Emergency Medicine Commons^™

Beta2-Adrenoceptor Agonists For Dysmenorrhoea, Zbys Fedorowicz, Mona Nasser, Vanitha A. Jagannath, Jessica H. Beaman, Kiran Ejaz, Esther J. Van Zuuren

Department of Emergency Medicine

Background:Dysmenorrhoea is a common gynaecological complaint that can affect as many as 50% of premenopausal women, 10% of whom suffer severely enough to be rendered incapacitated for one to three days during each menstrual cycle. Primary dysmenorrhoea is where women suffer from menstrual pain but lack any pathology in their pelvic anatomy. Beta2-adrenoceptor agonists have been used in the treatment of women with primary dysmenorrhoea but their effects are unclear.
Objectives:To determine the effectiveness and safety of beta2-adrenoceptor agonists in the treatment of primary dysmenorrhoea. Search methods: We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, …

A Successful Model Of Road Traffic Injury Surveillance In A Developing Country: Process And Lessons Learnt, Junaid Abdul Razzak, Muhammad Shahzad Shamim, Amber Mehmood, Syed Ameer Hussain, Mir Shabbar Ali, Rashid Jooma

Department of Emergency Medicine

Background: Road Traffic Injuries (RTIs) are one of the leading causes of death and disability worldwide with 90% of global mortality concentrated in the low and middle income countries. RTI surveillance is recommended to define the burden, identify high risk groups, plan intervention and monitor their impact. Despite its stated importance in the literature, very few examples of sustained surveillance systems are reported from low income countries. This paper shares the experience of setting up an urban RTI surveillance program in the emergency departments of five major hospitals in Karachi, Pakistan.
Method: We describe the process of establishing a surveillance …

Teaching With Cultural Competence Requires Gender Sensitivity, Marna R. Greenberg Do, Mph, Facep

Department of Emergency Medicine

No abstract provided.

Accuracy Of Diagnosis And Relationship With Quality Of Emergency Medicine Training Program, Muhammad Shahid, Kamran Hameed, Romaina Iqbal, Osama Afzal, Rooham Nakeer, Junaid Razzak

Department of Emergency Medicine

An indicator for emergency room performance is the ability to establish the correct diagnosis within the emergency room over the years. The authors chose to examine the non-congruence of Emergency Room diagnoses to that established after hospital stay for three selected years. A total of 8488 records were reviewed and all disparate diagnosis were recorded and categorized. Retrospective chart reviews were done from July 2008 to February 2009 at the Aga Khan University Hospital, Karachi. A substantial reduction in the percentage of disparate diagnoses was seen over the years from 41% in the initial year to 14% in the last …

Increasing Labor And Delivery Nurse Knowledge Of Triaging Non-Obstetrical Medical Emergencies In Pregnant Women Through The Use Of Simulation, Julie Hoffman

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of this study was to evaluate the effect simulation training has on an OB nurse's ability to correctly triage pregnant patients. Registered Nurses (RNs) working in OB triage must be able to correctly and expediently identify the care a pregnant patient needs. OB triage nurses are trained to recognize pregnancy related issues that commonly present during the months leading up to delivery. It is as important for these nurses to have the skills to realize when a pregnant patient is having a non-obstetrical health crisis. A group of OB triage RNs participated in simulation-training scenarios based on non- …

Boarding And Press Ganey Patient Satisfaction Scores Among Discharged Patients - Quantifying The Relationship, Paris B. Lovett

Paris B Lovett

Boarding and Press Ganey Patient Satisfaction Scores Among Discharged Patients - Quantifying the Relationship

Paris B. Lovett, Frederick T. Randolph, Rex G. Mathew

Thomas Jefferson University, Philadelphia, PA

Background: Long wait times, long length of stay, use of hallway beds, and physical crowding have all been reported to negatively affect patient satisfaction. There is a need for quantitative assessment of the relationship among patients discharged from the ED.

Objectives: To describe the association between total boarding hours for given calendar days, and mean Press Ganey patient satisfaction raw scores (PGs) on those days. To determine a quantitative coefficient for the …

Attending In Triage: Impact On Resident Experience, Paris B. Lovett

Paris B Lovett

Attending in Triage: Impact on Resident Experience

Paris B. Lovett, Jamie A. Kahn, Linda Davis- Moon, Rex G. Mathew, Frederick T. Randolph, Bernard L. Lopez

Thomas Jefferson University, Philadelphia, PA

Background: EDs commonly face increasing volume with resultant significant boarding and crowding. New operational measures to improve patient flow in response to these challenges have been developed. One measure is to have a physician evaluate the patient during triage (Attending-in-Triage, AIT). This results in a Medical Screening Examination (MSE) early in the patient visit. Residents in training, as part of their education, participate in medical decision-making for the undifferentiated patient. …

