included 44 EM residents, five EM attendings who participated as facilitators, and three EM attendings who acted as participants. The four working groups ultimately reached a consensus on their specific objectives to improve resident wellness on both the individual and program level. Conclusion: The Resident Wellness Consensus Summit was a unique and novel consensus meeting, involving residents as the primary stakeholders. The summit demonstrated that it is possible to galvanize a large group of stakeholders in a relatively short time by creating robust trust, communication, and online learning networks to create resources that support resident wellness.

  8. Survey of emergency medicine resident debt status and financial planning preparedness.

    Science.gov (United States)

    Glaspy, Jeffrey N; Ma, O John; Steele, Mark T; Hall, Jacqueline

    2005-01-01

    Most resident physicians accrue significant financial debt throughout their medical and graduate medical education. The objective of this study was to analyze emergency medicine resident debt status, financial planning actions, and educational experiences for financial planning and debt management. A 22-item questionnaire was sent to all 123 Accreditation Council on Graduate Medical Education-accredited emergency medicine residency programs in July 2001. Two follow-up mailings were made to increase the response rate. The survey addressed four areas of resident debt and financial planning: 1) accrued debt, 2) moonlighting activity, 3) financial planning/debt management education, and 4) financial planning actions. Descriptive statistics were used to analyze the data. Survey responses were obtained from 67.4% (1,707/2,532) of emergency medicine residents in 89 of 123 (72.4%) residency programs. Nearly one half (768/1,707) of respondents have accrued more than 100,000 dollars of debt. Fifty-eight percent (990/1,707) of all residents reported that moonlighting would be necessary to meet their financial needs, and more than 33% (640/1,707) presently moonlight to supplement their income. Nearly one half (832/1,707) of residents actively invested money, of which online trading was the most common method (23.3%). Most residents reported that they received no debt management education during residency (82.1%) or medical school (63.7%). Furthermore, 79.1% (1,351/1,707) of residents reported that they received no financial planning lectures during residency, although 84.2% (1,438/1,707) reported that debt management and financial planning education should be available during residency. Most emergency medicine residency programs do not provide their residents with financial planning education. Most residents have accrued significant debt and believe that more financial planning and debt management education is needed during residency.

  9. What is the Prevalence and Success of Remediation of Emergency Medicine Residents?

    OpenAIRE

    Silverberg, Mark; Weizberg, Moshe; Murano, Tiffany; Smith, Jessica L.; Burkhardt, John C.; Santen, Sally A.

    2015-01-01

    Introduction: The primary objective of this study was to determine the prevalence of remediation, competency domains for remediation, the length, and success rates of remediation in emergency medicine (EM). Methods: We developed the survey in SurveymonkeyTM with attention to content and response process validity. EM program directors responded how many residents had been placed on remediation in the last three years. Details regarding the remediation were collected inclu...

  10. Tweeting the meeting: A comparative analysis of an Australian emergency medicine conference over four years

    Directory of Open Access Journals (Sweden)

    Cristian Udovicich

    2016-01-01

    Full Text Available Objective: Social media allows user-generated content and dialog between users and has also entered into the domain of healthcare. The purpose of this study was to compare the use of Twitter at the Australasian College of Emergency Medicine Annual Scientific Meeting (ACEM ASM from 2011 to 2014 and analyze its ability to spread emergency medicine education. Materials and Methods: Retrospectively, TweetReach was utilized to analyze relevant tweets. Each Annual Scientific Meeting (ASM had an associated Twitter account/s from, which data were collected. Duplicate tweets were excluded from the analysis. Information on the number of total tweets (regular tweets, retweets, and replies and contributors was gathered. The potential audience, the reach, was calculated. Results: From 2011 to 2014 the number of tweets rose from 460 to 4694, a 920% increase. Only 54 Twitter users contributed to the 2011 ASM. This rose to 252 (2012, 291 (2013 and 572 (2014. The average number of tweets per contributor ranged from 8.2 to 10.9. The reach, the potential number of Twitter users exposed to posts, rose >30 times from 2011 (15,502 users to 2014 (471,166. Conclusion: The use of Twitter at the ACEM ASM rose significantly from 2011 to 2014. It is a highly useful tool for the dissemination of emergency medicine education. Twitter has been harnessed by the ASM to enhance the conference experience by further generating interaction between delegates as well as those worldwide.

  11. Tweeting the meeting: A comparative analysis of an Australian emergency medicine conference over four years.

    Science.gov (United States)

    Udovicich, Cristian; Barberi, Anthony; Perera, Kalpa

    2016-01-01

    Social media allows user-generated content and dialog between users and has also entered into the domain of healthcare. The purpose of this study was to compare the use of Twitter at the Australasian College of Emergency Medicine Annual Scientific Meeting (ACEM ASM) from 2011 to 2014 and analyze its ability to spread emergency medicine education. Retrospectively, TweetReach was utilized to analyze relevant tweets. Each Annual Scientific Meeting (ASM) had an associated Twitter account/s from, which data were collected. Duplicate tweets were excluded from the analysis. Information on the number of total tweets (regular tweets, retweets, and replies) and contributors was gathered. The potential audience, the reach, was calculated. From 2011 to 2014 the number of tweets rose from 460 to 4694, a 920% increase. Only 54 Twitter users contributed to the 2011 ASM. This rose to 252 (2012), 291 (2013) and 572 (2014). The average number of tweets per contributor ranged from 8.2 to 10.9. The reach, the potential number of Twitter users exposed to posts, rose >30 times from 2011 (15,502 users) to 2014 (471,166). The use of Twitter at the ACEM ASM rose significantly from 2011 to 2014. It is a highly useful tool for the dissemination of emergency medicine education. Twitter has been harnessed by the ASM to enhance the conference experience by further generating interaction between delegates as well as those worldwide.

