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Sample records for emergency medicine public

  1. Public Health Education for Emergency Medicine Residents

    PubMed Central

    Betz, Marian E.; Bernstein, Steven L.; Gutman, Deborah; Tibbles, Carrie D.; Joyce, Nina; Lipton, Robert; Schweigler, Lisa; Fisher, Jonathan

    2015-01-01

    Emergency medicine (EM) has an important role in public health, but the ideal approach for teaching public health to EM residents is unclear. As part of the national regional public health–medicine education centers-graduate medical education (RPHMEC-GM) initiative from the CDC and the American Association of Medical Colleges, three EM programs received funding to create public health curricula for EM residents. Curricula approaches varied by residency. One program used a modular, integrative approach to combine public health and EM clinical topics during usual residency didactics, one partnered with local public health organizations to provide real-world experiences for residents, and one drew on existing national as well as departmental resources to seamlessly integrate more public health–oriented educational activities within the existing residency curriculum. The modular and integrative approaches appeared to have a positive impact on resident attitudes toward public health, and a majority of EM residents at that program believed public health training is important. Reliance on pre-existing community partnerships facilitated development of public health rotations for residents. External funding for these efforts was critical to their success, given the time and financial restraints on residency programs. The optimal approach for public health education for EM residents has not been defined. PMID:21961671

  2. Public health education for emergency medicine residents.

    PubMed

    Betz, Marian E; Bernstein, Steven L; Gutman, Deborah C; Tibbles, Carrie D; Joyce, Nina R; Lipton, Robert I; Schweigler, Lisa M; Fisher, Jonathan

    2011-10-01

    Emergency medicine (EM) has an important role in public health, but the ideal approach for teaching public health to EM residents is unclear. As part of the national Regional Public Health-Medicine Education Centers-Graduate Medical Education initiative from the CDC and the American Association of Medical Colleges, three EM programs received funding to create public health curricula for EM residents. Curricula approaches varied by residency. One program used a modular, integrative approach to combine public health and EM clinical topics during usual residency didactics, one partnered with local public health organizations to provide real-world experiences for residents, and one drew on existing national as well as departmental resources to seamlessly integrate more public health-oriented educational activities within the existing residency curriculum. The modular and integrative approaches appeared to have a positive impact on resident attitudes toward public health, and a majority of EM residents at that program believed public health training is important. Reliance on pre-existing community partnerships facilitated development of public health rotations for residents. External funding for these efforts was critical to their success, given the time and financial restraints on residency programs. The optimal approach for public health education for EM residents has not been defined. PMID:21961671

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

    PubMed Central

    Lammers, Richard; Simunich, Thomas; Ashurst, John

    2016-01-01

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

  4. The globalization of emergency medicine and its importance for public health.

    PubMed Central

    Anderson, Philip; Petrino, Roberta; Halpern, Pinchas; Tintinalli, Judith

    2006-01-01

    Emergency medicine (EM) is a global discipline that provides secondary disease prevention and is also a tool for primary prevention. It is a horizontally integrated system of emergency care consisting of access to EM care; provision of EM care in the community and during transportation of patients; and provision of care at the receiving facility or hospital emergency department. EM can offer many tools to improve public health. These tools include primary disease prevention; interventions for addressing substance abuse and interpersonal violence; education about safety practices; epidemiological surveillance; enrolment of patients in clinical research trials focusing on acute interventions; education and clinical training of health-care providers; and participation in local and regional responses to natural and man-made disasters. Public health advocates and health policy-makers can benefit from the opportunities of EM and can help overcome its challenges. Advocating the establishment and recognition of the specialty of EM worldwide can result in benefits for health-care education, help in incorporating the full scope of EM care into the system of public health, and expand the capabilities of EM for primary and secondary prevention for the benefit of the health of the public. PMID:17128364

  5. Humanism in emergency medicine.

    PubMed

    Rosenzweig, S

    1993-09-01

    Emergency medicine has not yet appropriated "humanism" as a term of its own. Medical humanism needs to be interpreted in a way that is consistent with the practical goals of emergency medicine. In this essay, humanism in emergency medicine is defined by identifying the dehumanizing aspects of sudden illness and exploring of ways for sustaining the humanity of emergency department patients. Excerpts from Dr Oliver Sacks' autobiographical work A Leg to Stand On give voice to the human needs created by sudden illness and its treatment. PMID:8363690

  6. The Progress of Emergency Medicine in Taiwan, China, and Hong Kong: Perspective from Publications in Emergency Medicine Journals, 1992–2011

    PubMed Central

    Lee, Ching-Hsing; Chaou, Chung-Hsien; Lin, Chih-Chuan

    2014-01-01

    Study Objective. The progress of emergency medicine (EM) in Taiwan, China, and Hong Kong was evaluated from the perspective of publications in EM journals. Methods. This was a retrospective study. All articles published from 1992 to 2011 in all journals in the EM category in the 2010 Journal Citation Reports (JCR) were included. A computerized literature search was conducted using the SciVerse Scopus database. The slope (β) of the linear regression was used to evaluate the trends in the numbers of articles as well as the ratios to the total number of EM journal articles. Results. The trends in the numbers of articles from Taiwan, China, and Hong Kong were 6.170, 1.908, and 2.835 and the trends in the ratios of their publication numbers to the total number of EM journal articles were 15.0 × 10−4, 4.60 × 10−4, and 6.80 × 10−4, respectively. All P-values were <0.01. The mean, median, and 75th percentiles of the number of citations in all EM journals were greater than those of these three areas. Conclusions. The publications from Taiwan, China, and Hong Kong have increased at a higher rate than those of the overall EM field in the past 20 years and indicated the rapid progress in these three areas. PMID:24707496

  7. Emergency medicine in Ecuador.

    PubMed

    Webb, H R; Sagarin, M J

    2001-09-01

    Emergency medical care in Ecuador is limited by geographic, economic, political, and infrastructural barriers. Afflictions of the developing world (eg, tropical infections and natural disasters) combine with ailments of the developed world (eg, trauma and cardiovascular disease) to mandate improved emergency medical systems. The nation has recently initiated FASBASE, a program dedicated to the enhancement of both prehospital and emergency department (ED) services. Furthermore, a dedicated residency program in Emergency and Disaster Medicine recently graduated its first class. Although more programs and funding are necessary to sustain the effort, Ecuador has begun to develop a modern emergency medical system. PMID:11555804

  8. Medicine and the Public:

    PubMed Central

    Berridge, Virginia

    2007-01-01

    The 1962 report of the Royal College of Physicians on smoking was a significant event in the history of smoking. Its significance was, however, more than smoking-specific: the RCP committee's appointment, its membership, its work, and the manner of its publication signified the changes within social medicine, and within the medical profession more generally, in postwar Britain. Doctors assumed the right to speak to the public and to government on matters of individual health, and a new risk-based public health was in the process of formation. A public health “policy community” formed, and governments began to assume responsibility for advising the public on health matters. The use of research in the report, and of social research in response to it, was important in the emergence of evidence-based medicine within public health. The paper argues for greater attention to the change in public health epitomized by the report in current debates on the concept of the 1960s “permissive society.” It was the harbinger of a new style of “coercive permissiveness” in health. PMID:17369672

  9. Emergency medicine in Russia.

    PubMed

    Townes, D A; Lee, T E; Gulo, S; VanRooyen, M J

    1998-08-01

    Russia has undergone sweeping political and social reforms within the past 5 years. The economic and social reforms heralded by the "new openness" of perestroika have led to a restructuring of medicine as well. Changes include the emergence of "for profit" organizations and acute care facilities, the introduction of private health insurance, modifications in the medical education system, and realignment of health priorities with a new trend toward primary care. PMID:9701309

  10. Emergency medicine in modern Europe.

    PubMed

    Fleischmann, Thomas; Fulde, Gordian

    2007-08-01

    Emergency medicine in the highly advanced world is traditionally performed in two different ways. The first is the well-known Anglo-American system with skilled EDs, and a pre-hospital emergency medical service utilizing paramedics. The second is the so-called Franco-German system, with a highly developed pre-hospital emergency physician service, but only a basic organization of hospital-based emergency medicine. This gap is now closing fast because of the rapid advancement of hospital-based emergency medicine in Europe. Four criteria might be used to measure this: the recognition as a specialty, the specialist training programme, the professional organization of emergency physicians and the presence of academic centres in Europe. Eleven of the 27 European countries recognize hospital-based emergency medicine as a specialty already. These include Belgium, Czech Republic, Estonia, Hungary, Ireland, Italy, Malta, Poland, Romania, Slovenia and the United Kingdom. Other nations are striving to do so, for example Sweden, France, Germany and Greece. There is no doubt that emergency medicine is gaining momentum and other countries will follow. Training for the specialty of emergency medicine is advanced already. Several curricula presently exist in the respective European countries. A task force, governed by the European Society for Emergency Medicine has been working hard to create a model curriculum for all of Europe, which is expected to be published in 2007. This comprises a 5-year specialty training, with three of them spent in an ED. The curriculum follows a symptom-oriented approach to emergency medicine, and includes a skilled description of the key competencies of the future trained emergency physicians. Given the century-long history of the pre-hospital emergency physician service in some European countries, a number of professional bodies exist representing pre-hospital emergency doctors. Within the last few years, ED physicians followed suit forming

  11. Educating Internists in Emergency Medicine

    PubMed Central

    Sanders, Arthur B.; Kobernick, Marc E.

    1984-01-01

    The education of internists in emergency medicine needs to be thoughtfully planned by those involved in their education. Objectives for their emergency medicine rotation include the recognition and initial treatment of true medical and surgical emergencies, clinical experience with and knowledge of common acute primary care problems, the ability to handle several patients with problems having different degrees of urgency, effective use of consultants in the follow-up and management of difficult patients and a knowledge of and clinical experience with the prehospital care system. A curriculum should be designed to give the resident a core of didactic material in addition to supervised clinical experience. The rotation should be evaluated by both residents and faculty from internal medicine and emergency medicine to determine if it is accomplishing the objectives set forth. PMID:6506692

  12. [Crisis management in emergency medicine].

    PubMed

    Mizobata, Yasumitsu

    2016-02-01

    There is no "complete safety" in the medical treatment. Unavoidable events or human errors may frighten the patients' safety. Because of its characteristics, emergency medicine is one of the medical fields where treating the patients under the vast safety is difficult. It is inevitable to understand the background of human errors in the emergency medicine under the "SHEL" model. The implementation of the safety measures, such as minimum encounter, minimum probability, multiple detections, and minimum damage is helpful to prevent unfortunate outcomes. Since the emergency medicine treats the severely injured or critical ill patients, its daily works are the picture of the crisis management, and the most suitable environment to train the crisis management competence. The person in charge of crisis management of the institution should put the emergency department to practical use of medical staffs' crisis management training. PMID:26915239

  13. Zoological medicine and public health.

    PubMed

    Chomel, Bruno B; Osburn, Bennie I

    2006-01-01

    Public-health issues regarding zoological collections and free-ranging wildlife have historically been linked to the risk of transmission of zoonotic diseases and accidents relating to bites or injection of venom or toxins by venomous animals. It is only recently that major consideration has been given worldwide to the role of the veterinary profession in contributing to investigating zoonotic diseases in free-ranging wildlife and integrating the concept of public health into the management activities of game preserves and wildlife parks. At the veterinary undergraduate level, courses in basic epidemiology, which should include outbreak investigation and disease surveillance, but also in population medicine, in infectious and parasitic diseases (especially new and emerging or re-emerging zoonoses), and in ecology should be part of the core curriculum. Foreign diseases, especially dealing with zoonotic diseases that are major threats because of possible agro-terrorism or spread of zoonoses, need to be taught in veterinary college curricula. Furthermore, knowledge of the principles of ecology and ecosystems should be acquired either during pre-veterinary studies or, at least, at the beginning of the veterinary curriculum. At the post-graduate level, master's degrees in preventive veterinary medicine, ecology and environmental health, or public health with an emphasis on infectious diseases should be offered to veterinarians seeking job opportunities in public health and wildlife management. PMID:17035205

  14. Emergency medicine in Vietnam.

    PubMed

    Richards, J R

    1997-04-01

    The Socialist Republic of Vietnam is one of the poorest countries in the world. Recent economic developments, as the country attempts to start a market economy, have had a profound impact on its health care system. This report describes the state of prehospital and emergency medical care in Vietnam and possibilities for the future. PMID:9095019

  15. [Sepsis in Emergency Medicine].