Needles In A Needlestack: ‘‘Prodromal’’ Symptoms Of Unusual Fatigue And Insomnia Are Too Prevalent Among Adult Women Visiting The Ed To Be Useful In Diagnosing Acs Acutely, Paris B. Lovett

Paris B Lovett

Needles In A Needlestack: ‘‘Prodromal’’ Symptoms of Unusual Fatigue and Insomnia Are Too Prevalent Among Adult Women Visiting the ED to be Useful in Diagnosing ACS Acutely

Paris B. Lovett1, Yvonne N. Ezeala1, Rex G. Mathew1, Julia L. Moon2 1

Thomas Jefferson University, Philadelphia, PA; 2Drexel University, School of Public Health, Philadelphia, PA

Background: In 2003, McSweeney et al. reported surveys on ‘‘prodromal’’ symptoms recalled by women who had experienced myocardial infarctions (MI). Unusual fatigue was reported by 70.7% (severe 29.7%) and insomnia by 47.8% (severe 21.0%). These findings have led to risk management recommendations to consider these symptoms as …

Medical Knowledge Professional Growth Plan, Gavin C. Barr Jr. Md, Kevin R. Weaver Do, Michael B. Weigner Md, Bryan G. Kane Md, Dawn M. Yenser, Donna M. Chormanski-Bigelow

Department of Emergency Medicine

No abstract provided.

Profiling The Ethnic Characteristics Of Domestic Injuries In Children Younger Than Age 5 Years., Tolulope A. Oyetunji, Adrienne A. Stevenson, Aderonke O. Oyetunji, Sharon K. Onguti, Sarah A. Ames, Adil H. Haider, Benedict C. Nwomeh

Manuscripts, Articles, Book Chapters and Other Papers

The home remains a very common location for deadly injuries among children younger than 5 years. The aim of this study is to describe the demographic and injury characteristics of domestic injuries in children younger than 5 years. The National Trauma Data Bank's National Sample Program data set was queried for children younger than 5 years with the injury site classified as home. Bivariate analysis was performed to determine unadjusted differences by ethnicity. Appropriate weight was applied to the sample to determine accurate national estimates. A total of 7,364 children, representing 32,033 children, were analyzed. Overall mortality was 1.6 per …

Sdot Faculty And Resident Training Study, Kevin Weaver Do, Kathleen E. Kane Md, Gavin Barr Jr. Md, Allison Raines Do, Nicole L. Bendock Do, Brian M. Berry Do, Gregory Smeriglio Jr, Do, Bruce C. Stouch Phd, Dawn M. Yenser, Bryan G. Kane Md

Department of Emergency Medicine

No abstract provided.

Essential Role Of Caveolin-3 In Adiponectin Signalsome Formation And Adiponectin Cardioprotection., Yajing Wang, Xiaoliang Wang, Jean-François Jasmin, Wayne Bond Lau, Rong Li, Yuexin Yuan, Wei Yi, Kurt Chuprun, Michael P. Lisanti, Walter J Koch, Erhe Gao, Xin-Liang Ma

Department of Emergency Medicine Faculty Papers

OBJECTIVE: Adiponectin (APN) system malfunction is causatively related to increased cardiovascular morbidity/mortality in diabetic patients. The aim of the current study was to investigate molecular mechanisms responsible for APN transmembrane signaling and cardioprotection.

METHODS AND RESULTS: Compared with wild-type mice, caveolin-3 knockout (Cav-3KO) mice exhibited modestly increased myocardial ischemia/reperfusion injury (increased infarct size, apoptosis, and poorer cardiac function recovery; P

CONCLUSIONS: Taken together, these results demonstrated for the first time that Cav-3 plays an essential role in APN transmembrane signaling and APN anti-ischemic/cardioprotective actions.

Improvement In Satisfaction Scores With Operational Improvements From Front-End Redesign And Attenting-In-Triage, Paris B. Lovett

Paris B Lovett

Improvement in Satisfaction Scores with Operational Improvements from Front-End Redesign and Attenting-in-Triage

Linda Davis-Moon, MSN, CRNP, Paris B. Lovett, MD MBA, Jamie A. Kahn, MD MBA, Rex G. Mathew, MD, Frederick T. Randolph, MD MBA, Logan J. Harper, BS

Thomas Jefferson University Hospitals. Philadelphia, PA.

Background: With ED volumes increasing, and with boarding and overcrowding problems, many EDs have introduced an Attending-in-Triage (AIT) to improve patient flow. One of the aims of AIT is to improve patient satisfaction.

Objectives: To report changes in patient satisfaction scores associated with introduction of AIT and resultant operational improvements.