  12. Development of experts for radiation emergency medicine. An experience at the National Institute of Radiological Sciences

    International Nuclear Information System (INIS)

    Tatsuzaki, H.; Hachiya, M.

    2016-01-01

    The National Institute of Radiological Sciences has been conducting many training courses on radiation emergency medicine, both for Japanese and foreigners. Medical professionals working in hospitals and first responders who deal with victims have been main participants of these courses for Japanese. Typically, these courses include table top exercises and/or practical drills, which give unique features to our courses, in addition to lectures. Apart from training courses, some medical professionals came to work as a staff member of NIRS for a long term, such as two years, to learn about radiation emergency medicine. Some foreigners also stayed in NIRS as short to middle term visitors to learn about the fields. Courses for foreigners were organized sometimes in cooperation with international organizations. Participants were mainly from Asian countries, and some courses targeted one country. For example, courses for Korean professionals were organized nine times. The NIRS will continue to contribute to human development in radiation emergency medicine with training courses and other methods of education. (author)

  13. The development of the specialism of emergency medicine: media and cultural influences.

    Science.gov (United States)

    Timmons, Stephen; Nairn, Stuart

    2015-01-01

    In this article we analyse, via a critical review of the literature, the development of a relatively new medical specialism in the United Kingdom, that of emergency medicine. Despite the high media profile of emergency care, it is a low-status specialism within UK medicine. The creation of a specialist College in 2008 means that, symbolically, recognition as a full specialism has now been achieved. In this article, we will show, using a sociology of professions approach, how emergency medicine defined itself as a specialism, and sought to carve out a distinctive jurisdiction. While, in the context of the UK National Health Service, the state was clearly an important factor in the development of this profession, we wish to develop the analysis further than is usual in the sociology of professions. We will analyse the wider cultural context for the development of this specialism, which has benefited from its high profile in the media, through both fictional and documentary sources. © The Author(s) 2014.

  14. Clinical Study on Treatment of Depression with Combined Acupuncture & Medicine

    Institute of Scientific and Technical Information of China (English)

    XU Hong; WANG Qiao-chu; HAN Chou-ping

    2003-01-01

    Purpose To observe and compare the curative effects of combined acupuncture and medicine with simple herbal medicine on treatment of depression. Method Altogether 63 cases were enrolled according to the determination of internationally accepted self-evaluation depression scales (SDS), among them 33 cases were treated with combination of acupuncture and herbal medicine (acupuncture-medicine group) and the other 30 cases were in treated with herbal medicine alone (herbal medicine group) Results The total effective rate of acupuncture-medicine group was 90.9% and that of herbal group was 80.0%. And there was significant statistics difference between the curative effects of two groups (P <0.05) without obvious adverse reaction. Conclusion Combination of acupuncture and medicine has better effect in treating depression than herbal medicine group.

  15. Corporate and Hospital Profiteering in Emergency Medicine: Problems of the Past, Present, and Future.

    Science.gov (United States)

    Derlet, Robert W; McNamara, Robert M; Plantz, Scott H; Organ, Matthew K; Richards, John R

    2016-06-01

    Health care delivery in the United States has evolved in many ways over the past century, including the development of the specialty of Emergency Medicine (EM). With the creation of this specialty, many positive changes have occurred within hospital emergency departments (EDs) to improve access and quality of care of the nation's de facto "safety net." The specialty of EM has been further defined and held to high standards with regard to board certification, sub-specialization, maintenance of skills, and research. Despite these advances, problems remain. This review discusses the history and evolution of for-profit corporate influence on EM, emergency physicians, finance, and demise of democratic group practice. The review also explores federal and state health care financing issues pertinent to EM and discusses potential solutions. The monopolistic growth of large corporate contract management groups and hospital ownership of vertically integrated physician groups has resulted in the elimination of many local democratic emergency physician groups. Potential downsides of this trend include unfair or unlawful termination of emergency physicians, restrictive covenants, quotas for productivity, admissions, testing, patient satisfaction, and the rising cost of health care. Other problems impact the financial outlook for EM and include falling federal, state, and private insurance reimbursement for emergency care, balance-billing, up-coding, unnecessary testing, and admissions. Emergency physicians should be aware of the many changes happening to the specialty and practice of EM resulting from corporate control, influence, and changing federal and state health care financing issues. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. A Formalized Three-Year Emergency Medicine Residency Ultrasound Education Curriculum

    Directory of Open Access Journals (Sweden)

    Andrew King

    2016-09-01

    Full Text Available Audience and type of curriculum: The Ohio State University Wexner Medical Center Emergency Medicine Residency Program Ultrasound Education Curriculum is a three-year curriculum for PGY-1 to PGY-3 learners. Introduction/Background: Each year of the three-year The Ohio State University Wexner Medical Center Emergency Medicine Ultrasound Curriculum focuses on different aspects of emergency ultrasonography, thereby promoting progressive understanding and utilization of point-of-care ultrasound in medical decision-making during residency training. Ultrasound is an invaluable bedside tool for emergency physicians; this skill must be mastered by resident learners during residency training, and ultrasound competency is a required ACGME milestone.1 The American College of Emergency Physicians (ACEP currently recommends that 11 applications of emergency ultrasound be part of the core skills of an emergency physician.2 This curriculum acknowledges the standards developed by ACEP and the ACGME. Objectives: Learners will 1 know the indications for each the 11 ACEP point-of-care ultrasound (POCUS applications; 2 perform each of the 11 ACEP POCUS applications; 3 integrate POCUS into medical decision-making. Methods: The educational strategies used in this curriculum include: independent, self-directed learning (textbook and literature reading, brief didactic sessions describing indications and technique for each examination, hands-on ultrasound scanning under the direct supervision of ultrasound faculty with real-time feedback, and quality assurance review of ultrasound images. Residents are expected to perform a minimum of 150 ultrasound examinations with associated quality assurance during the course of their residency training. The time requirements, reading material, and ultrasound techniques taught vary depending on the year of training. Length of curriculum: The entirety of the curriculum is three years; however, each year of residency training has