    PubMed

    Christ, Michael; Geier, Felicitas; Bertsch, Thomas; Singler, Katrin

    2016-07-01

    Sepsis is defined as "life-threatening organ dysfunction caused by a dysregulated host-response to infection". Presence of organ dysfunction is associated with a mortality of 10% and higher in hospitalized sepsis patients.Introduction of standards in diagnosis and treatment of sepsis in intensive care units has not considerably reduced sepsis mortality. About 80% of patients with sepsis are transferred to intensive care units from usual care wards and emergency departments. Thus, it is tempting to speculate whether opportunities for further improvement of sepsis management exist outside of intensive care units. Performing a "quick sequential organ assessment" (qSOFA; two of following criteria have to be present: respiratory rate >22/min; sytolic blood pressure <100mmHg; altered mental status) supports to identify patients with suspicion of an infection and an increased risk of death within the hospital. Subsequent treatment according to current guidelines on sepsis management will reduce in-hospital mortality of sepsis patients. Indeed, we were able to show a substantial decrease of in-hospital mortality of about 20% in patients presenting with community acquired pneumonia to the emergency department.In summary, decision of further management of sepsis patients has to be done outside intensive care units at the time of initial presentation to professional care givers. Sepsis management in acute care settings should include a structured and standardized protocol to further improve survival in affected patients with even mild organ dysfunction. PMID:27464279

  16. Pre-hospital emergency medicine.

    PubMed

    Wilson, Mark H; Habig, Karel; Wright, Christopher; Hughes, Amy; Davies, Gareth; Imray, Chirstopher H E

    2015-12-19

    Pre-hospital care is emergency medical care given to patients before arrival in hospital after activation of emergency medical services. It traditionally incorporated a breadth of care from bystander resuscitation to statutory emergency medical services treatment and transfer. New concepts of care including community paramedicine, novel roles such as emergency care practitioners, and physician delivered pre-hospital emergency medicine are re-defining the scope of pre-hospital care. For severely ill or injured patients, acting quickly in the pre-hospital period is crucial with decisions and interventions greatly affecting outcomes. The transfer of skills and procedures from hospital care to pre-hospital medicine enables early advanced care across a range of disciplines. The variety of possible pathologies, challenges of environmental factors, and hazardous situations requires management that is tailored to the patient's clinical need and setting. Pre-hospital clinicians should be generalists with a broad understanding of medical, surgical, and trauma pathologies, who will often work from locally developed standard operating procedures, but who are able to revert to core principles. Pre-hospital emergency medicine consists of not only clinical care, but also logistics, rescue competencies, and scene management skills (especially in major incidents, which have their own set of management principles). Traditionally, research into the hyper-acute phase (the first hour) of disease has been difficult, largely because physicians are rarely present and issues of consent, transport expediency, and resourcing of research. However, the pre-hospital phase is acknowledged as a crucial period, when irreversible pathology and secondary injury to neuronal and cardiac tissue can be prevented. The development of pre-hospital emergency medicine into a sub-specialty in its own right should bring focus to this period of care. PMID:26738719

  17. [Personalized medicine, privatized medicine? legal and public health stakes].

    PubMed

    Rial-Sebbag, Emmanuelle

    2014-11-01

    Personalized medicine is booming. It tends to provide a medical management "tailored" for groups of patients, or for one unique patient, but also to identify risk groups to develop public health strategies. In this context, some radicalization phenomenon can emerge, leading to not only personalized medicine but also privatized medicine, which can lead to a capture of the medical public resource. If the "privatization" of medicine is not limited to producing adverse effects, several potentially destabilizing phenomena for patients still remain. First, some objective factors, like the adjustment of scientific prerequisites, are emerging from personalized medicine practices (clinical trial, public health policy) and are interfering with the medical doctor/patient relationship. Another risk emerges for patients concomitantly to their demand for controlling their own health, in terms of patients' security although these risks are not clearly identified and not effectively communicated. These practices, related to a privatized medicine, develop within the healthcare system but also outside, and the government and legislators will have to take into account these new dimensions in drafting their future regulations and policies. PMID:25407457

  18. Psychological factors in emergency medicine.

    PubMed

    Gutenstein, Marc

    2014-06-01

    Human psychology, neuroscience and behavioural economics study the human mind, brain and behaviour. Scientific research has discovered a great deal about the factors that influence human perception, judgment and activity in the real world. In this article, I aim to provide an outline of the relationship between decision-making, cognition, emotion and behaviour. I propose that meta-cognition, or thinking-about-thinking, has the potential to inform how we practice emergency medicine. By accommodating human traits rather than trying to defy them, we can ultimately benefit our patients. PMID:24712897

  19. Telemedicine: emerging e-medicine.

    PubMed

    Mun, S K; Turner, J W

    1999-01-01

    This paper reviews the emergence of telemedicine and its recent expansion and use within the healthcare industry. Through this review, several examples of telemedicine within a variety of applications provide a broad context to discuss the challenges and opportunities facing the emergence of e-medicine. These examples provide snapshots of a teleradiology system used by the military, teleconsultations used in neurosurgery and hemodialysis, and home telemedicine used in diabetes care. Based on the discussion of telemedicine's history and expansion and the examples provided, a framework is offered for understanding the evolution of telemedicine applications through four stages. These stages include: (a) development of basic technological capabilities, (b) development of relevant applications, (c) the integration of technical applications within a complex environment, and (d) transformation of the operating environment. Implications for this framework are discussed. PMID:11701501

  20. Inadequate analgesia in emergency medicine.

    PubMed

    Rupp, Timothy; Delaney, Kathleen A

    2004-04-01

    Review of emergency department pain management practices demonstrates pain treatment inconsistency and inadequacy that extends across all demographic groups. This inconsistency and inadequacy appears to stem from a multitude of potentially remediable practical and attitudinal barriers that include (1) a lack of educational emphasis on pain management practices in nursing and medical school curricula and postgraduate training programs; (2) inadequate or nonexistent clinical quality management programs that evaluate pain management; (3) a paucity of rigorous studies of populations with special needs that improve pain management in the emergency department, particularly in geriatric and pediatric patients; (4) clinicians' attitudes toward opioid analgesics that result in inappropriate diagnosis of drug-seeking behavior and inappropriate concern about addiction, even in patients who have obvious acutely painful conditions and request pain relief; (5) inappropriate concerns about the safety of opioids compared with nonsteroidal anti-inflammatory drugs that result in their underuse (opiophobia); (6) unappreciated cultural and sex differences in pain reporting by patients and interpretation of pain reporting by providers; and (7) bias and disbelief of pain reporting according to racial and ethnic stereotyping. This article reviews the literature that describes the prevalence and roots of oligoanalgesia in emergency medicine. It also discusses the regulatory efforts to address the problem and their effect on attitudes within the legal community. PMID:15039693

  1. Emergency medicine in the United Arab Emirates

    PubMed Central

    2014-01-01

    It has been a decade since emergency medicine was recognized as a specialty in the United Arab Emirates (UAE). In this short time, emergency medicine has established itself and developed rapidly in the UAE. Large, well-equipped emergency departments (EDs) are usually located in government hospitals, some of which function as regional trauma centers. Most of the larger EDs are staffed with medically or surgically trained physicians, with board-certified emergency medicine physicians serving as consultants overseeing care. Prehospital care and emergency medical services (EMS) operate under the auspices of the police department. Standardized protocols have been established for paramedic certification, triage, and destination decisions. The majority of ambulances offer basic life support (BLS/Type 2) with a growing minority offering advanced life support (ALS/Type 3). Medicine residency programs were established 5 years ago and form the foundation for training emergency medicine specialists for UAE. This article describes the full spectrum of emergency medicine in the UAE: prehospital care, EMS, hospital-based emergency care, training in emergency medicine, and disaster preparedness. We hope that our experience, our understanding of the challenges faced by the specialty, and the anticipated future directions will be of importance to others advancing emergency medicine in their region and across the globe. PMID:24401695

  2. Funding strategies for emergency medicine research.

    PubMed

    Carden, D L; Dronen, S C; Gehrig, G; Zalenski, R J

    1998-02-01

    The importance of adequate funding for sustaining research efforts cannot be overemphasized. This article addresses funding strategies for emergency physicians including the necessity of establishing a research track record, developing a well-written grant proposal, and anticipating the grant review process. Funding sources are reviewed with an emphasis on federal institute support and private foundations (including the Emergency Medicine Foundation) in the United States. Sources of current grant support information available from the Internet are provided. Recommendations for enhancing research funding in emergency medicine are made, including enhancement of formal research training, promotion of emergency medicine research and investigators, federal study section membership, and collaboration with established investigators. PMID:9472178

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

    PubMed Central

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

    2014-01-01

    Introduction Both the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA) require core faculty to engage in scholarly work, including publication in peer-reviewed journals. With the ACGME/AOA merger, we sought to evaluate the frequency of publication in high-impact peer-reviewed EM journals from authors affiliated with osteopathic emergency medicine (EM) programs. Methods We performed a retrospective literature review using the Journal Citation Report database and identified the top five journals in the category of ‘Emergency Medicine’ by their 2011 Impact Factor. We examined all publications from each journal for 2011. For each article we recorded article type, authors’ names, position of authorship (first, senior or other), the author’s degree and affiliated institution. We present the data in raw numbers and percentages. Results The 2011 EM journals with the highest impact factor were the following: Annals of Emergency Medicine, Resuscitation, Journal of Trauma, Injury, and Academic Emergency Medicine. Of the 9,298 authors published in these journals in 2011; 1,309 (15%) claimed affiliation with U.S.-based EM programs, of which 16 (1%) listed their affiliations with eight different osteopathic EM programs. The 16 authors claimed affiliation with 8 of 46 osteopathic EM programs (17%), while 1,301 authors claimed affiliation with 104 of 148 (70%) U.S.-based allopathic programs. Conclusion Authors from osteopathic EM programs are under-represented in the top EM journals. With the pending ACGME/AOA merger, there is a significant opportunity for improvement in the rate of publication of osteopathic EM programs in top tier EM journals. PMID:25493152

  4. Current Trends in Geriatric Emergency Medicine.

    PubMed

    Kahn, Joseph H; Magauran, Brendan G; Olshaker, Jonathan S; Shankar, Kalpana N

    2016-08-01

    The number of geriatric visits to United States emergency departments continues to rise. This article reviews demographics, statistics, and future projections in geriatric emergency medicine. Included are discussions of US health care spending, geriatric emergency departments, prehospital care, frailty of geriatric patients, delirium, geriatric trauma, geriatric screening and prediction tools, medication safety, long-term care, and palliative care. PMID:27475008

  5. Celebrating Leadership in Public Health and Medicine

    MedlinePlus

    ... Public Health and Medicine Friends of the National Library of Medicine (FNLM) Past Issues / Summer 2009 Table ... B. Lindberg, M.D., Director of the National Library of Medicine. 2 NIH researchers John T. Schiller, ...