Methods: The study design was …

Building A Nerve Center For Patient Flow: Outcomes From A Comprehensive Integration Of Services At An Academic Medical Center, Paris B. Lovett

Paris B Lovett

Building a Nerve Center for Patient Flow: Outcomes from a Comprehensive Integration of Services at an Academic Medical Center

Paris B. Lovett, MD MBA, Brian E. Sweeney, RN, MBA, FACHE, Megan L. Johnston, , MHSA, Lewis J. DeEugenio Jr, MD, FACP, BSME, Holly Meisner, RN, BSN

Patient Flow Management Center. Thomas Jefferson University Hospitals. Philadelphia, PA

Background: Improving patient flow metrics (inpatient length-of-stay (LOS), bed utilization, process cycle times and discharge efficiency) requires collaboration and coordination between multiple disciplines and departments within a hospital.

Objectives: To report outcomes from a comprehensive geographic and organizational integration of disciplines and services with …

Medical Direction Of Wilderness And Other Operational Emergency Medical Services Programs, Craig R. Warden, Michael G. Millin, Seth C. Hawkins, Richard N. Bradley

Richard N Bradley

Within a healthcare system, operational emergency medical services (EMS) programs provide prehospital emergency care to patients in austere and resource-limited settings. Some of these programs are additionally considered to be wilderness EMS programs, a specialized type of operational EMS program, as they primarily function in a wilderness setting (eg, wilderness search and rescue, ski patrols, water rescue, beach patrols, and cave rescue). Other operational EMS programs include urban search and rescue, air medical support, and tactical law enforcement response. The medical director will help to ensure that the care provided follows protocols that are in accordance with local and state …

Uchunguzi (Journal Watch/Montre De Journal) March 2012, Benjamin Wachira

Emergency Medicine, East Africa

Uchunguzi means investigation in Swahili and provides a summary of some of the most recent international literature as presented in other leading journals, but with an emphasis on what is relevant to our continent.

Alcohol And Marijuana Use While Driving-An Unexpected Crash Risk In Pakistani Commercial Drivers: A Cross-Sectional Survey, Mohammed Umer Mir, Imran Khan, Bilal Ahmed, J. Razzak

Department of Emergency Medicine

Background:A significant proportion of road traffic crashes are attributable to alcohol and marijuana use while driving globally. Sale and use of both substances is illegal in Pakistan and is not considered a threat for road traffic injuries. However literature hints that this may not be the case. We did this study to assess usage of alcohol and marijuana in Pakistani commercial drivers.
Methods:A sample of 857 commercial bus and truck drivers was interviewed in October 2008 at the largest commercial vehicle station in Rawalpindi and Islamabad, Pakistan. Time location cluster sampling was used to select the subjects and …

Understanding Unintentional Childhood Home Injuries: Pilot Surveillance Data From Karachi, Pakistan., Nukhba Zia, Uzma R. Khan, J. Razzak, Prasanthi Puvanachandra, Adnan A. Hyder

Department of Emergency Medicine

Background: Childhood injuries, an important public health issue, globally affects more than 95% of children living in low-and middle-income countries. The objective of this study is to describe the epidemiology of childhood unintentional injuries in Karachi, Pakistan with a specific focus on those occurring within the home environment.
Methods:This was a secondary analysis of a childhood unintentional injury surveillance database setup in the emergency department of the Aga Khan Hospital, Karachi, Pakistan for 3 months. The data was collected by interviewing caretakers of children under 12 years of age presenting with an unintentional injury to the emergency departments of …

Novel Electronic Refreshers For Cardiopulmonary Resuscitation: A Randomized Controlled Trial, Stephen Magura, Michael G. Miller, Timothy J. Michael, Robert J. Bensley, J. Burkhardt, A. C. Puente, C. Sullins

Human Performance and Health Education Faculty Research

Background: Currently the American Red Cross requires that individuals renew their cardiopulmonary resuscitation (CPR) certification annually; this often requires a 4- to 8-hour refresher course. Those trained in CPR often show a decrease in essential knowledge and skills within just a few months after training. New electronic means of communication have expanded the possibilities for delivering CPR refreshers to members of the general public who receive CPR training. The study’s purpose was to determine the efficacy of three novel CPR refreshers - online website, e-mail and text messaging – for improving three outcomes of CPR training - skill retention, confidence …

That’S All It Took- Just One Look. Can A Five Second Look At A Patient Predict Disposition, Paris B. Lovett

Paris B Lovett

Study Objectives •To determine whether a five-second viewing of a patient contributes to prediction of disposition. Conclusion •For all but the resident group, a five second viewing of a patient contributes to prediction of disposition status. •The effect size is small, however. Such quick visual impressions may provide a piece of the overall decision-making process in the final disposition of patients.