  17. Postgraduate Emergency Medicine Training in India: An Educational Partnership with the Private Sector.

    Science.gov (United States)

    Douglass, Katherine; Pousson, Amelia; Gidwani, Shweta; Smith, Jeffrey

    2015-11-01

    Emergency medicine (EM) is a recently recognized specialty in India, still in its infancy. Local training programs are developing, but remain very limited. Private, for-profit hospitals are an important provider of graduate medical education (GME) in India, and are partnering with United States (US) universities in EM to expand training opportunities. Our aim was to describe current private-sector programs affiliated with a US university providing postgraduate EM training in India, the evolution and structure of these programs, and successes and challenges of program implementation. Programs have been established in seven cities in India in partnership with a US academic institution. Full-time trainees have required didactics, clinical rotations, research, and annual examinations. Faculty members affiliated with the US institution visit each program monthly. Regular evaluations have informed program modifications, and a local faculty development program has been implemented. Currently, 240 trainees are enrolled in the EM postgraduate program, and 141 physicians have graduated. A pilot survey conducted in 2012 revealed that 93% of graduates are currently practicing EM, 82% of those in India; 71% are involved in teaching, and 32% in research. Further investigation into programmatic impacts is necessary. Challenges include issues of formal program recognition both in India and abroad. This unique partnership is playing a major early role in EM GME in India. Future steps include official program recognition, expanded numbers of training sites, and a gradual transition of training and education to local faculty. Similar partnership programs may be effective in other settings outside of India. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Relationship between category size and journals' impact factor: implications for emergency medicine journals and researchers.

    Science.gov (United States)

    Miró, Òscar; Brown, Anthony F T; Graham, Colin A; Ducharme, James; Martin-Sanchez, Francisco J; Cone, David C

    2015-10-01

    We assessed the relationship between the size of the 39 Journal Citation Reports (JCR) medical categories and impact factor (IF) of journals in these categories, and the implications that it might have for emergency medicine (EM) journals. Using the 2010 JCR database, we calculated the mean IF, 5-year IF (5y-IF), Eigenfactor (EF), and Article Influence (AI) scores including all journals for each category. We also calculated a 'weighted IF' for all journals by dividing each journal IF by the mean IF of its category. We ranked EM journals according to IF and 'weighted IF' into all the journals included in the 39 categories. We assessed the relationship between category size and bibliometric scores by linear regression. Category size varied from 252 journals (Pharmacology and Pharmacy) to 14 (Primary Healthcare), EM category occupying the 36th position (23 journals). The mean IF of EM category ranked in 34th position, 5-yIF in 32nd, EF in 34th, and AI in 34th position. Category size had a direct and significant association with mean IF, 5y-IF, and AI but not with mean EF. When the EM journals were ranked among all the journals according to their IF, only two (9%) were placed into the first quartile and raised up to eight (35%) when 'weighted IF' was considered. There is a negative relationship between JCR size category and IF achieved by the journals. This places EM journals at a clear disadvantage because they represent one of the smallest clinical medical research disciplines.

  19. Implementing standardized, inter-unit communication in an international setting: handoff of patients from emergency medicine to internal medicine.

    Science.gov (United States)

    Balhara, Kamna S; Peterson, Susan M; Elabd, Mohamed Moheb; Regan, Linda; Anton, Xavier; Al-Natour, Basil Ali; Hsieh, Yu-Hsiang; Scheulen, James; Stewart de Ramirez, Sarah A

    2018-04-01

    Standardized handoffs may reduce communication errors, but research on handoff in community and international settings is lacking. Our study at a community hospital in the United Arab Emirates characterizes existing handoff practices for admitted patients from emergency medicine (EM) to internal medicine (IM), develops a standardized handoff tool, and assesses its impact on communication and physician perceptions. EM physicians completed a survey regarding handoff practices and expectations. Trained observers utilized a checklist based on the Systems Engineering Initiative for Patient Safety model to observe 40 handoffs. EM and IM physicians collaboratively developed a written tool encouraging bedside handoff of admitted patients. After the intervention, surveys of EM physicians and 40 observations were subsequently repeated. 77.5% of initial observed handoffs occurred face-to-face, with 42.5% at bedside, and in four different languages. Most survey respondents considered face-to-face handoff ideal. Respondents noted 9-13 patients suffering harm due to handoff in the prior month. After handoff tool implementation, 97.5% of observed handoffs occurred face-to-face (versus 77.5%, p = 0.014), with 82.5% at bedside (versus 42.5%, p face-to-face and bedside handoff, positively impacted workflow, and increased perceptions of safety by EM physicians in an international, non-academic setting. Our three-step approach can be applied towards developing standardized, context-specific inter-specialty handoff in a variety of settings.

  20. Can You Multitask? Evidence and Limitations of Task Switching and Multitasking in Emergency Medicine.

    Science.gov (United States)

    Skaugset, L Melissa; Farrell, Susan; Carney, Michele; Wolff, Margaret; Santen, Sally A; Perry, Marcia; Cico, Stephen John

    2016-08-01

    Emergency physicians work in a fast-paced environment that is characterized by frequent interruptions and the expectation that they will perform multiple tasks efficiently and without error while maintaining oversight of the entire emergency department. However, there is a lack of definition and understanding of the behaviors that constitute effective task switching and multitasking, as well as how to improve these skills. This article reviews the literature on task switching and multitasking in a variety of disciplines-including cognitive science, human factors engineering, business, and medicine-to define and describe the successful performance of task switching and multitasking in emergency medicine. Multitasking, defined as the performance of two tasks simultaneously, is not possible except when behaviors become completely automatic; instead, physicians rapidly switch between small tasks. This task switching causes disruption in the primary task and may contribute to error. A framework is described to enhance the understanding and practice of these behaviors. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  1. Clinical relevance of pharmacist intervention in an emergency department.