  6. State of emergency medicine in Spain

    PubMed Central

    2010-01-01

    Spain has universal public health care coverage. Emergency care provisions are offered to patients in different modalities and levels according to the characteristics of the medical complaint: at primary care centers (PCC), in an extrahospital setting by emergency medical services (EMS) and at hospital emergency departments (ED). We have more than 3,000 PCCs, which are run by family doctors (general practitioners) and pediatricians. On average, there is 1 PCC for every 15,000 to 20,000 inhabitants, and every family doctor is in charge of 1,500 to 2,000 citizens, although less populated zones tend to have lower ratios. Doctors spend part of their duty time in providing emergency care to their own patients. While not fully devoted to emergency medicine (EM) practice, they do manage minor emergencies. However, Spanish EMSs contribute hugely to guarantee population coverage in all situations. These EMS are run by EM technicians (EMT), nurses and doctors, who usually work exclusively in the emergency arena. EDs dealt with more than 25 million consultations in 2008, which implies, on average, that one out of two Spaniards visited an ED during this time. They are usually equipped with a wide range of diagnostic tools, most including ultrasonography and computerized tomography scans. The academic and training background of doctors working in the ED varies: nearly half lack any structured specialty residence training, but many have done specific master or postgraduate studies within the EM field. The demand for emergency care has grown at an annual rate of over 4% during the last decade. This percentage, which was greater than the 2% population increase during the same period, has outpaced the growth in ED capacity. Therefore, Spanish EDs become overcrowded when the system exerts minimal stress. Despite the high EM caseload and the potential severity of the conditions, training in EM is still unregulated in Spain. However, in April 2009 the Spanish Minister of Health

  7. Emergency medicine: A comprehensive review

    SciTech Connect

    Kravis, T.C.; Warner, C.G.

    1987-01-01

    This book contains 91 chapters divided among 14 sections. Some of the chapter titles are: Transfusions; Minor Lacerations and Abrasions; Diabetic Emergencies; Adrenal Insufficiency; Hypercalcemia; Medical Genetics; Burns; Hazardous Materials; Gastrointestinal Emergencies; Infectious Disease Emergencies; Reye's Syndrome; Bites and Stings; and Hypothermia.

  8. Celebrating Leadership in Public Health and Medicine

    MedlinePlus

    ... Home Current Issue Past Issues Celebrating Leadership in Public Health and Medicine Friends of the National Library of ... 2009 FNLM Annual Awards Dinner celebrated advances in public health and medicine, along with the individuals and organizations ...

  9. Funding strategies for emergency medicine research.

    PubMed

    Carden, D L; Dronen, S C; Gehrig, G; Zalenski, R J

    1998-02-01

    The importance of adequate funding for sustaining research efforts cannot be overemphasized. This article addresses funding strategies for emergency physicians, including the necessity of establishing a research track record, developing a well-written grant proposal, and anticipating the grant review process. Funding sources are reviewed with an emphasis on federal institute support and private foundations (including the Emergency Medicine Foundation) in the United States. Sources of current grant support information available from the Internet are provided. Recommendations for enhancing research funding in emergency medicine (EM) are made, including enhancement of formal research training, promotion of EM research and investigators, federal study section membership, and collaboration with established investigators. PMID:9492141

  10. Emerging technologies in aesthetic medicine.

    PubMed

    Reddy, Bobby Y; Hantash, Basil M

    2009-10-01

    Recent advances in technology have drastically improved aesthetic treatment for skin. Of particular interest is the emergence of laser- and lightbased technologies, which have offered great promise among skin-rejuvenation therapies. New laser resurfacing techniques for skin rejuvenation offer significant advantages over conventional ablative lasers, such as the CO(2) and erbiumYAG laser systems. Nonablative and fractional lasers, although not as efficacious as ablative therapies, are associated with significantly diminished complication rates and shortened recovery times. Novel devices combining ablative and fractional technologies have also surfaced, demonstrating noteworthy results. In this review, the authors will discuss the implications of current developments in research and technology for skin rejuvenation. Furthermore, the authors will address emerging therapies for acne vulgaris, lipolysis, and cellulite. PMID:19850201

  11. The admissibility of research in emergency medicine.

    PubMed

    Wnukiewicz-Kozłowska, Agata

    2007-09-01

    The main goal in this paper is to present the legal rules connected with medical experiment on human beings in emergency medicine and to explain the scope, significance, and meaning of these rules, especially with regard to their interpretation. As the provisions about medical experiments truly make sense only if they can be observed by the whole "civilised" international community, they are presented in the context of international law with reference to Polish law. By considering the appropriate regulations of research contained in legal documents, it is possible to formulate a catalogue of doctors' duties and patients' rights. This general catalogue refers to all kinds of medical research involving human beings. In the field of emergency medicine, general provisions are sometimes involved, and they are sometimes limited. The main and most important conclusion is that a medical experiment in emergency medicine is admissible only if previously indicated conditions based on general rules of conducting research are fulfilled. PMID:18210226

  12. Interpreter services in emergency medicine.

    PubMed

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

    2010-02-01

    Emergency physicians are routinely confronted with problems associated with language barriers. It is important for emergency health care providers and the health system to strive for cultural competency when communicating with members of an increasingly diverse society. Possible solutions that can be implemented include appropriate staffing, use of new technology, and efforts to develop new kinds of ties to the community served. Linguistically specific solutions include professional interpretation, telephone interpretation, the use of multilingual staff members, the use of ad hoc interpreters, and, more recently, the use of mobile computer technology at the bedside. Each of these methods carries a specific set of advantages and disadvantages. Although professionally trained medical interpreters offer improved communication, improved patient satisfaction, and overall cost savings, they are often underutilized due to their perceived inefficiency and the inconclusive results of their effect on patient care outcomes. Ultimately, the best solution for each emergency department will vary depending on the population served and available resources. Access to the multiple interpretation options outlined above and solid support and commitment from hospital institutions are necessary to provide proper and culturally competent care for patients. Appropriate communications inclusive of interpreter services are essential for culturally and linguistically competent provider/health systems and overall improved patient care and satisfaction. PMID:18571358

  13. Opportunities for emergency medicine training in Australia.

    PubMed Central

    Ryan, J M; Gaudry, P I

    1997-01-01

    Opportunities exist for graduates from the United Kingdom to undertake some of their emergency medicine training in Australia. Guidelines for graduates are presented on when to travel, how to find a position, what information one should obtain about a position, and how to acquire the necessary visa and medical registration. A successful visit takes some time to plan and requires cooperation between the negotiating parties. The graduate who undertakes training abroad can expect to benefit professionally and personally. The development of an international exchange network for trainees would streamline the process and broaden the appeal to graduates of completing some of their emergency medicine training in another country. PMID:9023622

  14. Space medicine research publications: 1984-1986

    NASA Technical Reports Server (NTRS)

    Wallace, Janice S.

    1988-01-01

    A list is given of the publications of investigators supported by the Biomedical Research and Clinical Medicine Programs of the Space Medicine and Biology Branch, Life Sciences Division, Office of Space Science and Applications. It includes publications entered into the Life Sciences Bibliographic Database by the George Washington University as of December 31, 1986. Publications are organized into the following subject areas: Clinical Medicine, Space Human Factors, Musculoskeletal, Radiation and Environmental Health, Regulatory Physiology, Neuroscience, and Cardiopulmonary.

  15. Space medicine research publications: 1983-1984

    NASA Technical Reports Server (NTRS)

    Solberg, J. L.; Pleasant, L. G.

    1984-01-01

    A list of publications supported by the Space Medicine Program, Office of Space Science and Applications is given. Included are publications entered into the Life Sciences Bibliographic Database by The George Washington University as of October 1, 1984.

  16. Queensland Emergency Medicine Research Foundation: special report.

    PubMed

    FitzGerald, Gerry; Codd, Catrina; Aitken, Peter; Sinnott, Michael

    2012-02-01

    Development of any new profession is dependent on the development of a special body of knowledge that is the domain of the profession. Key to this is research. Following sustained lobbying, the Queensland Government agreed to establish an emergency medicine research fund as part of an Enterprise Bargaining Agreement in 2006. That fund is managed by the Queensland Emergency Medicine Research Foundation. The present article describes the strategic approaches of the Foundation in its first 3 years, the application of research funds, and foreshadows an evaluative framework for determining the strategic value of this investment. The Foundation has developed a range of personnel and project support funding programmes, and competition for funding has increased. Ongoing evaluation will seek to determine the effectiveness of the current funding strategy on improving the effectiveness of research performance. It will also evaluate the clinical and organizational outcomes. PMID:22313558

  17. An update on emergency care and emergency medicine in Russia.

    PubMed

    Rodigin, Anthony

    2015-12-01

    Russia's national healthcare system is undergoing significant changes. Those changes which affect healthcare financing are particularly vital. As has often been the case in other nations, the emergency care field is at the forefront of such reforms. The ongoing challenges constitute the environment in which the hospital-based specialty of emergency medicine needs to develop as part of a larger system. Emergency care has to evolve in order to match true needs of the population existing today. New federal regulations recently adopted have recognized emergency departments as the new in-hospital component of emergency care, providing the long-needed legal foundation upon which the new specialty can advance. General knowledge of Western-style emergency departments in terms of their basic setup and function has been widespread among Russia's medical professionals for some time. Several emergency departments are functioning in select regions as pilots. Preliminary data stemming from their operation have supported a positive effect on efficiency of hospital bed utilization and on appropriate use of specialists and specialized hospital departments. In the pre-hospital domain, there has been a reduction of specialized ambulance types and of the number of physicians staffing all ambulances in favor of midlevel providers. Still, a debate continues at all levels of the medical hierarchy regarding the correct future path for emergency care in Russia with regard to adaptation and sustainability of any foreign models in the context of the country's unique national features. PMID:26608599

  18. Human factors and safety in emergency medicine

    NASA Technical Reports Server (NTRS)

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

    1994-01-01

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

  19. Asthma Exacerbation: An Emergency Medicine Simulation Scenario

    PubMed Central

    Angus, Karen; Parsons, Michael; Cheeseman, Neil

    2015-01-01

    In the practice of emergency medicine, simulation is a valuable tool that allows medical students and postgraduate residents to develop skills in a safe environment at no risk to patients. In this report, we present a case simulation of an acute asthma exacerbation utilizing a human patient simulator. The case is designed such that it can be easily modified to accommodate the trainee’s level of expertise, allowing instructors to challenge both the novice and advanced learner alike. PMID:26180682

  20. Priorities in global emergency medicine development.

    PubMed

    Smith, Jeffrey; Haile-Mariam, Tenagne

    2005-02-01

    EM initiatives are gaining global acceptance as a result of emergency physicians; local advocates; national, transnational, and international EM organizations; and governmental leadership, organizations, and agencies involved in international health and an evolving global health agenda. Spanning the spectrum from basic initiatives to improve acute care services to mature EM specialty development, all countries acknowledge the need for emergency care. The level of EM development in a country is fluid and depends on many variables, including status of health development, burden of disease,resources, advocacy, available expertise, and public demand. Emergency physicians should support the promotion of EM in the context of essential public health and primary care initiatives in these developing countries. Additionally, emergency physicians should work closely with stakeholders, health policy experts, health economics, and international organizations involved in health care to promote the advancement of EM worldwide. PMID:15663971

  1. Recruitment and Retention of Patients into Emergency Medicine Clinical Trials

    PubMed Central

    Cofield, Stacey; Conwit, Robin; Barsan, William; Quinn, James

    2010-01-01

    The emergency medicine and pre-hospital environments are unlike any other clinical environments and require special consideration to allow the successful implementation of clinical trials. This article reviews the specific issues involved in Emergency Medicine Clinical Trials (EMCT), and provides strategies from emergency medicine and non-emergency medicine trials to maximize recruitment and retention. While the evidence supporting some of these strategies is deficient, addressing recruitment and retention issues with specific strategies will help researchers deal with these issues in their funding applications and in turn develop the necessary infrastructure to participate in emergency medicine clinical trials. PMID:21040112

  2. Human factors and safety in emergency medicine.

    PubMed

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

    1994-12-01

    A model based on an input process and outcome conceptualisation is suggested to address safety-relevant factors in emergency medicine. As shown in other dynamic and demanding environments, human factors play a decisive role in attaining high quality service. Attitudes held by health-care providers, organisational shells and work-cultural parameters determine communication, conflict resolution and workload distribution within and between teams. These factors should be taken into account to improve outcomes such as operational integrity, job satisfaction and morale. PMID:7740192

  3. Space medicine research publications: 1987-1988

    NASA Technical Reports Server (NTRS)

    1991-01-01

    A list of publications of investigators supported by the Biomedical Research and Clinical Programs of the Life Sciences Division, Office of Space Science and Applications is given. Included are publications entered into the Life Sciences Bibliographic Database by the George Washington University as of 31 December 1988. Principal Investigators whose research tasks resulted in publication are identified by asterisk. Publications are organized into the following subject areas: space physiology and countermeasures (cardiopulmonary, musculoskeletal, neuroscience, and regulatory physiology), space human factors, environmental health, radiation health, clinical medicine, and general space medicine.

