MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Academic Emergency Medicine' source. Wed, 08 Feb 2012 14:35:35 +0100 http://www.medworm.com/index.php?rid=5648732&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01267.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5648732 Mon, 30 Jan 2012 05:00:00 +0100 5648732 http://www.medworm.com/index.php?rid=5648731&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01272.x Conclusions:  The presence of known psychiatric problems and substance use had the strongest associations with suicide screening, yet even patients presenting with these indicators were not screened for suicide. Understanding factors that currently influence suicide screening in the ED will guide the design and implementation of improved suicide screening protocols and related interventions.ACADEMIC EMERGENCY MEDICINE 2012; 1–5 © 2012 by the Society for Academic Emergency Medicine (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5648731 Mon, 30 Jan 2012 05:00:00 +0100 5648731 http://www.medworm.com/index.php?rid=5648730&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01274.x Conclusions:  There is a wide range in the didactic, online, and in‐field EMS educational experiences provided as part of EM training. Most residents participate in ground ride‐along activities, provide DMO, and have a dedicated EMS rotation. Disaster‐preparedness is the most common desired addition to existing EMS rotations.ACADEMIC EMERGENCY MEDICINE 2012; 19:1–6 © 2012 by the Society for Academic Emergency Medicine (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5648730 Mon, 30 Jan 2012 05:00:00 +0100 5648730 http://www.medworm.com/index.php?rid=5648729&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01277.x This article describes the development of a methodology for calculating the cost of an EMS system to its community. This includes a tool for calculating the cost of EMS (the “cost workbook”) and detailed directions for determining cost (the “cost guide”). The 12‐step process that was developed is consistent with current theories of health economics, applicable to prehospital care, flexible enough to be used in varying sizes and types of EMS systems, and comprehensive enough to provide meaningful conclusions. It was developed by an expert panel (the EMS Cost Analysis Project [EMSCAP] investigator team) in an iterative process that included pilot testing the process in three diverse communities. The iterative process allowed ongoing modification of the toolkit during the developmen... Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5648729 Mon, 30 Jan 2012 05:00:00 +0100 5648729 http://www.medworm.com/index.php?rid=5629257&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01260.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5629257 Tue, 24 Jan 2012 05:00:00 +0100 5629257 http://www.medworm.com/index.php?rid=5629256&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01261.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5629256 Tue, 24 Jan 2012 05:00:00 +0100 5629256 http://www.medworm.com/index.php?rid=5629255&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01262.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5629255 Tue, 24 Jan 2012 05:00:00 +0100 5629255 http://www.medworm.com/index.php?rid=5560717&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01238.x Conclusions:  These results suggest that a standardized questionnaire may contribute to ruling out tubal rupture in patients with EP. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5560717 Thu, 05 Jan 2012 05:00:00 +0100 5560717 http://www.medworm.com/index.php?rid=5560716&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01239.x Conclusions:  Urinary metabolites found at the time of presentation may be markers of early renal injury. It is therefore possible that the process of renal injury is initiated prior to ED arrival in patients with suspected heart failure, and these may be used to identify a high‐risk patient population. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5560716 Thu, 05 Jan 2012 05:00:00 +0100 5560716 http://www.medworm.com/index.php?rid=5560715&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01246.x Conclusions:  Frequent users accounted for a moderate proportion of visits at the Lausanne ED. Social and medical vulnerability factors were associated with frequent ED use. In addition, frequent users were more likely to have both social and medical vulnerabilities than were other patients. Case management strategies might address the vulnerability factors of frequent users to prevent inequities in health care and related costs. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5560715 Thu, 05 Jan 2012 05:00:00 +0100 5560715 http://www.medworm.com/index.php?rid=5560714&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01251.x Conclusions:  Plasma calprotectin and serum/urine LRG are elevated in pediatric appendicitis. No individual marker performed as well as the WBC count. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5560714 Thu, 05 Jan 2012 05:00:00 +0100 5560714 http://www.medworm.com/index.php?rid=5560713&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01254.x Conclusions:  These data indicate that short‐term memory appears to decline after day and overnight shifts and confirms the high incidence of disturbed sleep in this population. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5560713 Thu, 05 Jan 2012 05:00:00 +0100 5560713 http://www.medworm.com/index.php?rid=5560712&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01258.x ACADEMIC EMERGENCY MEDICINE 2012; 19:1–6 © 2012 by the Society for Academic Emergency MedicineAbstractThe benefits of mentorship for the protégé are well established and include increased career satisfaction, advancement, and income. Mentors can derive satisfaction from personal and professional networks within their institutions and specialties. However, the advantages of being a mentor are underreported in the medical literature. The purpose of this review is to investigate the effect of the mentoring relationship on the mentors and institutions in disciplines that have studied it widely and to draw parallels to academic medicine. Literature in the fields of business, organizational psychology, and kindergarten through high school (K‐12) education describe benefits of serving as a... Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5560712 Thu, 05 Jan 2012 05:00:00 +0100 5560712 http://www.medworm.com/index.php?rid=5648728&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01279.x Conclusions:  In this retrospective pilot study, FOCUS demonstrated good agreement with CTA measurements of maximal thoracic aortic diameter. FOCUS appears to be specific for aortic dilation and aneurysm when compared to CTA, but requires further prospective study.ACADEMIC EMERGENCY MEDICINE 2012; 19:1–4 © 2012 by the Society for Academic Emergency Medicine (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5648728 Sun, 01 Jan 2012 05:00:00 +0100 5648728 http://www.medworm.com/index.php?rid=5629254&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01271.x Conclusions:  Both first‐attempt and ultimate success rates were higher with GlideScope intubations in the ED when the rigid stylet was used compared to the malleable stylet. The number of complications and, in particular, the incidence of oxygen desaturation were lower in the GRS group than in the SMS group. The two stylet groups were similar regarding difficulty of the airway and experience level of the operator. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5629254 Sun, 01 Jan 2012 05:00:00 +0100 5629254 http://www.medworm.com/index.php?rid=5598347&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2012.01303.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5598347 Sun, 01 Jan 2012 05:00:00 +0100 5598347 http://www.medworm.com/index.php?rid=5598346&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2012.01302.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5598346 Sun, 01 Jan 2012 05:00:00 +0100 5598346 http://www.medworm.com/index.php?rid=5598345&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01256.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5598345 Sun, 01 Jan 2012 05:00:00 +0100 5598345 http://www.medworm.com/index.php?rid=5598344&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01257.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5598344 Sun, 01 Jan 2012 05:00:00 +0100 5598344 http://www.medworm.com/index.php?rid=5598343&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01255.x Conclusions:  The pilot data generated in this study support the concept that relative differences in respiratory sound intensity may be useful in distinguishing acute dyspnea caused by CHF, COPD, or asthma. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5598343 Sun, 01 Jan 2012 05:00:00 +0100 5598343 http://www.medworm.com/index.php?rid=5598342&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01250.x Conclusions:  The SCS demonstrates validity in its strong association with actual ED resource use. The use of readily available ICD‐9 diagnosis codes makes the SCS useful as a risk adjustment tool for health services research. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5598342 Sun, 01 Jan 2012 05:00:00 +0100 5598342 http://www.medworm.com/index.php?rid=5598341&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01248.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5598341 Sun, 01 Jan 2012 05:00:00 +0100 5598341 http://www.medworm.com/index.php?rid=5598340&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01252.x Conclusions:  Simulation, followed immediately by facilitated debriefing, uncovered underlying causes of active cognitive, procedural, affective, and teamwork errors, latent errors, and error‐producing conditions in EMS pediatric care. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5598340 Sun, 01 Jan 2012 05:00:00 +0100 5598340 http://www.medworm.com/index.php?rid=5598339&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01241.x Conclusions:  There were no serious adverse events identified in this pilot study of combined N2O and INF. However, there was an increased incidence of vomiting and deeper levels of sedation when compared to published data of single‐agent use of N2O, which could lead to more serious adverse events. Further investigation is needed to establish the analgesic efficacy of combining N2O and INF and to clarify the safety profile before this combination can be recommended for PSA in children. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5598339 Sun, 01 Jan 2012 05:00:00 +0100 5598339 http://www.medworm.com/index.php?rid=5598338&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01253.x Conclusions:  Clinicians should not use the observation of normalized vital signs as a reason to forego objective testing for symptomatic patients with a risk factor for PE. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5598338 Sun, 01 Jan 2012 05:00:00 +0100 5598338 http://www.medworm.com/index.php?rid=5598337&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01247.x Conclusions:  In a U.S. sample of mildly head‐injured patients, the CCHR and the NOC had equivalently high sensitivities for detecting any traumatic intracranial lesion on CT, clinically important brain injury, and neurosurgical intervention, but the CCHR was more specific. A larger cohort will be needed to validate these findings. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5598337 Sun, 01 Jan 2012 05:00:00 +0100 5598337 http://www.medworm.com/index.php?rid=5538412&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01240.x Conclusions:  Among our sample of more than 3,000 hospitals, the ESI was the most commonly used triage system, and more patients were triaged using the ESI than any other triage acuity system. Still, there is an opportunity to further promote the adoption of validated, reliable triage systems. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5538412 Fri, 23 Dec 2011 05:00:00 +0100 5538412 http://www.medworm.com/index.php?rid=5538411&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01242.x Conclusions:  The incidence of specific technical errors of EPs learning to perform FAST at our institution improved with hands‐on experience. Interpretive skills improved more rapidly than image acquisition skills. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5538411 Fri, 23 Dec 2011 05:00:00 +0100 5538411 http://www.medworm.com/index.php?rid=5538410&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01243.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5538410 Fri, 23 Dec 2011 05:00:00 +0100 5538410 http://www.medworm.com/index.php?rid=5538409&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01244.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5538409 Fri, 23 Dec 2011 05:00:00 +0100 5538409 http://www.medworm.com/index.php?rid=5538408&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01245.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5538408 Fri, 23 Dec 2011 05:00:00 +0100 5538408 http://www.medworm.com/index.php?rid=5560711&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01259.x Conclusions:  In patients presenting with acute right lower quadrant abdominal pain, we found the investigational enzyme‐linked immunosorbent assay (ELISA) test for S100A8/A9 to perform with high sensitivity but very limited specificity. We found that shipping effect and delay in analysis resulted in a subsequent rise in test values, thereby increasing the sensitivity and decreasing the specificity of the test. Further investigation with hospital‐based laboratory analyzers is the next critical step for determining the ultimate clinical utility of the ELISA test for S100A8/A9 in ED patients presenting with acute right lower quadrant abdominal pain. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5560711 Thu, 01 Dec 2011 05:00:00 +0100 5560711 http://www.medworm.com/index.php?rid=5538407&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01249.x Conclusions:  Electronically delivered prescriptions significantly minimized pharmacy wait time and improved patient satisfaction at the pharmacy, but did not improve primary compliance with prescriptions. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5538407 Thu, 01 Dec 2011 05:00:00 +0100 5538407 http://www.medworm.com/index.php?rid=5505625&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01282.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5505625 Thu, 01 Dec 2011 05:00:00 +0100 5505625 http://www.medworm.com/index.php?rid=5505624&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01229.x This article chronicles the history, activities, lessons learned, and future of the Urgent Matters program.ACADEMIC EMERGENCY MEDICINE 2011; 18:1392–1399 © 2011 by the Society for Academic Emergency Medicine (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5505624 Thu, 01 Dec 2011 05:00:00 +0100 5505624 http://www.medworm.com/index.php?rid=5505623&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01209.x Conclusions:  In this study on a single Monday evening, 47% of EDs in Michigan were actively boarding inpatients, while 24% were operating beyond capacity. On the following morning (Tuesday), EDs had fewer boarded inpatients than on Monday evening. However, these boarded inpatients remained in the ED for a significantly longer duration. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5505623 Thu, 01 Dec 2011 05:00:00 +0100 5505623 http://www.medworm.com/index.php?rid=5505622&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01221.x Conclusions:  Emergency department crowding is associated with delays in antibiotic administration to the febrile neonate despite rapid recognition of this patient population as a high‐risk group. Each component of ED crowding, in terms of input, throughput, and output factors, was associated with delays. Further work is required to develop processes that foster a more rapid treatment protocol for these high‐risk patients, regardless of ED crowding pressures. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5505622 Thu, 01 Dec 2011 05:00:00 +0100 5505622 http://www.medworm.com/index.php?rid=5505621&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01135.x ACADEMIC EMERGENCY MEDICINE 2011; 18:1371–1379 © 2011 by the Society for Academic Emergency MedicineAbstractEmergency department (ED) crowding is an international phenomenon that continues to challenge operational efficiency. Many statistical modeling approaches have been offered to describe, and at times predict, ED patient load and crowding. A number of formula‐based equations, regression models, time‐series analyses, queuing theory–based models, and discrete‐event (or process) simulation (DES) models have been proposed. In this review, we compare and contrast these modeling methodologies, describe the fundamental assumptions each makes, and outline the potential applications and limitations for each with regard to usability in ED operations and in ED operations and crowding r... Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5505621 Thu, 01 Dec 2011 05:00:00 +0100 5505621 http://www.medworm.com/index.php?rid=5505620&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01235.x This article describes emergency care systems and the extent of crowding across 15 countries outside of the United States: Australia, Canada, Denmark, Finland, France, Germany, Hong Kong, India, Iran, Italy, The Netherlands, Saudi Arabia, Catalonia (Spain), Sweden, and the United Kingdom. The authors are local emergency care leaders with knowledge of emergency care in their particular countries. Where available, data are provided about visit patterns in each country; however, for many of these countries, no national data are available on ED visits rates or crowding. For most of the countries included, there is both objective evidence of increases in ED visit rates and ED crowding and also subjective assessments of trends toward higher crowding in the ED. ED crowding appears to be worsening... Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5505620 Thu, 01 Dec 2011 05:00:00 +0100 5505620 http://www.medworm.com/index.php?rid=5505619&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01136.x Conclusions:  Crowding is associated with decreased timeliness and effectiveness, but not equity, of analgesia delivery for children with fracture‐related pain. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5505619 Thu, 01 Dec 2011 05:00:00 +0100 5505619 http://www.medworm.com/index.php?rid=5505618&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01236.x Conclusions:  Hospital mortality and hospital LOS are associated with length of ED boarding.ACADEMIC EMERGENCY MEDICINE 2011; 18:1324–1329 © 2011 by the Society for Academic Emergency Medicine (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5505618 Thu, 01 Dec 2011 05:00:00 +0100 5505618 http://www.medworm.com/index.php?rid=5505617&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01233.x ACADEMIC EMERGENCY MEDICINE 2011; 18:1318–1323 © 2011 by the Society for Academic Emergency MedicineAbstractThe effect of emergency department (ED) crowding on equitable care is the least studied of the domains of quality as defined by the Institute of Medicine (IOM). Inequities in access and treatment throughout the health care system are well documented in all fields of medicine. While there is little evidence demonstrating that inequity is worsened by crowding, theory and evidence from social science disciplines, as well as known barriers to care for vulnerable populations, would suggest that crowding will worsen inequities.To design successful interventions, however, it is important to first understand how crowding can result in disparities and base interventions on these mechanisms... Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5505617 Thu, 01 Dec 2011 05:00:00 +0100 5505617 http://www.medworm.com/index.php?rid=5505616&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01219.x This article summarizes the proceedings of a breakout session, “Interventions to Safeguard System Effectiveness,” at the 2011 Academic Emergency Medicine consensus conference, “Interventions to Assure Quality in the Crowded Emergency Department.” Key definitions fundamental to understanding the effectiveness of emergency care during periods of emergency department (ED) crowding are outlined. Next, a proposed research agenda to evaluate interventions directed at improving emergency care effectiveness is outlined, and the paper concludes with a prioritization of those interventions based on breakout session participant discussion and evaluation. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5505616 Thu, 01 Dec 2011 05:00:00 +0100 5505616 http://www.medworm.com/index.php?rid=5505615&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01222.x This article, a product of the breakout session on “interventions to safeguard efficiency of care,” explores various elements of the research agenda on efficiency and quality in crowded emergency departments (EDs). The authors discuss four areas identified as critical to achieving progress in the research agenda for improving ED efficiency: 1) What measures can be used to understand and improve the efficiency and quality of interventions in the ED? 2) Which factors outside of the ED’s control affect ED efficiency? 3) How do workforce factors affect ED efficiency? 4) How do ED design, patient flow structures, and use of technology affect efficiency? Filling these knowledge gaps is vital to identifying interventions that improve the delivery of emergency care in all EDs. (Source: Acade... Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5505615 Thu, 01 Dec 2011 05:00:00 +0100 5505615 http://www.medworm.com/index.php?rid=5505614&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01230.x This article summarizes the findings of the breakout session that investigated interventions to improve the timeliness of emergency care. This article will explore the background on the concept of timeliness of emergency care, the current state of interventions that have been implemented to improve timeliness, and specific questions as a framework for a future research agenda. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5505614 Thu, 01 Dec 2011 05:00:00 +0100 5505614 http://www.medworm.com/index.php?rid=5505613&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01224.x This article is the result of a breakout session of the 2011 Academic Emergency Medicine consensus conference “Interventions to Assure Quality in the Crowded Emergency Department” and focuses on three broad domains of patient‐centered care: patient satisfaction, patient involvement, and care related to patient needs.The working group provided background information and an overview of interventions that have been conducted in the domains of patient satisfaction, patient involvement (patients’ preferences and values in decision‐making), and patient needs (e.g., comfort, information, education). Participants in the breakout session discussed interventions reported in the medical literature as well as initiated at their institutions, discussed the effect of crowding on patient‐cent... Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5505613 Thu, 01 Dec 2011 05:00:00 +0100 5505613 http://www.medworm.com/index.php?rid=5505612&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01234.x This article describes the results of the Interventions to Safeguard Safety breakout session of the 2011 Academic Emergency Medicine (AEM) consensus conference entitled “Interventions to Assure Quality in the Crowded Emergency Department.” Using a multistep nominal group technique, experts in emergency department (ED) crowding, patient safety, and systems engineering defined knowledge gaps and priority research questions related to the maintenance of safety in the crowded ED. Consensus was reached for seven research priorities related to interventions to maintain safety in the setting of a crowded ED. Included among these are: 1) How do routine corrective processes and compensating mechanism change during crowding? 2) What metrics should be used to determine ED safety? 3) How can check... Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5505612 Thu, 01 Dec 2011 05:00:00 +0100 5505612 http://www.medworm.com/index.php?rid=5505611&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01227.x This article describes each panelist’s comments in detail. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5505611 Thu, 01 Dec 2011 05:00:00 +0100 5505611 http://www.medworm.com/index.php?rid=5505610&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01232.x Conclusions:  Crowding measured at the daily level will mask much of the variation in crowding that occurs within a 24‐hour period. ED census at arrival demonstrated similar variation in crowding exposure as time‐varying ED census. Discrete time survival analysis is a more appropriate approach for estimating the effect of crowding on an outcome. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5505610 Thu, 01 Dec 2011 05:00:00 +0100 5505610 http://www.medworm.com/index.php?rid=5505609&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01226.x ACADEMIC EMERGENCY MEDICINE 2011; 18:1262–1268 © 2011 by the Society for Academic Emergency MedicineAbstractOperations 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... Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5505609 Thu, 01 Dec 2011 05:00:00 +0100 5505609 http://www.medworm.com/index.php?rid=5505608&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01225.x ACADEMIC EMERGENCY MEDICINE 2011; 18:1255–1261 © 2011 by the Society for Academic Emergency MedicineAbstractOvercrowding of U.S. emergency departments (EDs) is a widely recognized and growing problem. This presentation offers the perspectives of a primary care physician (PCP) examining the problem at three levels: global health policy, quality process improvement, and more intimate clinical caring. It posits that ED overcrowding is actually a symptom of 10 more fundamental problems in U.S. health care and EDs: variations/supply‐demand mismatch; primary care provider shortfalls; limited after‐hours access; admission throughput challenges; clinical challenges related to discontinuity patients; clinical challenges related to those with special needs; interruptions; testing logistical c... Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5505608 Thu, 01 Dec 2011 05:00:00 +0100 5505608 http://www.medworm.com/index.php?rid=5505607&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01231.x This article presents a model of how a build‐up of interruptions can shift the dynamics of the emergency department (ED) from an adaptive, self‐regulating system into a fragile, crisis‐prone one. Drawing on case studies of organizational disasters and insights from the theory of high‐reliability organizations, the authors use computer simulations to show how the accumulation of small interruptions could have disproportionately large effects in the ED. In the face of a mounting workload created by interruptions, EDs, like other organizational systems, have tipping points, thresholds beyond which a vicious cycle can lead rather quickly to the collapse of normal operating routines and in the extreme to a crisis of organizational paralysis. The authors discuss some possible implication... Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5505607 Thu, 01 Dec 2011 05:00:00 +0100 5505607 http://www.medworm.com/index.php?rid=5505606&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01220.x ACADEMIC EMERGENCY MEDICINE 2011; 18:1242–1245 © 2011 by the Society for Academic Emergency MedicineAbstractOntario is Canada’s most populous province, with approximately 12 million people and 130 emergency departments (EDs). Canada has a national single‐payer universal health care system, but provinces are responsible for administration. After years of problems and failed attempts to address chronic ED overcrowding, in April 2008 Ontario embarked on an ambitious program to improve system performance through targeted investments (initially CAN$500 million over 3 years) and realigned incentives. Supporting the program were requirements for hospitals to submit timely data and targets for length of stay (LOS) and annual improvements; results are publicly reported. The program has bee... Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5505606 Thu, 01 Dec 2011 05:00:00 +0100 5505606 http://www.medworm.com/index.php?rid=5505605&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01223.x This article describes the benefits and disadvantages associated with a single time‐related measure of ED performance. The article also describes the subsequent development of a raft of quality indicators designed to provide a greater breadth of ED measurement, reflecting timeliness, quality, and safety. The intention is for these indicators to act as levers for change and to generate a program of continuing improvement in emergency care.The indicators were introduced in England in April 2011, and currently there is a period of bedding‐in and collective learning. The quality indicators will be reviewed and refined as required, with any amendments introduced in April 2012. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5505605 Thu, 01 Dec 2011 05:00:00 +0100 5505605 http://www.medworm.com/index.php?rid=5505604&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01237.x This article will review the effect of these strategies on demand for care and discuss the successes and failures with reference to future plans for tackling this increasingly difficult problem in health care. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5505604 Thu, 01 Dec 2011 05:00:00 +0100 5505604 http://www.medworm.com/index.php?rid=5505603&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01228.x This article describes the background and rationale for the conference and highlights some of the discussions that occurred on the day of the conference. A series of manuscripts on the details of the conference is presented in this issue of Academic Emergency Medicine. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5505603 Thu, 01 Dec 2011 05:00:00 +0100 5505603 http://www.medworm.com/index.php?rid=5422677&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01197.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5422677 Tue, 01 Nov 2011 04:00:00 +0100 5422677 http://www.medworm.com/index.php?rid=5422676&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01207.x Conclusions:  Helicopter EMS transport was associated with a decreased hazard of mortality among certain patients transported from the scene of injury directly to definitive care. Refinements in scene triage and transport guidelines are needed to more effectively select patients that may benefit from HEMS transport from those unlikely to benefit. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5422676 Tue, 01 Nov 2011 04:00:00 +0100 5422676 http://www.medworm.com/index.php?rid=5422675&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01193.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5422675 Tue, 01 Nov 2011 04:00:00 +0100 5422675 http://www.medworm.com/index.php?rid=5422674&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01200.x This article describes the case of a hospice patient who presented with sepsis and end‐stage cancer to the ED. Patient, system, and physician factors made management decisions in the ED difficult. The goal in the ED should be to determine the best way to address terminally ill patient needs while respecting wishes to limit interventions that will only increase suffering near the end of life. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5422674 Tue, 01 Nov 2011 04:00:00 +0100 5422674 http://www.medworm.com/index.php?rid=5422673&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01214.x Conclusions:  The BEEM rater scale is a highly reliable, single‐question tool for a small number of EPs to collectively rate the relative clinical relevance within the specialty of EM of recently published studies from a variety of medical journals. It compares favorably with the MORE system because it achieves a high IRR despite simply requiring raters to read each article’s title and conclusion. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5422673 Tue, 01 Nov 2011 04:00:00 +0100 5422673 http://www.medworm.com/index.php?rid=5422672&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01211.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5422672 Tue, 01 Nov 2011 04:00:00 +0100 5422672 http://www.medworm.com/index.php?rid=5422671&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01212.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5422671 Tue, 01 Nov 2011 04:00:00 +0100 5422671 http://www.medworm.com/index.php?rid=5422670&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01218.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5422670 Tue, 01 Nov 2011 04:00:00 +0100 5422670 http://www.medworm.com/index.php?rid=5422669&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01215.x ACADEMIC EMERGENCY MEDICINE 2011; 18:1186–1187 © 2011 by the Society for Academic Emergency MedicineThis lecture can be viewed in its entirety online by visiting http://vimeo.com/24148123. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5422669 Tue, 01 Nov 2011 04:00:00 +0100 5422669 http://www.medworm.com/index.php?rid=5422668&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01208.x Conclusions:  This study simultaneously assessed cognitive knowledge and simulated field performance. Utilization of these measurement techniques allowed for the assessment and comparison of field performance and cognitive knowledge. Results demonstrated an association between a practicing paramedic’s performance on a cognitive examination and field performance, assessed by a simulated EMS response. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5422668 Tue, 01 Nov 2011 04:00:00 +0100 5422668 http://www.medworm.com/index.php?rid=5422667&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01213.x Conclusions:  Good quantitative agreement between the experimental data and the theoretical model suggests that the constant peak displacement CPR model provides reasonable prediction of CC mechanics during CPR over a wide range of CC rates. Conflicts in the literature are also explained by showing that backboards can significantly enhance CPR CC performance when the back support stiffness is less than 250 N/cm, while for surfaces with higher stiffness, the benefit of using a backboard is reduced. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5422667 Tue, 01 Nov 2011 04:00:00 +0100 5422667 http://www.medworm.com/index.php?rid=5422666&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01203.x Conclusions:  A moderate, nonlinear correlation exists between ESI acuity levels and ED E&M billing codes. Increasing age affects this correlation. Race and E&M code affect the correlation between ESI level and total professional charges. As such, basic triage data can be used to estimate E&M code and total professional charges. Future studies are needed to validate these findings across other institutional settings. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5422666 Tue, 01 Nov 2011 04:00:00 +0100 5422666 http://www.medworm.com/index.php?rid=5422665&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01210.x Conclusions:  The SNS and SLS are reliable, valid tests that can be used to rapidly estimate general health literacy and numeracy skill levels in adult ED patients. Continuing work is needed to establish their ability to predict clinical outcomes. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5422665 Tue, 01 Nov 2011 04:00:00 +0100 5422665 http://www.medworm.com/index.php?rid=5422664&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01202.x Conclusions:  The overall incidence of neutropenia was 4.2% in all cocaine users and 2.1% in the levamisole‐positive group. A striking number of the reported patients with levamisole‐associated neutropenia have presented to care with oropharyngeal complaints, vasculitis, or fever. A clinical algorithm for identifying levamisole toxicity in the emergency department setting is provided. Further research is necessary to determine the circumstances required for levamisole‐associated neutropenia. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5422664 Tue, 01 Nov 2011 04:00:00 +0100 5422664 http://www.medworm.com/index.php?rid=5422663&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01217.x Conclusions:  When compared with saline, IV l‐carnitine increases survival and MAP in a murine model of severe verapamil toxicity. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5422663 Tue, 01 Nov 2011 04:00:00 +0100 5422663 http://www.medworm.com/index.php?rid=5422662&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01205.x Conclusions:  This study validated the previously derived four‐variable DIVA score. A simpler three‐variable rule was as predictive of failed IV placement on first attempt as the four‐variable rule. Validation in nonpediatric EDs is needed to thoroughly evaluate generalizability. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5422662 Tue, 01 Nov 2011 04:00:00 +0100 5422662 http://www.medworm.com/index.php?rid=5422661&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01216.x Conclusions:  The sample size of the studies included in this review is too small to draw any definitive conclusion. However, their findings suggest that that the risk of bacterial meningitis in children presenting with simple febrile seizure is very low. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5422661 Tue, 01 Nov 2011 04:00:00 +0100 5422661 http://www.medworm.com/index.php?rid=5387912&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01195.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5387912 Tue, 01 Nov 2011 04:00:00 +0100 5387912 http://www.medworm.com/index.php?rid=5387911&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01196.x Conclusions:  In this study, junior EPs were able to obtain measurements of EPSS that correlated closely with visual estimates of LVEF by clinicians with extensive point‐of‐care and comprehensive echocardiography experience. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5387911 Tue, 01 Nov 2011 04:00:00 +0100 5387911 http://www.medworm.com/index.php?rid=5387910&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01198.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5387910 Tue, 01 Nov 2011 04:00:00 +0100 5387910 http://www.medworm.com/index.php?rid=5387909&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01199.x ACADEMIC EMERGENCY MEDICINE 2011; 18:1–3 © 2011 by the Society for Academic Emergency MedicineAbstractFacebook and social media networking applications use is ubiquitous across all ages and cultures. Facebook has finally begun to appear in the medical–scientific press. Today’s medical literature is focused on concerns of professionalism in young health care practitioners vis‐à‐vis the lay public as they continuously expose themselves through this online social medium.With over 500 million users, Facebook hosts many of our patients, who are also exposed to the Internet and social media. Nobody so far has considered the opposite issue: that of physician invasion of privacy by “looking‐up” a patient on Facebook during clinical practice for purposes of history‐taking or dia... Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5387909 Tue, 01 Nov 2011 04:00:00 +0100 5387909 http://www.medworm.com/index.php?rid=5387908&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01206.x Conclusions:  Although young age is associated with increased PTSD symptom severity scores, characteristics associated with young age, specifically assaultive trauma and low SES, account for this risk. Young age is not an independent risk factor for PTSD. Psychological assessment in the ED can be targeted toward assaultive trauma patients, especially those of low SES, to establish early intervention and hopefully prevent the development of PTSD. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5387908 Tue, 01 Nov 2011 04:00:00 +0100 5387908 http://www.medworm.com/index.php?rid=5336702&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01192.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5336702 Thu, 20 Oct 2011 04:00:00 +0100 5336702 http://www.medworm.com/index.php?rid=5387907&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01204.x Conclusions:  The TennCare disenrollment of 2005 was associated with a modest decrease in the number of total ED visits in Tennessee. However, the payer mix among the Tennessee ED population shifted abruptly. The increased rate of ED visits by Tennessee’s uninsured and the increased proportion of uninsured ED visits leading to hospital admission suggest an increased burden of illness in this highly vulnerable population. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5387907 Sat, 01 Oct 2011 04:00:00 +0100 5387907 http://www.medworm.com/index.php?rid=5336701&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01194.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5336701 Sat, 01 Oct 2011 04:00:00 +0100 5336701 http://www.medworm.com/index.php?rid=5315139&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01179.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5315139 Sat, 01 Oct 2011 04:00:00 +0100 5315139 http://www.medworm.com/index.php?rid=5315138&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01178.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5315138 Sat, 01 Oct 2011 04:00:00 +0100 5315138 http://www.medworm.com/index.php?rid=5315137&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01185.x Academic Emergency Medicine 2011; 18:1099–1104 © 2011 by the Society for Academic Emergency MedicineAbstractRegression techniques are versatile in their application to medical research because they can measure associations, predict outcomes, and control for confounding variable effects. As one such technique, logistic regression is an efficient and powerful way to analyze the effect of a group of independent variables on a binary outcome by quantifying each independent variable’s unique contribution. Using components of linear regression reflected in the logit scale, logistic regression iteratively identifies the strongest linear combination of variables with the greatest probability of detecting the observed outcome. Important considerations when conducting logistic regression includ... Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5315137 Sat, 01 Oct 2011 04:00:00 +0100 5315137 http://www.medworm.com/index.php?rid=5315136&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01191.x Conclusions:  Forty‐one EM educational studies published in 2010 were identified. This critical appraisal reviews and highlights five studies that met a priori quality indicators. Current trends and common methodologic pitfalls in the 2010 papers are noted. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5315136 Sat, 01 Oct 2011 04:00:00 +0100 5315136 http://www.medworm.com/index.php?rid=5315135&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01168.x Academic Emergency Medicine 2011; 18:1072–1080 © 2011 by the Society for Academic Emergency MedicineAbstractThe management of acutely ill and injured patients is an essential component of medical student education, yet the formal integration of emergency medicine (EM) into the medical school curriculum has progressed slowly since the inception of the specialty. Medical student interest and the number of resident positions in the National Resident Matching Program are higher than any time in the past, yet students often find access to EM faculty and clinical experience limited to a fourth‐year rotation. Incorporating EM into all years of the undergraduate medical student curriculum can offer unique educational experiences and enhance exposure to the necessary and recommended knowledg... Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5315135 Sat, 01 Oct 2011 04:00:00 +0100 5315135 http://www.medworm.com/index.php?rid=5315134&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01173.x Conclusions:  In the study sample, elevated CACS was associated with a higher likelihood of underlying CAD on coronary CTA, but the addition of CACS to coronary CTA did not help predict 30‐day cardiovascular events. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5315134 Sat, 01 Oct 2011 04:00:00 +0100 5315134 http://www.medworm.com/index.php?rid=5315133&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01177.x Conclusions:  When compared with OCA alone, the novel tape–OCA combination is equivalent with regard to complete wound edge apposition and cosmetic appearance. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5315133 Sat, 01 Oct 2011 04:00:00 +0100 5315133 http://www.medworm.com/index.php?rid=5315132&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01167.x Conclusions:  An interactive computer kiosk accurately, efficiently, and safely expedited the management of women with uncomplicated UTI in a busy, urban ED. Expanding the use of this technology to other conditions could help to improve ED patient flow. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5315132 Sat, 01 Oct 2011 04:00:00 +0100 5315132 http://www.medworm.com/index.php?rid=5315131&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01171.x Conclusions:  To redress the linearity of most literature on patient flow, this study adopts a systems perspective and ethnographic methods to bring to light the dynamic role that individuals play, interacting with their work contexts, to maintain patient flow. The study provides an empirical foundation, uniquely discernible through qualitative research, about aspects of ED work that previously have been the subject only of discussion or commentary articles. This study provides empirical documentation of the moment‐to‐moment responses of emergency clinicians to work pressure brought about by factors outside much of their control, establishing the relationship between patient flow and work pressure. We conceptualize the ED as a dynamic system, combining socioprofessional influences to... Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5315131 Sat, 01 Oct 2011 04:00:00 +0100 5315131 http://www.medworm.com/index.php?rid=5315130&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01163.x Conclusions:  Ambulance use varies by health insurance status. Medicaid coverage and lack of insurance are each independently associated with increased odds of ambulance use, suggesting a disproportionate role for emergency medical services (EMS) in the care of patients with limited financial resources. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5315130 Sat, 01 Oct 2011 04:00:00 +0100 5315130 http://www.medworm.com/index.php?rid=5315129&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01165.x Conclusions:  Male and female adolescents with acute assault‐related injuries were very similar. Both reported extremely high rates of past year peer violence, assault‐related injury, and substance use. The greater prevalence of some risk factors among adolescent females, such as depressive symptoms, dating aggression, and independent living status, should be further investigated. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5315129 Sat, 01 Oct 2011 04:00:00 +0100 5315129 http://www.medworm.com/index.php?rid=5261395&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01158.x Conclusions:  The VBG electrolytes were 97.8% sensitive and 100% specific for the diagnosis of DKA in hyperglycemic patients. These preliminary findings support the use of VBG electrolytes in lieu of VBG along with serum chemistry analysis to rule in or rule out DKA.ACADEMIC EMERGENCY MEDICINE 2011; 18:1–4 © 2011 by the Society for Academic Emergency Medicine (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5261395 Mon, 26 Sep 2011 04:00:00 +0100 5261395 http://www.medworm.com/index.php?rid=5261394&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01159.x Conclusions:  With commonly available angiocatheters, the lateral approach is less likely to be successful than the anterior approach. The anterior approach may fail in many patients as well. Longer angiocatheters may increase the chances of decompression, but would also carry a higher risk of damage to surrounding vital structures. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5261394 Mon, 26 Sep 2011 04:00:00 +0100 5261394 http://www.medworm.com/index.php?rid=5261393&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01164.x Conclusions:  Changing the EMS trauma triage cutoff for elders from GCS 13 to GCS 14 results in improved sensitivity for clinically relevant outcomes. In injured elders, the decline in GCS from 15 to 14 is associated with increased mortality, a finding not observed in younger adults. Elders with GCS 14 have greater odds of mortality and TBI than adults with GCS 13. These results support recent changes in EMS trauma triage guidelines for elders adopted in Ohio. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5261393 Mon, 26 Sep 2011 04:00:00 +0100 5261393 http://www.medworm.com/index.php?rid=5261392&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01166.x Conclusions:  Current trauma guidelines suggest that the pregnant trauma patient be placed in a 15° left lateral tilt position to prevent aortocaval compression. A computer simulation study suggests that this tilt may be inadequate to offload the vena cava and normalize the circulation. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5261392 Mon, 26 Sep 2011 04:00:00 +0100 5261392 http://www.medworm.com/index.php?rid=5261391&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01175.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5261391 Mon, 26 Sep 2011 04:00:00 +0100 5261391 http://www.medworm.com/index.php?rid=5261390&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01176.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5261390 Mon, 26 Sep 2011 04:00:00 +0100 5261390 http://www.medworm.com/index.php?rid=5261389&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01178.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5261389 Mon, 26 Sep 2011 04:00:00 +0100 5261389 http://www.medworm.com/index.php?rid=5261387&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01190.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5261387 Thu, 01 Sep 2011 04:00:00 +0100 5261387 http://www.medworm.com/index.php?rid=5209529&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01201.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5209529 Thu, 01 Sep 2011 04:00:00 +0100 5209529 http://www.medworm.com/index.php?rid=5209528&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01148.x Conclusions:  Using a previously published process, a structured literature review, and consensus expert panel opinion, only the GCS can currently be firmly recommended as a specific RAM or OM for prehospital trauma research (along with core measures that have already been established and published). This effort highlights the paucity of reliable, validated RAMs and OMs currently available for outcomes research in the prehospital setting and hopefully will encourage additional, methodologically sound evaluations of the promising, Category 2 RAMs and OMs, as well as the development of new measures. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5209528 Thu, 01 Sep 2011 04:00:00 +0100 5209528 http://www.medworm.com/index.php?rid=5209527&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01150.x Conclusions:  MR‐proADM and copeptin, alone or in combination, may provide superior short‐term mortality prediction compared to natriuretic peptides and troponin. Presented results are explorative due to the limited number of events, but validation in larger trials seems promising. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5209527 Thu, 01 Sep 2011 04:00:00 +0100 5209527 http://www.medworm.com/index.php?rid=5209526&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01149.x Conclusions:  There was marked variation in ED workload rates and whether or not ambulance diversion occurred during a 24‐hour period. This variability in initiating ambulance diversion suggests different or inconsistently applied decision‐making criteria for initiating diversion. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5209526 Thu, 01 Sep 2011 04:00:00 +0100 5209526 http://www.medworm.com/index.php?rid=5209525&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01147.x Conclusions:  Nonmydriatic fundus photography taken by nurse practitioners is a feasible alternative to direct ophthalmoscopy in the ED. It is performed well by nonphysician staff, is well‐received by staff and patients, and requires a trivial amount of time to perform. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5209525 Thu, 01 Sep 2011 04:00:00 +0100 5209525 http://www.medworm.com/index.php?rid=5209524&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01157.x Conclusions:  This study showed that serial visual estimations of the respiratory variation of IVC diameter and LVF agreed with bedside measurements of caval index and LVF during early fluid challenges to symptomatic hypotensive ED patients. There was moderate inter‐rater agreement in both visual estimates. In addition, acute volume loading was associated with detectable acute changes in IVC measurements. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5209524 Thu, 01 Sep 2011 04:00:00 +0100 5209524 http://www.medworm.com/index.php?rid=5184625&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01140.x Conclusions:  In this study, patients undergoing shoulder dislocation reduction using US‐guided interscalene block spent less time in the ED and required less one‐on‐one health care provider time compared to those receiving procedural sedation. There was no difference in pain level or satisfaction when compared to procedural sedation patients.ACADEMIC EMERGENCY MEDICINE 2011; 18:1–6 © 2011 by the Society for Academic Emergency Medicine (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5184625 Mon, 29 Aug 2011 23:00:00 +0100 5184625 http://www.medworm.com/index.php?rid=5184624&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01144.x Conclusions:  Leadership courses for aspiring chairs in EM should foster the development of academic experience and managerial skills. Advanced degrees in leadership or administration are highly desirable in future chairs.ACADEMIC EMERGENCY MEDICINE 2011; 18:1–7 © 2011 by the Society for Academic Emergency Medicine (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5184624 Mon, 29 Aug 2011 23:00:00 +0100 5184624 http://www.medworm.com/index.php?rid=5184623&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01145.x Conclusions:  Out‐of‐hospital care was associated with improved in‐hospital processes for the care of critically ill patients. Despite shortened ED treatment times for septic patients who arrive by EMS, a mortality benefit could not be demonstrated.ACADEMIC EMERGENCY MEDICINE 2011; 18:1–7 © 2011 by the Society for Academic Emergency Medicine (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5184623 Mon, 29 Aug 2011 23:00:00 +0100 5184623 http://www.medworm.com/index.php?rid=5184622&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01146.