    Science.gov (United States)

    Pérez-Moreno, Maria Antonia; Rodríguez-Camacho, Juan Manuel; Calderón-Hernanz, Beatriz; Comas-Díaz, Bernardino; Tarradas-Torras, Jordi

    2017-08-01

    To evaluate the clinical relevance of pharmacist intervention on patient care in emergencies, to determine the severity of detected errors. Second, to analyse the most frequent types of interventions and type of drugs involved and to evaluate the clinical pharmacist's activity. A 6-month observational prospective study of pharmacist intervention in the Emergency Department (ED) at a 400-bed hospital in Spain was performed to record interventions carried out by the clinical pharmacists. We determined whether the intervention occurred in the process of medication reconciliation or another activity, and whether the drug involved belonged to the High-Alert Medications Institute for Safe Medication Practices (ISMP) list. To evaluate the severity of the errors detected and clinical relevance of the pharmacist intervention, a modified assessment scale of Overhage and Lukes was used. Relationship between clinical relevance of pharmacist intervention and the severity of medication errors was assessed using ORs and Spearman's correlation coefficient. During the observation period, pharmacists reviewed the pharmacotherapy history and medication orders of 2984 patients. A total of 991 interventions were recorded in 557 patients; 67.2% of the errors were detected during medication reconciliation. Medication errors were considered severe in 57.2% of cases and 64.9% of pharmacist intervention were considered relevant. About 10.9% of the drugs involved are in the High-Alert Medications ISMP list. The severity of the medication error and the clinical significance of the pharmacist intervention were correlated (Spearman's ρ=0.728/pclinical pharmacists identified and intervened on a high number of severe medication errors. This suggests that emergency services will benefit from pharmacist-provided drug therapy services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  2. Complementary/alternative medicine use among chronic pain clinic patients.

    Science.gov (United States)

    Konvicka, James J; Meyer, Tricia A; McDavid, Andrew J; Roberson, Charles R

    2008-02-01

    Complementary and alternative therapies have enjoyed increasingly widespread use in recent years. Because of this trend, we were eager to obtain a better grasp on the actual number of people in our hospital's pain clinic who have used these modalities. In an effort to explore the use of complementary/alternative medicine (CAM) by patients seen in an anesthesiology chronic pain clinic, we conducted a study using a questionnaire. This questionnaire contained two sections, one covering complementary/alternative modalities and the other dealing with herbals or nutraceuticals. More than 400 patients were surveyed, 41% of whom were male and 59% of whom were female. Comparing alternative therapies by gender revealed no statistical difference in males versus females. The most commonly chosen modalities overall were nutraceuticals, massage therapy, and acupuncture. In terms of age, we found that the patients surveyed who were older than 60 years of age preferred nutraceuticals, and that the younger age group preferred more interactive relaxation techniques, such as meditation and massage.

  3. An international fellowship training program in pediatric emergency medicine: establishing a new subspecialty in the Land of the Dragon.

    Science.gov (United States)

    Goldman, Ran D; Cheng, Adam; Jarvis, Anna; Keogh, Kelly; Lu, Guo-ping; Wang, Jian-she; Kissoon, Niranjan; Larson, Charles

    2011-12-01

    The health care system reform in the People's Republic of China has brought plans for establishment of a universal coverage for basic health services, including services for children. This effort demands significant change in health care planning. Pediatric emergency medicine (PEM) is not currently identified as a specialty in China, and emergency medicine systems suffer from lack of appropriate training.In 2006, the Centre for International Child Health and the Department of Pediatrics, British Columbia Children's Hospital, Vancouver, Canada, initiated a fellowship training program in PEM for pediatricians working in emergency departments or critical care settings with the Children's Hospital of Fudan University, China. The main objective was to upgrade the professional and clinical experience of emergency physicians practicing PEM and build PEM capacity throughout China by training the future trainers. After selecting trainees, the program included a structured curriculum over 2 years of training in China by Canadian and Australian PEM faculty and then practical exposure to PEM in Canada. All trainees underwent a structured evaluation after their final rotation in Canada. A total of 12 trainees completed the first 2 program cycles. The trainees considered the "overall rating of the training experience" as "excellent" (10/12) or "good" (2/12). All trainees considered the program as a relevant training to their practice and felt it will change their practice. They reported the program to be effective, with excellent complexity of content. Despite its current success, the program faces challenges in the development of the new subspecialty and ensuring its acceptance among other health care providers and decision makers. Identification and preparation of a capable training force to lead educational activities in China are daunting tasks. Time constraints, funding, and language barriers are other challenges. Future effort should be focused on improving and sustaining

  4. Combating slavery in the 21st century: the role of emergency medicine.

    Science.gov (United States)

    Chisolm-Straker, Makini; Richardson, Lynne D; Cossio, Tania

    2012-08-01

    Human trafficking (HT) victims may present to emergency departments (ED) as patients, but are infrequently identified. To address this issue, we developed and piloted a training intervention for emergency providers on HT and how to identify and treat these patients. Included in the intervention participants were emergency medicine residents, ED attendings, ED nurses, and hospital social workers. Prior to the intervention, 4.8% felt some degree of confidence in their ability to identify and 7.7% to treat a trafficked patient. After the 20-minute intervention, 53.8% felt some degree of confidence in their ability to identify and 56.7% care for this patient population. Because this problem is global, we created a Website that includes an instructive toolkit and an interactive course for self-learning and/or assessment. This intervention will give ED providers the tools they need to assess and treat a patient who might be a victim of human trafficking.