  4. Determination of "futility" in emergency medicine.

    PubMed

    Marco, C A; Larkin, G L; Moskop, J C; Derse, A R

    2000-06-01

    The practice of emergency medicine routinely requires rapid decisionmaking regarding various interventions and therapies. Such decisions should be based on the expected risks and benefits to the patient, family, and society. At times, certain interventions and therapies may be considered "futile," or of low expected likelihood of benefit to the patient. Various interpretations of the term "futility" and its practical application to the practice of emergency medicine are explored, as well as background information and potential application of various legal, ethical, and organizational policies regarding the determination of "futility. "Decisions regarding potential benefit of interventions should be based on scientific evidence, societal consensus, and professional standards, not on individual bias regarding quality of life or other subjective matters. Physicians are under no ethical obligation to provide treatments they judge to have no realistic likelihood of benefit to the patient. Decisions to withhold treatment should be made with careful consideration of scientific evidence of likelihood of medical benefit, other benefits (including intangible benefits), potential risks of the proposed intervention, patient preferences, and family wishes. When certain interventions are withheld, special efforts should be made to maintain effective communication, comfort, support, and counseling for the patient, family, and friends. PMID:10828774

  5. Public health medicine: the constant dilemma.

    PubMed

    Eskin, Frada

    2002-03-01

    There is a well-known quotation by the nineteenth-century sociologist Virchow (quoted in Ref. 1) that aptly captures the dilemma that has confronted public health medicine since the specialty was created as a discrete entity in 1848. Virchow said: 'Medicine is politics and social medicine is politics writ large!' What does this mean in relation to effective public health medicine practice and how is it likely to affect its future? There is increasingly limited freedom of expression within the current context of political correctness, central control and a rapidly burgeoning litigious climate. The purpose of this paper is to explore these issues and to propose a means of maintaining public health medicine integrity within a working environment where action is becoming rapidly constrained by political rigidity. An additional factor to be included in the dialogue is the current context within which public health physicians work. Because the majority of public health doctors are employed within the National Health Service (NHS), they are finding themselves being expected to take on tasks and responsibilities marginal to their essential purpose and function. For example, public health physicians spend a great deal of time involved in detailed deliberations about health service provision. Although there is a great deal of evidence to show that good quality health care provision positively affects the health of the individual, there is no evidence to show that this activity has any effect on the population's health status. The essence of public health medicine practice is the prevention of ill-health and the promotion of the health of the population and, consequently, attention needs to be focused on the root causes of disease. However, as these are outside the aegis of the NHS, public health medicine involvement in such issues as education, nutrition, housing, transport and poverty is regarded as marginal to the NHS corporate agenda. PMID:11939386

  6. Emergency medicine rural rotations: a program director's guide.

    PubMed

    Casaletto, Jennifer J; Wadman, Michael C; Ankel, Felix K; Bourne, Christina L; Ghaemmaghami, Chris A

    2013-05-01

    The Institute of Medicine's 2006 report titled "Hospital-Based Emergency Care: At the Breaking Point" called national attention to the lack of specialty-trained emergency care practitioners, particularly in rural America. One suggested strategy for narrowing the gap between the prevalence of residency-trained, board-certified emergency physicians practicing in rural and urban emergency departments is the development of rural clinical experiences for emergency medicine residents during the course of their training. This article addresses promotion of a rural emergency medicine rotation to hospital leadership and resident recruits, examines funding sources, discusses medical liability and disability insurance options, provides suggestions for meeting faculty and planned educational activity residency review committee requirements, and offers guidance about site selection to direct emergency medicine academic leaders considering or planning a new rural emergency medicine rotation. PMID:23083967

  7. Emerging infectious diseases and travel medicine.

    PubMed

    Ostroff, S M; Kozarsky, P

    1998-03-01

    International movement of individuals, populations, and products is one of the major factors associated with the emergence and reemergence of infectious diseases as the pace of global travel and commerce increases rapidly. Travel can be associated with disease emergence because (1) the disease arises in an area of heavy tourism, (2) tourists may be at heightened risk because of their activities, or (3) because they can act as vectors to transport the agent to new areas. Examples of recently recognized diseases with relationship to travel include HIV, Legionnaire's disease, cyclosporiasis, Vibrio cholerae O139 Bengal, hantavirus, and variant Creutzfeldt-Jacob disease. Reemerging diseases include dengue fever, malaria, cholera, schistosomiasis, leptospirosis, and viral hemorrhagic fevers. In addition, tuberculosis, drug-resistant shigellosis, and cholera have been major concerns in refugee and migrant populations. Because of the unique role of travel in emerging infections, efforts are underway to address this factor by agencies such as the CDC, WHO, the International Society of Travel Medicine, and the travel industry. PMID:9494841

  8. Regenerative medicine: the emergence of an industry

    PubMed Central

    Nerem, Robert M.

    2010-01-01

    Over the last quarter of a century there has been an emergence of a tissue engineering industry, one that has now evolved into the broader area of regenerative medicine. There have been ‘ups and downs’ in this industry; however, it now appears to be on a track that may be described as ‘back to the future’. The latest data indicate that for 2007 the private sector activity in the world for this industry is approaching $2.5 billion, with 167 companies/business units and more than 6000 employee full time equivalents. Although small compared with the medical device and also the pharmaceutical industries, these numbers are not insignificant. Thus, there is the indication that this industry, and the related technology, may still achieve its potential and address the needs of millions of patients worldwide, in particular those with needs that currently are unmet. PMID:20843840

  9. Expectations of an emergency medicine clerkship director.

    PubMed

    Rogers, Robert L; Wald, David A; Lin, Michelle; Zun, Leslie S; Christopher, Theodore; Manthey, David E

    2011-05-01

    The clerkship director (CD) serves as a faculty leader within a school of medicine and plays a vital role in the hierarchy of undergraduate medical education. Collectively, CDs across specialties serve a multitude of roles and are responsible for clerkship administration, curricular development, teaching, mentoring, and advising students. The emergency medicine (EM) CD has a vitally important role to play in the future development of medical students. EM CDs should be valued and supported, because they often represent our specialty within the medical school and play a vital role in training the physicians of tomorrow. Opportunities and resources must be made available to CDs to run and maintain a successful EM clerkship, while also balancing their clinical duties and academic endeavors. In addition, EM CDs need support from their respective medical schools and departments to run highly successful medical student rotations. This article was prepared with the objective of establishing the importance of the EM CD, defining the job description of the CD, explaining the importance of adequate release time to perform the role of the CD, and describing the necessary resources and support for the position. With EM becoming an increasingly popular and integral rotation for medical students, it is likely that additional emphasis will be placed on the role of the EM CD. This reference document serves as a template for the job description and expectations of an EM CD. PMID:21521403

  10. Emerging paradigms in mind-body medicine.

    PubMed

    Shang, C

    2001-02-01

    The emerging paradigms in medicine can be seen through mind-body interactions. Observations in many meditative traditions suggest a series of objective indicators of health beyond absence of disease. Several of the physical signs have been confirmed by research or are consistent with modern science. Further correlation with long term health outcome is needed. Integration of meditation with conventional therapy has enriched psychotherapy with parallels drawn between the Nine Step Qigong and Freudian developmental psychology. A unified theory of the chakra system and the meridian system widely used in traditional mind-body interventions and acupuncture is presented in terms of modern science based on the morphogenetic singularity theory. Acupuncture points originate from the organizing centers in morphogenesis. Meridians and chakras are related to the underdifferentiated, interconnected cellular network that regulates growth and physiology. This theory explains the distribution and nonspecific activation of organizing centers and acupuncture points; the high electric conductance of the meridian system; the polarity effect of electroacupuncture; the side-effect profile of acupuncture; and the ontogeny, phylogeny, and physiologic function of the meridian system and chakra system. It also successfully predicted several findings in conventional biomedical science. These advances have implications in many disciplines of medicine. PMID:11246939

  11. Blog and Podcast Watch: Pediatric Emergency Medicine

    PubMed Central

    Zaver, Fareen; Hansen, Michael; Leibner, Evan; Little, Andrew; Lin, Michelle

    2016-01-01

    Introduction By critically appraising open access, educational blogs and podcasts in emergency medicine (EM) using an objective scoring instrument, this installment of the ALiEM (Academic Life in Emergency Medicine) Blog and Podcast Watch series curated and scored relevant posts in the specific areas of pediatric EM. Methods The Approved Instructional Resources – Professional (AIR-Pro) series is a continuously building curriculum covering a new subject area every two months. For each area, six EM chief residents identify 3–5 advanced clinical questions. Using FOAMsearch.net to search blogs and podcasts, relevant posts are scored by eight reviewers from the AIR-Pro Board, which is comprised of EM faculty and chief residents at various institutions. The scoring instrument contains five measurement outcomes based on 7-point Likert scales: recency, accuracy, educational utility, evidence based, and references. The AIR-Pro label is awarded to posts with a score of ≥26 (out of 35) points. An “Honorable Mention” label is awarded if Board members collectively felt that the posts were valuable and the scores were > 20. Results We included a total of 41 blog posts and podcasts. Key educational pearls from the 10 high quality AIR-Pro posts and four Honorable Mentions are summarized. Conclusion The WestJEM ALiEM Blog and Podcast Watch series is based on the AIR and AIR-Pro series, which attempts to identify high quality educational content on open-access blogs and podcasts. Until more objective quality indicators are developed for learners and educators, this series provides an expert-based, crowdsourced approach towards critically appraising educational social media content for EM clinicians. PMID:27625713

  12. Medicine as a Public Calling.

    PubMed

    Bagley, Nicholas

    2015-01-01

    The debate over how to tame private medical spending tends to pit advocates of government-provided insurance--a single-payer scheme--against those who would prefer to harness market forces to hold down costs. When it is mentioned at all, the possibility of regulating the medical industry as a public utility is brusquely dismissed as anathema to the American regulatory tradition. This dismissiveness, however, rests on a failure to appreciate just how deeply the public utility model shaped health law in the twentieth century-- and how it continues to shape health law today. Closer economic regulation of the medical industry may or may not be prudent, but it is by no means incompatible with our governing institutions and political culture. Indeed, the durability of such regulation suggests that the modern embrace of market-based approaches in the medical industry may be more ephemeral than it seems. PMID:26394459

  13. [Patients' declared intentions and emergency medicine].