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5184622 Mon, 29 Aug 2011 23:00:00 +0100 5184622 http://www.medworm.com/index.php?rid=5144508&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01138.x Conclusions:  Compared to internal medicine, pediatrics, anesthesiology, and family medicine, EM received the least amount of NIH support per active faculty member and ranked next to last for NIH support by active physician. Given the many benefits of research both for the specialty and for society, EM needs to continue to develop and support an adequate cohort of independent investigators.ACADEMIC EMERGENCY MEDICINE 2011; 18:1–4 © 2011 by the Society for Academic Emergency Medicine (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5144508 Thu, 18 Aug 2011 23:00:00 +0100 5144508 http://www.medworm.com/index.php?rid=5144507&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01139.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5144507 Thu, 18 Aug 2011 23:00:00 +0100 5144507 http://www.medworm.com/index.php?rid=5144506&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01141.x Conclusions:  This review of presentations at a national meeting found a lack of compliance with printed guidelines for COI disclosure during scientific presentation. Efforts to increase uniformity and clarity may result in increased compliance.ACADEMIC EMERGENCY MEDICINE 2011; 18:1–4 © 2011 by the Society for Academic Emergency Medicine (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5144506 Thu, 18 Aug 2011 23:00:00 +0100 5144506 http://www.medworm.com/index.php?rid=5144505&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01142.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5144505 Thu, 18 Aug 2011 23:00:00 +0100 5144505 http://www.medworm.com/index.php?rid=5144504&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01143.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5144504 Thu, 18 Aug 2011 23:00:00 +0100 5144504 http://www.medworm.com/index.php?rid=5144503&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01152.x Conclusions:  The frequency of severe, immediate complications from CECT imaging that includes IV contrast is less than 1%, and the frequency of mild complications is less than 2%. The authors conclude that CECT is associated with a very low rate of severe immediate complications.ACADEMIC EMERGENCY MEDICINE 2011; 18:1–5 © 2011 by the Society for Academic Emergency Medicine (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5144503 Thu, 18 Aug 2011 23:00:00 +0100 5144503 http://www.medworm.com/index.php?rid=5144502&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01153.x Conclusions:  Geospatial techniques and hospital data records can be used to characterize potential subjects and delineate a high‐risk population to inform directed CC and public disclosure strategies.ACADEMIC EMERGENCY MEDICINE 2011; 18:1–5 © 2011 by the Society for Academic Emergency Medicine (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5144502 Thu, 18 Aug 2011 23:00:00 +0100 5144502 http://www.medworm.com/index.php?rid=5144501&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01154.x Conclusions:  Cervical spine CT imaging for children discharged from the ED with trauma diagnoses increased from 2005 through 2009. Older age and evaluation outside a Level I pediatric trauma center were associated with a higher c‐spine CT rate. Educational interventions focused outside pediatric trauma centers may be an effective approach to decreasing CT imaging of the c‐spine of pediatric trauma patients. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5144501 Thu, 18 Aug 2011 23:00:00 +0100 5144501 http://www.medworm.com/index.php?rid=5184621&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01151.x Conclusions:  Over one‐third of U.S. EDs have an OU. Short‐stay admission patients have similar characteristics as ED observation patients and may represent an opportunity for the growth of OUs.ACADEMIC EMERGENCY MEDICINE 2011; 18:1–7 © 2011 by the Society for Academic Emergency Medicine (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5184621 Sun, 31 Jul 2011 23:00:00 +0100 5184621 http://www.medworm.com/index.php?rid=5144500&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01155.x Conclusions:  While no results were significant for the overall study group, subgroup analysis of children age 0 to 2 years suggests that the VeinViewer may decrease the time to PIV placement. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5144500 Sun, 31 Jul 2011 23:00:00 +0100 5144500 http://www.medworm.com/index.php?rid=5132610&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01137.x Conclusions:  An increasing number of international EM journals have appeared over the past 10 years. Every EM journal exhibited a positive impact factor trend, but the gap between EM journals’ impact factors has widened in the past 10 years. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5132610 Sun, 31 Jul 2011 23:00:00 +0100 5132610 http://www.medworm.com/index.php?rid=5132609&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01132.x ACADEMIC EMERGENCY MEDICINE 2011; 18:890–897 © 2011 by the Society for Academic Emergency MedicineAbstractDisease‐based registries can form the basis of comparative research to improve and inform policy for optimizing outcomes, for example, in out‐of‐hospital cardiac arrest (OHCA). Such registries are often lacking in resource‐limited countries and settings. Anecdotally, survival rates for OHCA in Asia are low compared to those in North America or Europe, and a regional registry is needed. The Pan‐Asian Resuscitation Outcomes Study (PAROS) network of hospitals was established in 2009 as an international, multicenter, prospective registry of OHCA across the Asia‐Pacific region, to date representing a population base of 89 million in nine countries. The network’s goal is to ... Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5132609 Sun, 31 Jul 2011 23:00:00 +0100 5132609 http://www.medworm.com/index.php?rid=5132608&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01134.x Conclusions:  Higher‐quality CPGs for mTBI are consistent in their recommendations about assessment, imaging, and provision of patient information. There is not, however, an agreed definition of mTBI, and the quality of future CPGs could be improved with better reporting of stakeholder involvement, procedures for updating, and greater consideration of the applicability of the recommendations (cost implications, monitoring procedures). Nevertheless, guideline developers may benefit from adapting existing CPGs to their local context rather than investing in developing CPGs de novo. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5132608 Sun, 31 Jul 2011 23:00:00 +0100 5132608 http://www.medworm.com/index.php?rid=5132607&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01131.x This article describes the structure of the program and discusses the history and major drivers behind its founding. We report major changes, cite ongoing challenges, and discuss lessons learned from the program’s first 7 years that may help advise other nascent training programs in developing countries. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5132607 Sun, 31 Jul 2011 23:00:00 +0100 5132607 http://www.medworm.com/index.php?rid=5132606&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01124.x Conclusions:  Feedback devices for CPR during transportation do not have an effect on objective components of physical strain, but decrease perceived exertion in experienced rescuers in an experimental setting. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5132606 Sun, 31 Jul 2011 23:00:00 +0100 5132606 http://www.medworm.com/index.php?rid=5132605&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01126.x Conclusions:  Copeptin and Prx4 are new prognostic markers in patients presenting to the ED with NSCs. Copeptin and Prx4 might be valuable tools for risk stratification and decision‐making in this patient group. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5132605 Sun, 31 Jul 2011 23:00:00 +0100 5132605 http://www.medworm.com/index.php?rid=5132604&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01125.x Conclusions:  A model for predicting the risk of immediate hospital admission at triage for all‐cause ED patients was developed and validated using routinely collected hospital data. Early prediction of the need for hospital admission at the time of triage may help identify patients deserving of early admission planning and resource allocation and thus potentially reduce ED overcrowding. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5132604 Sun, 31 Jul 2011 23:00:00 +0100 5132604 http://www.medworm.com/index.php?rid=5132603&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01127.x Conclusions:  In a setting with universal health insurance, worse health status is the largest predictor of ED utilization, but low SES is independently associated with increased use of the ED, regardless of visit urgency. This study lends support to findings in other health systems that those using EDs are more ill and more disadvantaged. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5132603 Sun, 31 Jul 2011 23:00:00 +0100 5132603 http://www.medworm.com/index.php?rid=5132602&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01128.x Conclusions:  High plasma lactate was associated with increased in‐hospital mortality in this sample of patients with acute PE. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5132602 Sun, 31 Jul 2011 23:00:00 +0100 5132602 http://www.medworm.com/index.php?rid=5132601&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01122.x Conclusions:  All three triage systems appear to be equally valid. Although the ESI showed the highest percentage of undertriage and the ISS the lowest, it seems preferable to use a verifiable, formally structured triage system. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5132601 Sun, 31 Jul 2011 23:00:00 +0100 5132601 http://www.medworm.com/index.php?rid=5132600&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01130.x Conclusions:  This study showed poor repeatability and accuracy in bladder volume measurements using BladderScan ABUS when compared to RTUS. The ABUS method does not appear to be a reliable method for assessing bladder volumes in children aged 0 to 24 months prior to bladder instrumentation. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5132600 Sun, 31 Jul 2011 23:00:00 +0100 5132600 http://www.medworm.com/index.php?rid=5132599&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01133.x Conclusions:  The ketamine/propofol combination provides adequate sedation and analgesia for painful procedures and appears to be a safe and useful technique in the ED. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5132599 Sun, 31 Jul 2011 23:00:00 +0100 5132599 http://www.medworm.com/index.php?rid=5132598&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01123.x ACADEMIC EMERGENCY MEDICINE 2011; 18:797–799 © 2011 by the Society for Academic Emergency MedicineAbstractThe interpretation and optimal application of the myriad of diagnostic modalities at the emergency physician’s (EP’s) disposal is a core challenge of clinical practice. Connecting the wealth of scientific literature that informs our understanding of test performance, including elements of the history and the physical examination, is a daunting task. Translating this knowledge into improved patient outcomes requires two fundamentals; the first involves getting the evidence “straight” through systematic approaches that highlight quality work and methods for getting evidence to the point of need. This commentary discusses the potential impact of the first installment in the “... Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5132598 Sun, 31 Jul 2011 23:00:00 +0100 5132598 http://www.medworm.com/index.php?rid=5132597&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01121.x Conclusions:  Recent joint surgery or cellulitis overlying a prosthetic hip or knee were the only findings on history or physical examination that significantly alter the probability of nongonococcal septic arthritis. Extreme values of sWBC (>50 × 109/L) can increase, but not decrease, the probability of septic arthritis. Future ED‐based diagnostic trials are needed to evaluate the role of clinical gestalt and the efficacy of nontraditional synovial markers such as lactate. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5132597 Sun, 31 Jul 2011 23:00:00 +0100 5132597 http://www.medworm.com/index.php?rid=5132596&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01172.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5132596 Sun, 31 Jul 2011 23:00:00 +0100 5132596 http://www.medworm.com/index.php?rid=4999632&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01100.x Conclusions:  Human immunodeficiency virus screening using an additional staff model has no clinically significant effect on the overall LOS for discharged patients.ACADEMIC EMERGENCY MEDICINE 2011; 18:1–6 © 2011 by the Society for Academic Emergency Medicine (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4999632 Mon, 04 Jul 2011 23:00:00 +0100 4999632 http://www.medworm.com/index.php?rid=4999631&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01101.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4999631 Mon, 04 Jul 2011 23:00:00 +0100 4999631 http://www.medworm.com/index.php?rid=4999630&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01102.x This article discusses initial implementation and results.ACADEMIC EMERGENCY MEDICINE 2011; 18:1–8 © 2011 by the Society for Academic Emergency Medicine (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4999630 Mon, 04 Jul 2011 23:00:00 +0100 4999630 http://www.medworm.com/index.php?rid=4999629&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01104.x Conclusions:  This study found no evidence that clerkship site affected final exam score. Academic EM clerkships may consider partnering with other hospitals for clinical experiences without compromising education.ACADEMIC EMERGENCY MEDICINE 2011; 18:1–4 © 2011 by the Society for Academic Emergency Medicine (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4999629 Mon, 04 Jul 2011 23:00:00 +0100 4999629 http://www.medworm.com/index.php?rid=4999628&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01105.x Conclusions:  SCC can have a subtle presentation with absent or unilateral motor and sensory deficits, but gait ataxia may be an additional finding. ED misdiagnosis of SCC in nontrauma patients is common.ACADEMIC EMERGENCY MEDICINE 2011; 18:1–7 © 2011 by the Society for Academic Emergency Medicine (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4999628 Mon, 04 Jul 2011 23:00:00 +0100 4999628 http://www.medworm.com/index.php?rid=4999627&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01107.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=4999627 Mon, 04 Jul 2011 23:00:00 +0100 4999627 http://www.medworm.com/index.php?rid=5064047&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01129.x This article is not intended to serve as a systematic review or clinical guideline but is instead meant to be a selection of current high‐quality IEM literature, with the hope that it will foster further growth in the field, highlight evidence‐based practice, and encourage discourse.ACADEMIC EMERGENCY MEDICINE 2011; 18:1–8 © 2011 by the Society for Academic Emergency Medicine (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5064047 Thu, 30 Jun 2011 23:00:00 +0100 5064047 http://www.medworm.com/index.php?rid=5040425&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01113.x Conclusions:  In this cohort of patients suspected of having any infection in the ED, the accuracy of nCD64, s‐TREM‐1, and HMGB‐1 was not significantly sensitive or specific for diagnosis of sepsis.ACADEMIC EMERGENCY MEDICINE 2011; 18:1–9 © 2011 by the Society for Academic Emergency Medicine (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5040425 Thu, 30 Jun 2011 23:00:00 +0100 5040425 http://www.medworm.com/index.php?rid=5030986&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01156.x (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5030986 Thu, 30 Jun 2011 23:00:00 +0100 5030986 http://www.medworm.com/index.php?rid=5030985&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01117.x Conclusions:  Inhaled corticosteroids are infrequently prescribed for children with asthma at discharge from U.S. EDs. Other than the fall season, there are no identified demographic or clinical factors associated with the likelihood of ICS prescriptions. ED clinicians should consider interventions to increase ICS prescriptions for children with persistent asthma. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5030985 Thu, 30 Jun 2011 23:00:00 +0100 5030985 http://www.medworm.com/index.php?rid=5030984&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01111.x Conclusions:  A substantial proportion of adolescent females presenting to a pediatric ED with lower abdominal or GU symptoms had TV infection. TV testing should be considered as part of the evaluation of adolescent females presenting to the ED with lower abdominal, urinary, or vaginal complaints. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5030984 Thu, 30 Jun 2011 23:00:00 +0100 5030984 http://www.medworm.com/index.php?rid=5030983&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01118.x Conclusions:  For EPs, receipt of an R01 from the NIH requires more than a decade of work following the completion of training. This period is characterized by pursuit of advanced research training, active and accelerating publication and collaboration, and acquisition of smaller extramural grants. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5030983 Thu, 30 Jun 2011 23:00:00 +0100 5030983 http://www.medworm.com/index.php?rid=5030982&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01110.x Conclusions:  Targeted HIV screening, as implemented in an urban ED, is cost saving and increases quality‐adjusted life expectancy. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5030982 Thu, 30 Jun 2011 23:00:00 +0100 5030982 http://www.medworm.com/index.php?rid=5030981&cid=s_36972_14_f&fid=36972&url=http%3A%2F%2Fdx.doi.org%2F10.1111%252Fj.1553-2712.2011.01112.x Conclusions:  The point of entry to health care for many children with TB is the ED. The more protean manifestations of TB in children can decrease the utility of screening tools developed to identify adults with TB. While TB in adults often is a microbiologic diagnosis, childhood TB often is an epidemiologic diagnosis. Therefore, questioning caregivers about TB risk factors in the family may identify a higher percentage of children with possible TB. (Source: Academic Emergency Medicine) Academic Emergency Medicine journals http://www.medworm.com/rss/comments.php?id=5030981 Thu, 30 Jun 2011 23:00:00 +0100 5030981