  5. [Organizational forms of emergency medicine from the perspective of DIVI. Discipline-specific or interdisciplinary?].

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    Quintel, M; Kumle, B

    2011-04-01

    Modern processes in the organization in German hospitals are decisive to the development of emergency departments and as these represent the interface between outpatient and inpatient care, they have been identified as a strategic success factor. In larger hospitals emergency departments are generally run as independent units with their own management. The growing number of patients in emergency rooms each year demonstrates the future importance of these structures and successful hospital management has to face and handle this challenge. Clear job profiles for the leadership, staff members and structures of these units are needed. This article highlights the requirements for these structures from the perspective of the German Interdisciplinary Association of Critical Care Medicine (DIVI).

  6. Sexual Assault Training in Emergency Medicine Residencies: A Survey of Program Directors

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    Margaret K Sande

    2013-09-01

    Full Text Available Introduction: There is currently no standard forensic medicine training program for emergency medicine residents. In the advent of sexual assault nurse examiner (SANE programs aimed at improving the quality of care for sexual assault victims, it is also unclear how these programs impact emergency medicine (EM resident forensic medicine training. The purpose of this study was togather information on EM residency programs’ training in the care of sexual assault patients and determine what impact SANE programs may have on the experience of EM resident training from the perspective of residency program directors (PDs.Methods: This was a cross-sectional survey. The study cohort was all residency PDs from approved EM residency training programs who completed a closed-response self-administered survey electronically.Results: We sent surveys to 152 PDs, and 71 responded for an overall response rate of 47%. Twenty-two PDs (31% reported that their residency does not require procedural competency for the sexual assault exam, and 29 (41% reported their residents are required only to observe sexual assault exam completion to demonstrate competency. Residency PDs were asked how their programs established resident requirements for sexual assault exams. Thirty-seven PDs (52% did not know how their sexual assault exam requirement was established.Conclusion: More than half of residency PDs did not know how their sexual assault guidelines were established, and few were based upon recommendations from the literature. There is no clear consensus as to how PDs view the effect of SANE programs on resident competency with the sexual assault exam. This study highlights both a need for increased awareness of EM resident sexual assault education nationally and also a possible need for a training curriculum defining guidelines forEM residents performing sexual assault exams. [West J Emerg Med. 2013;14(5:461–466.

  7. The women in emergency medicine mentoring program: an innovative approach to mentoring.

    Science.gov (United States)

    Welch, Julie L; Jimenez, Heather L; Walthall, Jennifer; Allen, Sheryl E

    2012-09-01

    Women in medicine report many gender-specific barriers to their career success and satisfaction, including a lack of mentors and role models. The literature calls for innovative strategies to enhance mentorship for women in medicine. To describe the content, perceived value, and ongoing achievements of a mentoring program for women in emergency medicine. The program offered mentoring for female faculty and residents in an academic emergency medicine department. Volunteers participated in group mentoring sessions using a mosaic of vertical and peer mentoring. Sessions focused on topics specific to women in medicine. An anonymous, electronic survey was sent to women who participated during 2004-2010 to assess the perceived value of the program and to collect qualitative feedback. Preliminary achievements fulfilling the program's goals were tracked. A total of 46 women (64%) completed the survey. The results showed a positive perceived value of the program (average, 4.65 on a 5-point Likert scale) in providing mentors and role models (4.41), in offering a supportive environment (4.39), in providing discussions pertinent to both personal (4.22) and professional development (4.22), while expanding networking opportunities (4.07). Notable achievements included work on the creation of a family leave policy, establishing lactation space, collaboration on projects, awards, and academic advancement. This innovative model for mentoring women is perceived as a valuable asset to the academic department and residency. It offers the unique combination of expanding a female mentor pool by recruiting alumni and using a mosaic of vertical and peer mentoring.

  8. The emerging potential for network analysis to inform precision cancer medicine.

    Science.gov (United States)

    Ozturk, Kivilcim; Dow, Michelle; Carlin, Daniel E; Bejar, Rafael; Carter, Hannah

    2018-06-14

    Precision cancer medicine promises to tailor clinical decisions to patients using genomic information. Indeed, successes of drugs targeting genetic alterations in tumors, such as imatinib that targets BCR-ABL in chronic myelogenous leukemia, have demonstrated the power of this approach. However biological systems are complex, and patients may differ not only by the specific genetic alterations in their tumor, but by more subtle interactions among such alterations. Systems biology and more specifically, network analysis, provides a framework for advancing precision medicine beyond clinical actionability of individual mutations. Here we discuss applications of network analysis to study tumor biology, early methods for N-of-1 tumor genome analysis and the path for such tools to the clinic. Copyright © 2018. Published by Elsevier Ltd.