    PubMed

    Wurmb, T; Brederlau, J

    2016-03-01

    Patients with complex medical problems and acute life-threatening diseases deserve a physician with the capability of rapid decision making. Despite an emergency scenario with several unknown or uncertain variables an individual therapeutic plan needs to be defined for each patient. In order to achieve this goal the physician must define medical indications for each form of treatment. Secondly, the patients declared intentions must be respected concerning the previously defined medical indications; however, very often the patients' will is not known. It is very difficult to define an individual treatment plan especially if the patient is not able to adequately communicate. In these situations a custodian is helpful to find out the patients declared intentions towards the current medical situation. If there is no advance directive, family members often have to act as surrogates to find out what therapy goal is best for the individual patient. The patients' autonomy is a very highly respected ethical priority even when the ability for the otherwise usual practice of shared decision-making between physician and patient is compromised. Therefore, in order to do justice to this demanding situation it is necessary to deal with the characteristics of the physician-patient-relatives relationship in emergency medicine. PMID:26374338

  14. Quality criteria for electronic publications in medicine.

    PubMed

    Schulz, S; Auhuber, T; Schrader, U; Klar, R

    1998-01-01

    This paper defines "electronic publications in medicine (EPM)" as computer based training programs, databases, knowledge-based systems, multimedia applications and electronic books running on standard platforms and available by usual distribution channels. A detailed catalogue of quality criteria as a basis for development and evaluation of EPMs is presented. The necessity to raise the quality level of electronic publications is stressed considering aspects of domain knowledge, software engineering, media development, interface design and didactics. PMID:10179625

  15. Special feature: emergency medicine in Role 2 Afloat.

    PubMed

    Doherty, S; Gilbert, S; Henning, D C W

    2013-01-01

    The Emergency Medicine aspects of care are described from recent experience of exercising a Role 2 Afloat team on board RFA CARDIGAN BAY. Lessons learned specific to this platform are outlined, as well as the more general issues of delivering Emergency Medicine in the maritime environment. PMID:24511799

  16. Pharmacogenomics and public health: implementing 'populationalized' medicine.

    PubMed

    Mette, Lindsey; Mitropoulos, Konstantinos; Vozikis, Athanassios; Patrinos, George P

    2012-05-01

    Pharmacogenomics are frequently considered in personalized medicine to maximize therapeutic benefits and minimize adverse drug reactions. However, there is a movement towards applying this technology to populations, which may produce the same benefits, while saving already scarce health resources. We conducted a narrative literature review to examine how pharmacogenomics and public health can constructively intersect, particularly in resource-poor settings. We identified 27 articles addressing the research question. Real and theoretical connections between public health and pharmacogenomics were presented in the areas of disease, drugs and public policy. Suggested points for consideration, such as educational efforts and cultural acceptability, were also provided. Including pharmacogenomics in public health can result in both health-related and economic benefits. Including pharmacogenomics in public health holds promise but deserves extensive consideration. To fully realize the benefits of this technology, support is needed from private, public and governmental sectors in order to ensure the appropriateness within a society. PMID:22594512

  17. The business of emergency medicine: a nonclinical curriculum proposal for emergency medicine residency programs.

    PubMed

    Falvo, Thomas; McKniff, Sueanne; Smolin, Gregory; Vega, David; Amsterdam, James T

    2009-09-01

    Over the course of their postgraduate medical education, physicians are expected not only to acquire an extensive knowledge of clinical medicine and sound procedural skills, but also to develop competence in their other professional roles as communicator, collaborator, mediator, manager, teacher, and patient advocate. Although the need for physicians to develop stronger service delivery skills is well recognized, residency programs may underemphasize formal training in nonclinical proficiencies. As a result, graduates can begin their professional careers with an incomplete understanding of the operation of health care systems and how to utilize system resources in the manner best suited to their patients' needs. This article proposes the content, educational strategy, and needs assessment for an academic program entitled The Business of Emergency Medicine (BOEM). Developed as an adjunct to the (predominantly) clinical content of traditional emergency medicine (EM) training programs, BOEM is designed to enhance the existing academic curricula with additional learning opportunities by which EM residents can acquire a fundamental understanding of the nonclinical skills of their specialty. PMID:19689483

  18. Emergency medicine as a primary specialty-French emergency medicine residents' attitudes.

    PubMed

    Yordanov, Youri; Sobotka, Jennifer; Dahan, Benjamin; Jacquin, Laurent; Kalpokdjian, Aurélie; Pateron, Dominique

    2015-11-01

    Emergency medicine (EM) has been a fellowship program (supra-specialty) in France since 2004. Even though the program can be accessed after completion of one of several primary specialties, the vast majority (97%) of its residents enter the program after having completed training in family medicine. A change to develop a primary EM specialty is being discussed. Our objective was to assess French residents and young EM physicians' attitudes toward EM as a primary specialty. We conducted a brief cross-sectional online survey among young EM physicians and trainees in November and December 2012. There were 288 respondents to the survey. Forty-nine percent (n=142) of respondents would have chosen EM if it was a primary specialty, but 73% (n=209) prefer maintaining the status quo, offering EM training as a supra-specialty fellowship program. Work-related quality of life was the main reason for those not choosing EM as a primary specialty. PMID:26012721

  19. Integrating the Accreditation Council for Graduate Medical Education Core competencies into the model of the clinical practice of emergency medicine.

    PubMed

    Chapman, Dane M; Hayden, Stephen; Sanders, Arthur B; Binder, Louis S; Chinnis, Ann; Corrigan, Kelly; LaDuca, Tony; Dyne, Pam; Perina, Debra G; Smith-Coggins, Rebecca; Sulton, Larry; Swing, Susan

    2004-06-01

    In response to public pressure for greater accountability from the medical profession, a transformation is occurring in the approach to medical education and assessment of physician competency. Over the past 5 years, the Accreditation Council for Graduate Medical Education (ACGME) has implemented the Outcomes and General Competencies projects to better ensure that physicians are appropriately trained in the knowledge and skills of their specialties. Concurrently, the American Board of Medical Specialties, including the American Board of Emergency Medicine (ABEM), has embraced the competency concept. The core competencies have been integral in ABEM's development of Emergency Medicine Continuous Certification and the development of the Model of Clinical Practice of Emergency Medicine (Model). ABEM has used the Model as a significant part of its blueprint for the written and oral certification examinations in emergency medicine and is fully supportive of the effort to more fully define and integrate the ACGME core competencies into training emergency medicine specialists. To incorporate these competencies into our specialty, an Emergency Medicine Competency Taskforce (Taskforce) was formed by the Residency Review Committee-Emergency Medicine to determine how these general competencies fit in the Model. This article represents a consensus of the Taskforce with the input of multiple organizations in emergency medicine. It provides a framework for organizations such as the Council of Emergency Medicine Residency Directors (CORD) and the Society for Academic Emergency Medicine to develop a curriculum in emergency medicine and program requirement revisions by the Residency Review Committee-Emergency Medicine. In this report, we describe the approach taken by the Taskforce to integrate the ACGME core competencies into the Model. Ultimately, as competency-based assessment is implemented in emergency medicine training, program directors, governing bodies such as the ACGME

  20. Pediatric Abdominal Pain: An Emergency Medicine Perspective.

    PubMed

    Smith, Jeremiah; Fox, Sean M

    2016-05-01

    Abdominal pain is a common complaint that leads to pediatric patients seeking emergency care. The emergency care provider has the arduous task of determining which child likely has a benign cause and not missing the devastating condition that needs emergent attention. This article reviews common benign causes of abdominal pain as well as some of the cannot-miss emergent causes. PMID:27133248

  1. Emergency Medicine Resident Perceptions of Medical Professionalism

    PubMed Central

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

    2016-01-01

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

  2. 'Need-to-Know' emergency medicine articles of 2014.

    PubMed

    Huis In 't Veld, Maite A; Nguyen, Tu C; Martinez, Joseph P; Mattu, Amal

    2015-01-01

    Every year, thousands of articles are published in numerous medical journals that relate to the clinical practice of medicine. However, it is impossible for a single clinician to stay abreast of the literature, let alone to determine which articles should change daily practice. Physicians in our department have searched the emergency medicine and the specialty literature of 2014 to determine which articles are most relevant to the clinical practice of emergency medicine, summarized them, and listed key take-home points from these 'need-to-know' articles. PMID:25852775

  3. Accident and emergency medicine--making waves on the Internet.

    PubMed Central

    Ryan, J M; Baldock, C; Lawson-Smith, R

    1997-01-01

    The internet is a communications and information tool which has recently entered the world of accident and emergency (A&E) medicine. It is a worldwide instrument facilitating the dissemination of ideas and clinical information in the specialty. It is being embraced by all disciplines involved in A&E medicine. Part I introduces the internet to those in A&E medicine unfamiliar with this technology. It describes the varied resources of the internet in A&E medicine and speculates on its future role. Part II supplies the reader with the necessary information to get on-line and explains some of the more technical aspects of the internet. PMID:9413781

  4. [Quality improvement of health care services in Croatian emergency medicine].

    PubMed

    Predavec, Sanja; Sogorić, Selma; Jurković, Drazen

    2010-12-01

    Emergency medical services (EMS) in the Republic of Croatia are currently organized as part of the existing health care system and delivered in the form of pre-hospital and hospital EMS. The pre-hospital EMS are delivered by standalone EMS Centers, EMS units set up in community health centers, and by general practitioners working in shifts and on call in remote and scarcely populated areas. In hospitals, each ward usually has its own emergency reception area, and only in a couple of cases there is an integrated emergency admission unit for the entire hospital. The current EMS structure does not meet the basic requirements that would make an EMS system optimal, i.e. equal quality, equal access, effectiveness and appropriate equipment. The EMS Restructuring Project is part of the Croatian health care system reform and is addressed by the National Health Development Strategy 2006-2011. As part of restructuring efforts, the Croatian National Institute of Emergency Medicine, 21 County Institutes of Emergency Medicine and county-level call centers are going to be set up. In addition, the project will introduce the following: integrated emergency admission areas at hospitals; telemedicine as part of emergency medicine; emergency medicine specialty for physicians and additional specialized training for nurses/technicians; separation of emergency and non-emergency transport; standards for vehicles and equipment and guidelines/protocols/algorithms for care. The Croatian National Institute of Emergency Medicine is an umbrella EMS organization. It shapes the EMS in Croatia and proposes, plans, monitors and analyzes EMS actions in Croatia. In addition, it submits a proposal of the Emergency Medicine Network to the minister, sets standards for EMS transport, and coordinates, guides and supervises the work of County Institutes of Emergency Medicine. County Institutes organize and deliver pre-hospital EMS in their counties. Integrated hospital emergency admission units represent a

  5. A Model Longitudinal Observation Medicine Curriculum for an Emergency Medicine Residency.

    PubMed

    Wheatley, Matthew; Baugh, Christopher; Osborne, Anwar; Clark, Carol; Shayne, Philip; Ross, Michael

    2016-04-01

    The role of observation services for emergency department patients has increased in recent years. Driven by changing health care practices and evolving payer policies, many hospitals in the United States currently have or are developing an observation unit (OU) and emergency physicians are most often expected to manage patients in this setting. Yet, few residency programs dedicate a portion of their clinical curriculum to observation medicine. This knowledge set should be integrated into the core training curriculum of emergency physicians. Presented here is a model observation medicine longitudinal training curriculum, which can be integrated into an emergency medicine (EM) residency. It was developed by a consensus of content experts representing the observation medicine interest group and observation medicine section, respectively, from EM's two major specialty societies: the Society for Academic Emergency Medicine (SAEM) and the American College of Emergency Physicians (ACEP). The curriculum consists of didactic, clinical, and self-directed elements. It is longitudinal, with learning objectives for each year of training, focusing initially on the basic principles of observation medicine and appropriate observation patient selection; moving to the management of various observation appropriate conditions; and then incorporating further concepts of OU management, billing, and administration. This curriculum is flexible and designed to be used in both academic and community EM training programs within the United States. Additionally, scholarly opportunities, such as elective rotations and fellowship training, are explored. PMID:26806664

  6. Emerging medicolegal issues in the practice of pediatric sleep medicine.

    PubMed

    Sachdeva, Ramesh C; D'Andrea, Lynn A

    2009-10-01

    With the rapid growth in the field of pediatric sleep medicine, health care providers need to be aware of several emerging legal issues that have the potential of impacting their clinical practice. This article provides an overview of emerging legal areas that might impact the practice of pediatric sleep medicine, and discusses civil liability emerging from medical malpractice, issues that health care providers must be aware of including issues related to providing care for minors, and newer areas that relate to legal prosecution for health care fraud as it may relate to violations of quality of care. PMID:19836702

  7. Scores and scales used in emergency medicine. Practicability in toxicology.

    PubMed

    Oprita, B; Aignatoaie, B; Gabor-Postole, D A

    2014-01-01

    Medical scores, criteria and classification systems support clinical decision-making and management. They enable the clinician to predict the outcome, stratify risk, assess conditions and diagnose diseases accurately. In the emergency medicine, it is very important to ascertain safety criteria to discharge patients, time to remain in the E.R., and also ascertain the time intervals for discharge/admission. The use of the scores in the emergency medicine, toxicology and other areas of intensive medicine have become increasingly efficient. Creating a prognostic score for the acute intoxications to be used by the personnel from the Emergency Departments may have positive effects in the management of the poisoned patients (e.g. the admission in a certain treatment space: cases expected to have a trend towards worsening will be directed to the resuscitation space and after a short period of time admitted in the appropriate facility; this way, the bed occupancy time in the Emergency Department will be shortened). PMID:25870686