  9. Disposition of Patients Before and After Establishment of Emergency Medicine Specialists

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    Payman Asadi

    2014-09-01

    Full Text Available Introduction: Emergency department (ED as the fundamental part of hospital has a specific importance due to admitting the most various and sensitive group of patients. The aim of the ED is presenting services with highest quality in the least time. To reach this goal establishment of an emergency medicine specialist who performs assessment, resuscitation, stabilization, detection, and maintenance of emergency patients is noteworthy. The aim of this study was evaluating the effect of establishing the emergency medicine specialists on the performance of ED in Poursina Hospital, Rasht, Iran.  Methods: In this cross-sectional study files of all patients hospitalized in the ED of Poursina, Rasht, Iran, through 2005-2012 were evaluated. Variables such as age, gender, cause of refer and number of hospitalization, number of discharging from department, percentage of bed occupation and daily bed occupation, time of hospitalization, number of discharging under six hours, number of transportation to other wards or hospitals, and the rate of bed circulation in the ED were assessed, too. Data was gathered through hospital information system and analyzed using SPSS 20. Results: Through 2005 to 2012 number of admitted patients in the ED has increased so that the most admitted number was related to 2012 (p=0.0001. The present of discharged patients under six hours and the rate of direct discharging before the presence of emergency medicine specialists have increased from 15.5% and 58.9% to 23.4% and 61.2% in after their presence, respectively(p=0.001. Transporting to other wards and hospitals were also decreased from 41.1% to 38.8% (p=0.0001. The occupied beds percentage after presenting of emergency medicine specialists has noticeably decreased compared to the past, while bed turnover rate increased. In other words, the bed turnover mean has increased from 354.5±108.4 during 2005-2008 to 637.7±30.8 through 2009-2012 (p=0.002. Also, during 2005-2008 the

  10. Approach to Acute Headache: A Flipped Classroom Module for Emergency Medicine Trainees

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    Jeff Riddell

    2016-07-01

    Full Text Available Audience: This module is designed for emergency medicine trainees. Though it focuses on those early in their career (medical students and junior residents, it is applicable to all emergency medicine learners. Introduction: In the United States, headache is the fifth most-common primary complaint of patients presenting to the emergency department and can be the primary symptomatic manifestation of many life-threatening illnesses. The emergency physician plays a unique role in diagnosing and managing these patients. The emergency physician’s two major responsibilities are to relieve headache pain and to ensure that life-threatening causes are diagnosed and treated. Objectives: At the end of this module, the learner will be able to: 1 list the diagnoses critical to the emergency physician that may present with headache; 2 identify key historical and examination findings that help differentiate primary (benign from secondary (serious causes of headache; 3 discuss the indications for diagnostic imaging, lumbar puncture and laboratory testing in patients with headache; 4 recognize life-threatening diagnoses on CT imaging and CSF examination; 5 describe treatment strategies to relieve headache symptoms. Methods: This module includes a complete flipped classroom module. Learners are responsible for viewing a 20-minute video prior to the 30-minute small-group, case-based didactic discussion portion. The learners are assessed with multiple-choice question assessments, for low stakes retrieval practice or spaced practice. This could alternatively be run as a team-based learning session, with the pre- and post-tests used as an individual or group readiness assessment test, and the small group exercises converted to a group application exercise.

  11. Improving the attractiveness of an emergency medicine career to medical students: An exploratory study.

    Science.gov (United States)

    Celenza, Antonio; Bharath, Jude; Scop, Jason

    2012-12-01

    To describe perceptions of medical students and emergency doctors towards careers in emergency medicine (EM), and to identify influences on career choice. A prospective, cross-sectional questionnaire study was performed in three EDs. The instrument used Likert-type items addressing: factors important in the choice of a career, factors offered by a career in EM, and opinions of EM. EM consultants and registrars and a cohort of final-year medical students participated. Overall, 22 consultants, 30 registrars and 164 students completed the questionnaire (77.1% overall response). Student interest in an EM career increased from 10/161 (6.2% [95% CI 3.0-11.1%]) before, to 26/137 (19.0% [95% CI 12.8-26.6%]) after an EM attachment (P = 0.0014). The highest proportion of students chose work-life balance as being an important factor for career choice (143/163 students, 87.7% [95% CI 81.2-92.6%]). Compared with consultants and registrars, students had negative perceptions about lifestyle factors that EM offered, as well as about the future of the specialty, job security and workplace stress. Some students also preferred careers with opportunities for research, subspecialty practice, and better pay and conditions, yet perceived EM as not offering these factors. Students considered EM as an acute, procedural, public hospital specialty, with diverse patient problems and minimal continuity of care. Smaller proportions of students considered these factors important for career choice. Increasing the attractiveness of a career in EM requires changing student perceptions of lifestyle and satisfaction benefits, access to EM subspecialties, increasing ED research, information about job security, and improved work conditions. © 2012 The Authors. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  12. Setting up and functioning of an Emergency Medicine Department: Lessons learned from a preliminary study

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    K Asish

    2016-01-01

    Full Text Available Background and Aims: Tertiary care teaching hospitals remain referral centres for victims of trauma and mass casualty. Often specialists from various disciplines manage these crowded casualty areas. These age old casualty areas are being replaced, throughout the country by Emergency Medicine Departments (EMDs, presumed to be better planned to confront a crisis. We aimed to gather basic data contributive in setting up of an EMD at a tertiary care teaching hospital from the lessons learned from functioning existent systems. Methods: This is primarily a questionnaire-based descriptive study at tertiary care referral centres across the country, which was purposively selected.The study models included one from a hospital without designated EMD and the other four from hospitals with established EMDs. Direct observation and focus group meetings with experienced informants at these hospitals contributed to the data. In the absence of a validated hospital preparedness assessment scale, comparison was done with regard to quantitative, qualitative and corroborative parameters using descriptive analysis. Results: The EMDs at best practice models were headed by specialist in Emergency Medicine assisted by organised staff, had protocols for managing mass casualty incident (MCI, separate trauma teams, ergonomic use of infrastructure and public education programmes. In this regard, these hospitals seemed well organised to manage MCIs and disasters. Conclusion: The observation may provide a preliminary data useful in setting up an EMD. In the absence of published Indian literature, this may facilitate further research in this direction. Anaesthesiologists, presently an approved Faculty in Emergency Medicine training can provide creative input with regard to its initial organisation and functioning, thus widening our horizons in a country where there is a severe dearth of trained emergency physicians.

  13. Pediatric crisis resource management training improves emergency medicine trainees' perceived ability to manage emergencies and ability to identify teamwork errors.

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    Bank, Ilana; Snell, Linda; Bhanji, Farhan

    2014-12-01

    Improved pediatric crisis resource management (CRM) training is needed in emergency medicine residencies because of the variable nature of exposure to critically ill pediatric patients during training. We created a short, needs-based pediatric CRM simulation workshop with postactivity follow-up to determine retention of CRM knowledge. Our aims were to provide a realistic learning experience for residents and to help the learners recognize common errors in teamwork and improve their perceived abilities to manage ill pediatric patients. Residents participated in a 4-hour objectives-based workshop derived from a formal needs assessment. To quantify their subjective abilities to manage pediatric cases, the residents completed a postworkshop survey (with a retrospective precomponent to assess perceived change). Ability to identify CRM errors was determined via a written assessment of scripted errors in a prerecorded video observed before and 1 month after completion of the workshop. Fifteen of the 16 eligible emergency medicine residents (postgraduate year 1-5) attended the workshop and completed the surveys. There were significant differences in 15 of 16 retrospective pre to post survey items using the Wilcoxon rank sum test for non-parametric data. These included ability to be an effective team leader in general (P < 0.008), delegating tasks appropriately (P < 0.009), and ability to ensure closed-loop communication (P < 0.008). There was a significant improvement in identification of CRM errors through the use of the video assessment from 3 of the 12 CRM errors to 7 of the 12 CRM errors (P < 0.006). The pediatric CRM simulation-based workshop improved the residents' self-perceptions of their pediatric CRM abilities and improved their performance on a video assessment task.

  14. World Workshop on Oral Medicine VI: an international validation study of clinical competencies for advanced training in oral medicine.

    Science.gov (United States)

    Steele, John C; Clark, Hadleigh J; Hong, Catherine H L; Jurge, Sabine; Muthukrishnan, Arvind; Kerr, A Ross; Wray, David; Prescott-Clements, Linda; Felix, David H; Sollecito, Thomas P

    2015-08-01

    To explore international consensus for the validation of clinical competencies for advanced training in Oral Medicine. An electronic survey of clinical competencies was designed. The survey was sent to and completed by identified international stakeholders during a 10-week period. To be validated, an individual competency had to achieve 90% or greater consensus to keep it in its current format. Stakeholders from 31 countries responded. High consensus agreement was achieved with 93 of 101 (92%) competencies exceeding the benchmark for agreement. Only 8 warranted further attention and were reviewed by a focus group. No additional competencies were suggested. This is the first international validated study of clinical competencies for advanced training in Oral Medicine. These validated clinical competencies could provide a model for countries developing an advanced training curriculum for Oral Medicine and also inform review of existing curricula. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Risk of discontinuation of Advanced Therapy Medicinal Products clinical trials.

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    Hanna, Eve; Rémuzat, Cecile; Auquier, Pascal; Toumi, Mondher

    2016-01-01

    Advanced therapy medicinal products (ATMPs) constitute a class of innovative products that encompasses gene therapy, somatic cell therapy, and tissue-engineered products (TEP). There is an increased investment of commercial and non-commercial sponsors in this field and a growing number of ATMPs randomized clinical trials (RCT) and patients enrolled in such trials. RCT generate data to prove the efficacy of a new therapy, but the discontinuation of RCTs wastes scarce resources. Our objective is to identify the number and characteristics of discontinued ATMPs trials in order to evaluate the rate of discontinuation. We searched for ATMPs trials conducted between 1999 to June 2015 using three databases, which are Clinicaltrials.gov, the International Clinical Trials Registry Platform (ICTRP), and the EU Drug Regulating Authorities Clinical Trials (EudraCT). We selected the ATMPs trials after elimination of the duplicates. We identified the disease areas and the sponsors as commercial or non-commercial organizations. We classified ATMPs by type and trial status, that is, ongoing, completed, terminated, discontinued, and prematurely ended. Then, we calculated the rate of discontinuation. Between 1999 and June 2015, 143 withdrawn, terminated, or prematurely ended ATMPs clinical trials were identified. Between 1999 and June 2013, 474 ongoing and completed clinical trials were identified. Therefore, the rate of discontinuation of ATMPs trials is 23.18%, similar to that for non-ATMPs drugs in development. The probability of discontinuation is, respectively, 27.35, 16.28, and 16.34% for cell therapies, gene therapies, and TEP. The highest discontinuation rate is for oncology (43%), followed by cardiology (19.2%). It is almost the same for commercial and non-commercial sponsors; therefore, the discontinuation reason may not be financially driven. No failure risk rate per development phase is available for ATMPs. The discontinuation rate may prove helpful when assessing the

  16. Emergency Medicine Evaluation of Community-Acquired Pneumonia: History, Examination, Imaging and Laboratory Assessment, and Risk Scores.

    Science.gov (United States)

    Long, Brit; Long, Drew; Koyfman, Alex

    2017-11-01

    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. To investigate emergency medicine evaluation of community-acquired pneumonia including history, physical examination, imaging, and the use of risk scores in patient assessment. Pneumonia is the number one cause of death from infectious disease. The condition is broken into several categories, the most common being community-acquired pneumonia. Diagnosis centers on history, physical examination, and chest radiograph. However, all are unreliable when used alone, and misdiagnosis occurs in up to one-third of patients. Chest radiograph has a sensitivity of 46-77%, and biomarkers including white blood cell count, procalcitonin, and C-reactive protein provide little benefit in diagnosis. Biomarkers may assist admitting teams, but require further study for use in the emergency department. Ultrasound has shown utility in correctly identifying pneumonia. Clinical gestalt demonstrates greater ability to diagnose pneumonia. Clinical scores including Pneumonia Severity Index (PSI); Confusion, blood Urea nitrogen, Respiratory rate, Blood pressure, age 65 score (CURB-65); and several others may be helpful for disposition, but should supplement, not replace, clinical judgment. Patient socioeconomic status must be considered in disposition decisions. The diagnosis of pneumonia requires clinical gestalt using a combination of history and physical examination. Chest radiograph may be negative, particularly in patients presenting early in disease course and elderly patients. Clinical scores can supplement clinical gestalt and assist in disposition when used appropriately. Published by Elsevier Inc.