  8. Emergency medicine and the airline passenger

    NASA Technical Reports Server (NTRS)

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

    1980-01-01

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

  9. Owning the cost of emergency medicine: beyond 2%.

    PubMed

    Lee, Michael H; Schuur, Jeremiah D; Zink, Brian J

    2013-11-01

    This article evaluates current evidence on the cost of emergency care. First, we reviewed data from national data sets and found that aggregate spending on emergency care is 5% to 6% of national health expenditures but could be as high as 10%. These figures are significantly higher than those previously published. Second, we reviewed the literature on economic models of the cost of emergency care and found that the results are inconclusive and incomplete. As an alternative, we discussed activity-based cost accounting and concluded that it is a promising research methodology for emergency medicine. We conclude by advocating for a strategy to demonstrate the value and strategic importance of emergency medicine rather than minimizing its role in national health care costs. PMID:23623558

  10. Primary care and public emergency department overcrowding.

    PubMed Central

    Grumbach, K; Keane, D; Bindman, A

    1993-01-01

    OBJECTIVES. Our objective was to evaluate whether referral to primary care settings would be clinically appropriate for and acceptable to patients waiting for emergency department care for nonemergency conditions. METHODS. We studied 700 patients waiting for emergency department care at a public hospital. Access to alternative sources of medical care, clinical appropriateness of emergency department use, and patients' willingness to use nonemergency services were measured and compared between patients with and without a regular source of care. RESULTS. Nearly half (45%) of the patients cited access barriers to primary care as their reason for using the emergency department. Only 13% of the patients waiting for care had conditions that were clinically appropriate for emergency department services. Patients with a regular source of care used the emergency department more appropriately than did patients without a regular source of care. Thirty-eight percent of the patients expressed a willingness to trade their emergency department visit for an appointment with a physician within 3 days. CONCLUSIONS. Public emergency departments could refer large numbers of patients to appointments at primary care facilities. This alternative would be viable only if the availability and coordination of primary care services were enhanced for low-income populations. PMID:8438975

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

    PubMed

    Lipp, M

    1993-09-01

    The tasks of preclinical emergency medicine systems (PEMS) are to stabilize and maintain the vital functions and to guarantee qualified transport to the hospital. Worldwide, different structures exist as a result of historical developments. Legal regulations for PEMS have been introduced in most of the industrialized countries since 1960. More and more aspects have been subject to detailed regulations. PEMS are provided either by state-owned or by state-controlled (private) organisations. In most of the "underdeveloped" countries legal regulations do not exist and PEMS is often provided by social workers, by the army or by volunteers. In most countries, PEMS are financed by the state with a charge on the patient. In a few states PEMS are totally financed by the public health structure. Modern PEMS are controlled from dispatch centres which receive emergency calls (mostly by telephone) and send the appropriate rescue unit. In most states the staff of dispatch centres are paramedics; in some countries and in some urban areas physicians control the dispatch centre. In PEMS without physicians on the scene, an information exchange between the scene and the hospital can be observed frequently, in contrast to systems with physicians on the scene. Worldwide, ground-based PEMS are preferred, but in most countries an additional air rescue system has been established. The quality and quantity of the technical equipment of the ground-based PEMS differ widely: nationwide regulations exist, however, in the USA and Germany. Generally, there are two main concepts concerning the personnel structure: PEMS are either physician based or not. Requirements for emergency physicians differ greatly: in some countries no formal requirements exist, in others extensive practical and theoretical training is required.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8214535

  12. Nanotechnology: emerging tools for biology and medicine

    PubMed Central

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

    2013-01-01

    Historically, biomedical research has been based on two paradigms. First, measurements of biological behaviors have been based on bulk assays that average over large populations. Second, these behaviors have then been crudely perturbed by systemic administration of therapeutic treatments. Nanotechnology has the potential to transform these paradigms by enabling exquisite structures comparable in size with biomolecules as well as unprecedented chemical and physical functionality at small length scales. Here, we review nanotechnology-based approaches for precisely measuring and perturbing living systems. Remarkably, nanotechnology can be used to characterize single molecules or cells at extraordinarily high throughput and deliver therapeutic payloads to specific locations as well as exhibit dynamic biomimetic behavior. These advances enable multimodal interfaces that may yield unexpected insights into systems biology as well as new therapeutic strategies for personalized medicine. PMID:24240230

  13. Emergency department overcrowding - implications for paediatric emergency medicine.

    PubMed

    Sinclair, Douglas

    2007-07-01

    Emergency department (ED) overcrowding has been an international phenomenon for more than 10 years. It is important to understand that ED overcrowding is a measure of health system efficiency and is not strictly related to ED volumes or capacity. ED overcrowding is defined as a situation in which the demand for emergency services exceeds the ability of physicians and nurses to provide quality care within a reasonable time. The major factor resulting in ED overcrowding is the presence of admitted patients in the ED for prolonged periods of time, not a high volume of low-acuity patients. While limited data are available for paediatric EDs, winter respiratory illnesses set the stage for ED overcrowding, which are epidemic in adult or general EDs. Prehospital-, ED- and hospital-related factors are described in the present article, and these may help prevent or manage this important patient safety problem. PMID:19030415

  14. Emergency department overcrowding – implications for paediatric emergency medicine

    PubMed Central

    Sinclair, Douglas

    2007-01-01

    Emergency department (ED) overcrowding has been an international phenomenon for more than 10 years. It is important to understand that ED overcrowding is a measure of health system efficiency and is not strictly related to ED volumes or capacity. ED overcrowding is defined as a situation in which the demand for emergency services exceeds the ability of physicians and nurses to provide quality care within a reasonable time. The major factor resulting in ED overcrowding is the presence of admitted patients in the ED for prolonged periods of time, not a high volume of low-acuity patients. While limited data are available for paediatric EDs, winter respiratory illnesses set the stage for ED overcrowding, which are epidemic in adult or general EDs. Prehospital-, ED- and hospital-related factors are described in the present article, and these may help prevent or manage this important patient safety problem. PMID:19030415

  15. The core content of emergency medical services medicine.

    PubMed

    Perina, Debra G; Pons, Peter T; Blackwell, Thomas H; Bogucki, Sandy; Brice, Jane H; Cunningham, Carol A; Delbridge, Theodore R; Gausche-Hill, Marianne; Gerard, William C; Gratton, Matthew C; Mosesso, Vincent N; Pirrallo, Ronald G; Rinnert, Kathy J; Sahni, Ritu; Harvey, Anne L; Kowalenko, Terry; Buckendahl, Chad W; O'Leary, Lisa S; Stokes, Myisha

    2012-01-01

    On September 23, 2010, the American Board of Medical Specialties (ABMS) approved emergency medical services (EMS) as a subspecialty of emergency medicine. As a result, the American Board of Emergency Medicine (ABEM) is planning to award the first certificates in EMS medicine in the fall of 2013. The purpose of subspecialty certification in EMS, as defined by ABEM, is to standardize physician training and qualifications for EMS practice, to improve patient safety and enhance the quality of emergency medical care provided to patients in the prehospital environment, and to facilitate integration of prehospital patient treatment into the continuum of patient care. In February 2011, ABEM established the EMS Examination Task Force to develop the Core Content of EMS Medicine (Core Content) that would be used to define the subspecialty and from which questions would be written for the examinations, to develop a blueprint for the examinations, and to develop a bank of test questions for use on the examinations. The Core Content defines the training parameters, resources, and knowledge of the treatment of prehospital patients necessary to practice EMS medicine. Additionally, it is intended to inform fellowship directors and candidates for certification of the full range of content that might appear on the examinations. This article describes the development of the Core Content and presents the Core Content in its entirety. PMID:22233528

  16. Systems Medicine as an Emerging Tool for Cardiovascular Genetics

    PubMed Central

    Haase, Tina; Börnigen, Daniela; Müller, Christian; Zeller, Tanja

    2016-01-01

    Cardiovascular disease (CVD) is a major contributor to morbidity and mortality worldwide. However, the pathogenesis of CVD is complex and remains elusive. Within the last years, systems medicine has emerged as a novel tool to study the complex genetic, molecular, and physiological interactions leading to diseases. In this review, we provide an overview about the current approaches for systems medicine in CVD. They include bioinformatical and experimental tools such as cell and animal models, omics technologies, network, and pathway analyses. Additionally, we discuss challenges and current literature examples where systems medicine has been successfully applied for the study of CVD. PMID:27626034

  17. Systems Medicine as an Emerging Tool for Cardiovascular Genetics.

    PubMed

    Haase, Tina; Börnigen, Daniela; Müller, Christian; Zeller, Tanja

    2016-01-01

    Cardiovascular disease (CVD) is a major contributor to morbidity and mortality worldwide. However, the pathogenesis of CVD is complex and remains elusive. Within the last years, systems medicine has emerged as a novel tool to study the complex genetic, molecular, and physiological interactions leading to diseases. In this review, we provide an overview about the current approaches for systems medicine in CVD. They include bioinformatical and experimental tools such as cell and animal models, omics technologies, network, and pathway analyses. Additionally, we discuss challenges and current literature examples where systems medicine has been successfully applied for the study of CVD. PMID:27626034

  18. Emerging issues in public health genomics

    PubMed Central

    Roberts, J. Scott

    2014-01-01

    This review highlights emerging areas of interest in public health genomics. First, recent advances in newborn screening (NBS) are described, with a focus on practice and policy implications of current and future efforts to expand NBS programs (e.g., via next-generation sequencing). Next, research findings from the rapidly progressing field of epigenetics and epigenomics are detailed, highlighting ways in which our emerging understanding in these areas could guide future intervention and research efforts in public health. We close by considering various ethical, legal and social issues posed by recent developments in public health genomics; these include policies to regulate access to personal genomic information; the need to enhance genetic literacy in both health professionals and the public; and challenges in ensuring that the benefits (and burdens) from genomic discoveries and applications are equitably distributed. Needs for future genomics research that integrates across basic and social sciences are also noted. PMID:25184533

  19. Emergency medicine in Nepal: present practice and direction for future.

    PubMed

    Pandey, Nishant Raj

    2016-12-01

    Emergency medicine is one of the youngest recognized specialties in Nepal, and its growth in clinical practice and academic development has been challenging. In this paper, we reviewed the current state of emergency medicine in Nepal based on review of the literature, personal observations and experience, and interviews with many Nepali and foreign emergency physicians. Most hospitals in Nepal have adopted a multi-specialist approach, where emergency room physicians are primarily general practitioners/family physicians or house officers. As physicians are receiving their training via various pathways, national standards in training and certification have not been developed. As a result, the scope of practice for emergency physicians and the quality of care vary greatly among hospitals. Difficult working conditions, physician recruitment, compensation, and academic enrichment remain major challenges in the development of emergency medicine. For the sustainable development of this specialty, more international guidance and local leadership is needed to standardize the training curriculum, to provide adequate funding opportunities for academic development and to promote the overall development of the emergency care system. PMID:27416937

  20. Enhancing crisis leadership in public health emergencies.

    PubMed

    Deitchman, Scott

    2013-10-01

    Reviews of public health emergency responses have identified a need for crisis leadership skills in health leaders, but these skills are not routinely taught in public health curricula. To develop criteria for crisis leadership in public health, published sources were reviewed to identify attributes of successful crisis leadership in aviation, public safety, military operations, and mining. These sources were abstracted to identify crisis leadership attributes associated with those disciplines and compare those attributes with crisis leadership challenges in public health. Based on this review, the following attributes are proposed for crisis leadership in public health: competence in public health science; decisiveness with flexibility; ability to maintain situational awareness and provide situational assessment; ability to coordinate diverse participants across very different disciplines; communication skills; and the ability to inspire trust. Of these attributes, only competence in public health science is currently a goal of public health education. Strategies to teach the other proposed attributes of crisis leadership will better prepare public health leaders to meet the challenges of public health crises. PMID:24274133

  1. The Association Between Money and Opinion in Academic Emergency Medicine

    PubMed Central

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

    2010-01-01

    Objectives: Financial conflicts of interest have come under increasing scrutiny in medicine, but their impact has not been quantified. Our objective was to use the results of a national survey of academic emergency medicine (EM) faculty to determine if an association between money and personal opinion exists. Methods: We conducted a web-based survey of EM faculty. Opinion questions were analyzed with regard to whether the respondent had either 1) received research grant money or 2) received money from industry as a speaker, consultant, or advisor. Responses were unweighted, and tests of differences in proportions were made using Chi-squared tests, with p<0.05 set for significance. Results: We received responses from 430 members; 98 (23%) received research grants from industry, while 145 (34%) reported fee-for-service money. Respondents with research money were more likely to be comfortable accepting gifts (40% vs. 29%) and acting as paid consultants (50% vs. 37%). They had a more favorable attitude with regard to societal interactions with industry and felt that industry-sponsored lectures could be fair and unbiased (52% vs. 29%). Faculty with fee-for-service money mirrored those with research money. They were also more likely to believe that industry-sponsored research produces fair and unbiased results (61% vs. 45%) and less likely to believe that honoraria biased speakers (49% vs. 69%). Conclusion: Accepting money for either service or research identified a distinct population defined by their opinions. Faculty engaged in industry-sponsored research benefitted socially (collaborations), academically (publications), and financially from the relationship. PMID:20823958

  2. Emergency medicine systems advancement through community-based development.

    PubMed

    Bloem, Martha M; Bloem, Christina M; Rosentsveyg, Juliana; Arquilla, Bonnie

    2014-02-01

    Humanitarian health programs frequently focus on immediate relief and are supply side oriented or donor driven. More emphasis should be placed on long-term development projects that engage local community leaders to ensure sustainable change in health care systems. With the Emergency Medicine Educational Exchange (EMEDEX) International Rescue, Recover, Rebuild initiative in Northeast Haiti as a model, this paper discusses the opportunities and challenges in using community-based development to establish emergency medical systems in resource-limited settings. PMID:24429185

  3. 1 CFR 17.3 - Criteria for emergency publication.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 1 General Provisions 1 2012-01-01 2012-01-01 false Criteria for emergency publication. 17.3..., AND PROCESSING OF DOCUMENTS FILING FOR PUBLIC INSPECTION AND PUBLICATION SCHEDULES Emergency Schedule § 17.3 Criteria for emergency publication. The emergency schedule is designed to provide the...

  4. 1 CFR 17.3 - Criteria for emergency publication.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 1 General Provisions 1 2014-01-01 2012-01-01 true Criteria for emergency publication. 17.3 Section..., AND PROCESSING OF DOCUMENTS FILING FOR PUBLIC INSPECTION AND PUBLICATION SCHEDULES Emergency Schedule § 17.3 Criteria for emergency publication. The emergency schedule is designed to provide the...

  5. 1 CFR 17.3 - Criteria for emergency publication.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 1 General Provisions 1 2010-01-01 2010-01-01 false Criteria for emergency publication. 17.3..., AND PROCESSING OF DOCUMENTS FILING FOR PUBLIC INSPECTION AND PUBLICATION SCHEDULES Emergency Schedule § 17.3 Criteria for emergency publication. The emergency schedule is designed to provide the...

  6. 1 CFR 17.3 - Criteria for emergency publication.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 1 General Provisions 1 2013-01-01 2012-01-01 true Criteria for emergency publication. 17.3 Section..., AND PROCESSING OF DOCUMENTS FILING FOR PUBLIC INSPECTION AND PUBLICATION SCHEDULES Emergency Schedule § 17.3 Criteria for emergency publication. The emergency schedule is designed to provide the...

  7. An eMERGE Clinical Center at Partners Personalized Medicine

    PubMed Central

    Smoller, Jordan W.; Karlson, Elizabeth W.; Green, Robert C.; Kathiresan, Sekar; MacArthur, Daniel G.; Talkowski, Michael E.; Murphy, Shawn N.; Weiss, Scott T.

    2016-01-01

    The integration of electronic medical records (EMRs) and genomic research has become a major component of efforts to advance personalized and precision medicine. The Electronic Medical Records and Genomics (eMERGE) network, initiated in 2007, is an NIH-funded consortium devoted to genomic discovery and implementation research by leveraging biorepositories linked to EMRs. In its most recent phase, eMERGE III, the network is focused on facilitating implementation of genomic medicine by detecting and disclosing rare pathogenic variants in clinically relevant genes. Partners Personalized Medicine (PPM) is a center dedicated to translating personalized medicine into clinical practice within Partners HealthCare. One component of the PPM is the Partners Healthcare Biobank, a biorepository comprising broadly consented DNA samples linked to the Partners longitudinal EMR. In 2015, PPM joined the eMERGE Phase III network. Here we describe the elements of the eMERGE clinical center at PPM, including plans for genomic discovery using EMR phenotypes, evaluation of rare variant penetrance and pleiotropy, and a novel randomized trial of the impact of returning genetic results to patients and clinicians. PMID:26805891

  8. A first survey. Measuring burnout in emergency medicine physician assistants.

    PubMed

    Bell, Robert B; Davison, Meredith; Sefcik, Donald

    2002-03-01

    Using the Maslach Burnout Inventory (a device used in prior studies on emergency physicians) and the EMPA Demographic, Work, and Lifestyle Characteristics Survey, we assessed the burnout levels of emergency medicine physician assistants (EMPAs) and the presence of characteristics associated with higher burnout levels. Fifty-nine percent had moderate or high burnout levels on the Emotional Exhaustion subscale; 66% on the Depersonalization subscale; and only 34% on the Personal Accomplishment subscale. Several associations were found between EMPA burnout and individual characteristics, including insomnia and low satisfaction with physician supervision. Similarities were noted with regard to burnout among EMPAs and emergency physicians. PMID:11949543

  9. Analysis of Publication Output of Internal Medicine Faculty Members.

    ERIC Educational Resources Information Center

    Manu, Peter; And Others

    1985-01-01

    The number of publications per year produced by a department of internal medicine faculty is analyzed. Publication output was correlated with sectional organization of a department of medicine, the location of faculty assignment, the age of the faculty member, and the change of career goals. (Author/MLW)

  10. Building a resident research program in emergency medicine.

    PubMed

    Nocera, Romy; Ramoska, Edward Anthony; Hamilton, Richard Joseph

    2016-03-01

    Residency training programs requirements state, "Residents should participate in scholarly activity." However, there is little consensus regarding how best to achieve these requirements. The objective of this study is to implement a resident research program that emphasizes resident participation in quantitative or qualitative empirical work. A three-step program "Think, Do, Write" roughly follows the 3 years of the residency. During the first phase, the resident chooses a topic, formulates a hypothesis, and completes standard research certifications. Phase 2 involves obtaining Institutional Review Board approval, and conducting the study. The final phase entails analyzing and interpreting the data, and writing an abstract to present during an annual research day. Residents are encouraged to submit their projects for presentation at scientific conferences and for publication. Multiple departmental resources are available, including a Resident Research Fund, and full support of the faculty. Prior to the new program, most scholarly activity consisted of case reports, book chapters, review articles, or other miscellaneous projects; only 27 % represented empirical studies. Starting in 2012, the new program was fully implemented, resulting in notable growth in original empirical works among residents. Currently there is almost 100 % participation in studies, and numerous residents have presented at national conferences, and have peer-reviewed publications. With a comprehensive and supported program in place, emergency medicine residents proved capable of conducting high-quality empirical research within their relatively limited time. Overall, residents developed valuable skills in research design and statistical analysis, and greatly increased their productivity as academic and clinical researchers. PMID:26597875

  11. Multicenter pediatric emergency medicine research and Rhode Island.

    PubMed

    Chun, Thomas H

    2014-01-01

    Multicenter clinical research studies are often needed to address issues of generalizability, conditions with low incidence, adequate statistical power, and potential study bias. While pediatric research networks began work in the 1950s, and Rhode Island physicians have contributed to many of these studies, pediatric emergency medicine (PEM) collaboratives are relative newcomers. Since the mid-1990s, Rhode Island pediatricians have contributed to multicenter studies of diabetic ketoacidosis, bronchiolitis, asthma, quality of PEM care, meningitis, brief interventions for substance use disorders, point-of-care ultrasound, and pre-hospital triage protocols. In 2011, Rhode Island Hospital joined the Pediatric Emergency Care Applied Research Network, the first federally funded pediatric emergency medicine network of its kind. Its mission is to perform high quality, high impact PEM research. Since joining the network, Rhode Island Hospital has quickly become a productive and valued member of the network, portending a bright future for multicenter PEM research in the Ocean State. PMID:24400311

  12. Preliminary elaboration on emergent properties of traditional Chinese medicine.

    PubMed

    Chai, Xing-yun

    2015-07-01

    Plant and animal derived secondary metabolites are the result of initiative and adaptability of natural evolution due to its adaptive stress responses. Based on countless attempts, rational thinking and thousands of years of clinical practice by ancient Chinese, the medicines were endowed with advantages for the treatment of diseases and keeping health balance through multiple components combination instead of single components, featured by a complex system with emergent properties. The emergence of traditional Chinese medicine is because of the integration of various components and its complex interactions. How to obtain the new multicomponent entities with the biological equivalent effect is an important and fundamental work for TCM-based new drug research and development. Currently, recognition of TCM emergence and development of related technical methods needs strengthened, and the understanding and research of TCM require a systematic integration of the holistic and reductive methods. PMID:26697666

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

    PubMed

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

    2016-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  15. [PUBLIC MEDICINE AND RESEARCH-- IMPORTANT AND CHALLENGING].

    PubMed

    Pillar, Giora; Shapira, Chen

    2015-06-01

    Fellows who travel to the US are familiar with the American concept of combining clinical medicine and research. Research activity enforces reading, being updated, thinking creatively initiating, opening horizons, and being in contact with researchers all over the world. Thus, performing research is advantageous not only for research itself, the public, the patients and the knowledge, but also for the development of the researcher, the hospital, and the academic institute with which the hospital is affiliated. However, given the huge clinical workload and obligations, along with the shortage of physicians, the time consuming nature of research activity and the difficulties in obtaining research funds, it is certainly not obvious that clinicians can manage to conduct research and publish it. Decision makers, policy determinants and the individual drive to academic progress, encourage research activity by physicians, albeit the external support is commonly theoretical and moral, and is not commonly combined with time or appropriate resource allocation. In the current issue of "Harefuah", physicians from the Lady Davis Carmel Medical Center publish their own research and review articles. The hospital is the second largest in the Haifa region, providing services to a population of over a million people. The manuscripts reflect only a small sample of the research and clinical activities of the hospital. PMID:26281075

  16. A transatlantic comparison of training in emergency medicine.

    PubMed Central

    Wyatt, J P; Weber, J E

    1998-01-01

    The system of training in accident and emergency (A&E) medicine in the United Kingdom is at a critical and much earlier stage of development than in the United States. Transatlantic comparison offers the opportunity to explore possible ways of improving training in the United Kingdom. Comparison revealed deficiencies in the UK training system in the following: prehospital care training, formal theoretical teaching, close supervision in a clinical setting, and in-service training examinations. Implementation of measures designed to address these deficiencies would enhance UK training in A&E medicine. PMID:9639180

  17. Reconstructing data: evidence-based medicine and evidence-based public health in context.

    PubMed

    Nadav, Davidovitch; Dani, Filc

    2006-01-01

    The emergence of Evidence-Based Medicine (EBM) as the gold-standard practice in biomedicine and public health practices represents a significant epistemological turn in modern medicine. The development of Evidence-Based Public Health (EBPH) followed the emergence of Evidence-Based Medicine, as an attempt to ground health policies and interventions on "sound facts". The present paper analyzes the historical and sociological roots of this turn. We evaluate the ethical and social consequences of this transformation, both within the medical profession (the polarization between a medical elite which strengthened its professional status, and a rank and file which experienced a process of "de-professionalization") and in its relationship to the welfare state (the link between the medical elite, EBM, EBPH and the commodification of health care and public health). PMID:17214142