  17. An assessment of emergency medicine residents' ability to perform in a multitasking environment.

    Science.gov (United States)

    Ledrick, David; Fisher, Susan; Thompson, Justin; Sniadanko, Mark

    2009-09-01

    Multitasking (MT) is a term often applied to emergency medicine (EM), but it is still poorly understood. In an effort to facilitate MT research in EM, the authors conducted this pilot study to describe EM residents' scores on a Multi-Tasking Assessment Tool (MTAT) and compare these scores with the residents' work efficiency in the emergency department. The authors administered a previously developed test of MT ability to EM residents. They performed a multiple regression analysis to determine the effect of MT ability on resident work efficiency, defining efficiency as the number of relative value units billed per hour. They controlled the analysis for year of training and medical knowledge using as a standard the in-service exam administered by the American Board of Emergency Medicine. Complete data for 35 residents were available for analysis. Work efficiency was multivariately correlated with MTAT scores and year of training (P training explained the majority of the variance, a resident's MT ability accounted for a smaller but still significant portion. This pilot study further validates the MTAT and lays the groundwork for further research in MT in EM. Resident year of training and MTAT scores explain the variability in resident work efficiency significantly more than medical knowledge. Understanding MT ability may ultimately help in resident selection, education, and remediation as well as career counseling and improvement of practice systems in EM.

  18. Strategies for coping with stress in emergency medicine: Early education is vital

    Directory of Open Access Journals (Sweden)

    Gillian R Schmitz

    2012-01-01

    Full Text Available Introduction: Physician burnout has received considerable attention in the literature and impacts a large number of emergency medicine physicians, but there is no standardized curriculum for wellness in resident education. A culture change is needed to educate about wellness, adopt a preventative and proactive approach, and focus on resiliency. Discussion: We describe a novel approach to wellness education by focusing on resiliency rather than the unintended endpoint of physician burnout. One barrier to adoption of wellness education has been establishing legitimacy among emergency medicine (EM residents and educators. We discuss a change in the language of wellness education and provide several specific topics to facilitate the incorporation of these topics in resident education. Conclusion: Wellness education and a culture of training that promotes well-being will benefit EM residents. Demonstrating the impact of several factors that positively affect emergency physicians may help to facilitate alert residents to the importance of practicing activities that will result in wellness. A change in culture and focus on resiliency is needed to adequately address and optimize physician self-care.

  19. A Simulation-based Approach to Measuring Team Situational Awareness in Emergency Medicine: A Multicenter, Observational Study.

    Science.gov (United States)

    Rosenman, Elizabeth D; Dixon, Aurora J; Webb, Jessica M; Brolliar, Sarah; Golden, Simon J; Jones, Kerin A; Shah, Sachita; Grand, James A; Kozlowski, Steve W J; Chao, Georgia T; Fernandez, Rosemarie

    2018-02-01

    Team situational awareness (TSA) is critical for effective teamwork and supports dynamic decision making in unpredictable, time-pressured situations. Simulation provides a platform for developing and assessing TSA, but these efforts are limited by suboptimal measurement approaches. The objective of this study was to develop and evaluate a novel approach to TSA measurement in interprofessional emergency medicine (EM) teams. We performed a multicenter, prospective, simulation-based observational study to evaluate an approach to TSA measurement. Interprofessional emergency medical teams, consisting of EM resident physicians, nurses, and medical students, were recruited from the University of Washington (Seattle, WA) and Wayne State University (Detroit, MI). Each team completed a simulated emergency resuscitation scenario. Immediately following the simulation, team members completed a TSA measure, a team perception of shared understanding measure, and a team leader effectiveness measure. Subject matter expert reviews and pilot testing of the TSA measure provided evidence of content and response process validity. Simulations were recorded and independently coded for team performance using a previously validated measure. The relationships between the TSA measure and other variables (team clinical performance, team perception of shared understanding, team leader effectiveness, and team experience) were explored. The TSA agreement metric was indexed by averaging the pairwise agreement for each dyad on a team and then averaging across dyads to yield agreement at the team level. For the team perception of shared understanding and team leadership effectiveness measures, individual team member scores were aggregated within a team to create a single team score. We computed descriptive statistics for all outcomes. We calculated Pearson's product-moment correlations to determine bivariate correlations between outcome variables with two-tailed significance testing (p teams (n = 41

  20. Personalized medicine. Closing the gap between knowledge and clinical practice.

    Science.gov (United States)

    Anaya, Juan-Manuel; Duarte-Rey, Carolina; Sarmiento-Monroy, Juan C; Bardey, David; Castiblanco, John; Rojas-Villarraga, Adriana

    2016-08-01

    Personalized medicine encompasses a broad and evolving field informed by a patient distinctive information and biomarker profile. Although terminology is evolving and some semantic interpretations exist (e.g., personalized, individualized, precision), in a broad sense personalized medicine can be coined as: "To practice medicine as it once used to be in the past using the current biotechnological tools." A humanized approach to personalized medicine would offer the possibility of exploiting systems biology and its concept of P5 medicine, where predictive factors for developing a disease should be examined within populations in order to establish preventive measures on at-risk individuals, for whom healthcare should be personalized and participatory. Herein, the process of personalized medicine is presented together with the options that can be offered in health care systems with limited resources for diseases like rheumatoid arthritis and type 1 diabetes. Copyright © 2016 Else