  18. Infant Trauma Management in the Emergency Department: An Emergency Medicine Simulation Exercise

    PubMed Central

    Mathieson, Sarah; Whalen, Desmond

    2015-01-01

    In a trauma situation, it is essential that emergency room physicians are able to think clearly, make decisions quickly and manage patients in a way consistent with their injuries. In order for emergency medicine residents to adequately develop the skills to deal with trauma situations, it is imperative that they have the opportunity to experience such scenarios in a controlled environment with aptly timed feedback. In the case of infant trauma, sensitivities have to be taken that are specific to pediatric medicine. The following describes a simulation session in which trainees were tasked with managing an infantile patient who had experienced a major trauma as a result of a single vehicle accident. The described simulation session utilized human patient simulators and was tailored to junior (year 1 and 2) emergency medicine residents. PMID:26487992

  19. Infant Trauma Management in the Emergency Department: An Emergency Medicine Simulation Exercise.

    PubMed

    Mathieson, Sarah; Whalen, Desmond; Dubrowski, Adam

    2015-01-01

    In a trauma situation, it is essential that emergency room physicians are able to think clearly, make decisions quickly and manage patients in a way consistent with their injuries. In order for emergency medicine residents to adequately develop the skills to deal with trauma situations, it is imperative that they have the opportunity to experience such scenarios in a controlled environment with aptly timed feedback. In the case of infant trauma, sensitivities have to be taken that are specific to pediatric medicine. The following describes a simulation session in which trainees were tasked with managing an infantile patient who had experienced a major trauma as a result of a single vehicle accident. The described simulation session utilized human patient simulators and was tailored to junior (year 1 and 2) emergency medicine residents. PMID:26487992

  20. Point-of-care ultrasonography by pediatric emergency medicine physicians.

    PubMed

    Marin, Jennifer R; Lewiss, Resa E

    2015-04-01

    Emergency physicians have used point-of-care ultrasonography since the 1990 s. Pediatric emergency medicine physicians have more recently adopted this technology. Point-of-care ultrasonography is used for various scenarios, particularly the evaluation of soft tissue infections or blunt abdominal trauma and procedural guidance. To date, there are no published statements from national organizations specifically for pediatric emergency physicians describing the incorporation of point-of-care ultrasonography into their practice. This document outlines how pediatric emergency departments may establish a formal point-of-care ultrasonography program. This task includes appointing leaders with expertise in point-of-care ultrasonography, effectively training and credentialing physicians in the department, and providing ongoing quality assurance reviews. PMID:25825532

  1. Regionalization findings in the national report card of the state of emergency medicine.

    PubMed

    Epstein, Stephen K

    2010-12-01

    The National Report Card on the State of Emergency Medicine (2009 edition) evaluated the conditions under which emergency care is delivered in each of the 50 states and compared those conditions between the states. The Report Card ranked states in five major categories: access to emergency care, quality and patient safety environment, public health and injury prevention, liability environment, and disaster preparedness. Three of those categories are particularly relevant to regionalization: access to emergency care, quality and patient safety environment, and disaster-preparedness. Within these categories, there was great variability between states in the distribution, planning, infrastructure, and available personnel for emergency care. Effective regionalization may require additional resources or a redistribution of existing resources within and among the states. PMID:21122018

  2. Getting back into the emergency department: diversifying general practice while relieving emergency medicine workforce shortages.

    PubMed

    Willcock, Simon M

    2008-07-21

    New medical graduates expect to work in an environment that allows scope for flexibility and change across a career in medicine. Recruitment to general practice is adversely affected by its perceived limited scope of practice. Training in procedural and hospital skills is not difficult to access for general practice trainees, but complex and inconsistent credentialling criteria and protectionist attitudes among some specialist colleges mean that many skilled general practitioners are unable to utilise the full range of their skills in clinical practice. The discipline of emergency medicine is also experiencing difficulty in recruiting trainees. The employment of skilled GPs in emergency departments (including metropolitan departments) could improve vocational satisfaction for GPs and emergency physicians, and possibly also improve patient outcomes and flow through the emergency department. PMID:18637784

  3. Obstetric training in Emergency Medicine: a needs assessment

    PubMed Central

    Janicki, Adam James; MacKuen, Courteney; Hauspurg, Alisse; Cohn, Jamieson

    2016-01-01

    Background Identification and management of obstetric emergencies is essential in emergency medicine (EM), but exposure to pregnant patients during EM residency training is frequently limited. To date, there is little data describing effective ways to teach residents this material. Current guidelines require completion of 2 weeks of obstetrics or 10 vaginal deliveries, but it is unclear whether this instills competency. Methods We created a 15-item survey evaluating resident confidence and knowledge related to obstetric emergencies. To assess confidence, we asked residents about their exposure and comfort level regarding obstetric emergencies and eight common presentations and procedures. We assessed knowledge via multiple-choice questions addressing common obstetric presentations, pelvic ultrasound image, and cardiotocography interpretation. The survey was distributed to residency programs utilizing the Council of Emergency Medicine Residency Directors (CORD) listserv. Results The survey was completed by 212 residents, representing 55 of 204 (27%) programs belonging to CORD and 11.2% of 1,896 eligible residents. Fifty-six percent felt they had adequate exposure to obstetric emergencies. The overall comfort level was 2.99 (1–5 scale) and comfort levels of specific presentations and procedures ranged from 2.58 to 3.97; all increased moderately with postgraduate year (PGY) level. Mean overall percentage of items answered correctly on the multiple-choice questions was 58% with no statistical difference by PGY level. Performance on individual questions did not differ by PGY level. Conclusions The identification and management of obstetric emergencies is the cornerstone of EM. We found preliminary evidence of a concerning lack of resident comfort regarding obstetric conditions and knowledge deficits on core obstetrics topics. EM residents may benefit from educational interventions to increase exposure to these topics. PMID:27357908

  4. Global emergency medicine journal club: social media responses to the January 2014 online emergency medicine journal club on subarachnoid hemorrhage.

    PubMed

    Chan, Teresa M; Rosenberg, Hans; Lin, Michelle

    2014-07-01

    From January 20 to 24, 2014, Annals continued a successful collaboration with an academic Web site, Academic Life in Emergency Medicine (ALiEM), to host another Global Emergency Medicine Journal Club session featuring the 2013 Journal of the American Medical Association article "Clinical Decision Rules to Rule Out Subarachnoid Hemorrhage for Acute Headache" by Perry et al. This online journal club used the power of rapid Twitter conversations, a live videocast with the authors, and more detailed discussions hosted on the ALiEM Web site's comment section. There were more than 1,431 individuals from 501 cities in 59 countries who viewed the blog post. During this 5-day event, 28 comments (average word count 153 words) and 206 tweets were made. This summary article details the community discussion, shared insights, and analytic data generated during this novel, multiplatform approach. PMID:24951414

  5. [Supraglottic airway devices in emergency medicine : impact of gastric drainage].

    PubMed

    Mann, V; Mann, S T; Alejandre-Lafont, E; Röhrig, R; Weigand, M A; Müller, M

    2013-04-01

    This case report describes a life-saving use of a supraglottic airway device (LT-D™-Larynxtubus, VBM Medizintechnik, Sulz, Germany) in an out-of-hospital emergency patient suffering from severe traumatic brain injury. Mechanical ventilation with the laryngeal tube was complicated by repeated airway obstructions and pronounced gastric distension with air as a consequence of oropharyngeal leakage. In this situation pulmonary ventilation of the patient was compromised so that emergency endotracheal intubation became necessary in the resuscitation area with vital indications. In this context the status of supraglottic airway devices in emergency medicine is discussed as well as the reasons for the gastric distension. Besides the immediate drastic consequences of gastric distension with respect to pulmonary ventilation, potential deleterious non-pulmonary consequences of this complication are highlighted. The clinical relevance of the described complications as well as the associated possibility of an optimized position control necessitate the recommendation only to use second generation supraglottic airway devices with integrated gastric access in (out-of-hospital) emergency medicine. PMID:23494024

  6. Refining the Enrolment Process in Emergency Medicine Research

    PubMed Central

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

    2016-01-01

    Research in the emergency setting involving patients with acute clinical conditions is needed if there are to be advances in diagnosis and treatment. But research in these areas poses ethical and practical challenges. One of these is the general inability to obtain informed consent due to the patient’s lack of mental capacity and insufficient time to contact legal representatives. Regulatory frameworks which allow this research to proceed with a consent ‘waiver’, provided patients lack mental capacity, miss important ethical subtleties. One of these is the varying nature of mental capacity among emergency medicine patients. Not only is their capacity variable and often unclear, but some patients are also likely to be able to engage with the researcher and the context to varying degrees. In this paper we describe the key elements of a novel enrolment process for emergency medicine research that refines the consent waiver and fully engages with the ethical rationale for consent and, in this context, its waiver. The process is verbal but independently documented during the ‘emergent’ stages of the research. It provides appropriate engagement with the patient, is context-sensitive and better addresses ethical subtleties. In line with regulation, full written consent for on-going participation in the research is obtained once the emergency is passed. PMID:27499840

  7. Acute pain management curriculum for emergency medicine residency programs.

    PubMed

    Motov, Sergey M; Marshall, John P

    2011-10-01

    Pain is the most common reason people visit emergency departments (EDs); this implies that emergency physicians (EPs) should be experts in managing acute painful conditions. The current trend in the literature, however, demonstrates that EPs possess inadequate knowledge and lack formal training in acute pain management. The purpose of this article is to create a formal educational curriculum that would assist emergency medicine (EM) residents in proper assessment and treatment of acute pain, as well as in providing a solid theoretical and practical knowledge base for managing acute pain in the ED. The authors propose a series of lectures, case-oriented study groups, practical small group sessions, and class-specific didactics with the goal of enhancing the theoretical and practical knowledge of acute pain management in the ED. PMID:21692900

  8. Biodiversity, traditional medicine and public health: where do they meet?

    PubMed Central

    2007-01-01

    Given the increased use of traditional medicines, possibilities that would ensure its successful integration into a public health framework should be explored. This paper discusses some of the links between biodiversity and traditional medicine, and addresses their implications to public health. We explore the importance of biodiversity and ecosystem services to global and human health, the risks which human impacts on ecosystems and biodiversity present to human health and welfare. PMID:17376227

  9. Citizens' perspectives on personalized medicine: a qualitative public deliberation study.

    PubMed

    Bombard, Yvonne; Abelson, Julia; Simeonov, Dorina; Gauvin, Francois-Pierre

    2013-11-01

    Our objective was to explore citizens' informed and reasoned values and expectations of personalized medicine, a timely yet novel genomics policy issue. A qualitative, public deliberation study was undertaken using a citizens' reference panel on health technologies, established to provide input to the health technology assessment process in Ontario, Canada. The citizens' panel consisted of five women and nine men, aged 18-71 years, with one member selected from each health authority region. There were shared expectations among the citizens' panel members for the potential of personalized medicine technologies to improve care, provided they are deemed clinically valid and effective. These expectations were tempered by concerns about value for money and the possibility that access to treatment may be limited by personalized medicine tests used to stratify patients. Although they questioned the presumed technological imperative presented by personalized medicine technologies, they called for increased efforts to prepare the health-care system to effectively integrate these technologies. This study represents an early but important effort to explore public values toward personalized medicine. This study also provides evidence of the public's ability to form coherent judgments about a new policy issue. Concerned that personalized tests might be used to ration care, they suggested that treatment should be made available if patients wanted it, irrespective of tests that indicate little benefit. This issue raises clinical and policy challenges that may undermine the value of personalized medicine. Further efforts to deliberate with the public are warranted to inform effective, efficient and equitable translation of personalized medicine. PMID:23340511

  10. Post‐war development of emergency medicine in Kosovo

    PubMed Central

    O'Hanlon, K P

    2007-01-01

    Objectives To (1) investigate emergency medical care priorities in Kosovo, (2) assess Kosovo's post‐war development of emergency medical services and (3) identify expectations. Methods An instrument with seven open‐ended questions, approved by the institutional review board, was designed for in‐person interviews (preferred) or written survey. The survey was administered in October 2003 at the Kosovo University Clinical Center, Pristina, Kosovo, and one regional hospital. Targeted participants were emergency care providers, clinical consultants and health policy consultants. Surveys were conducted by interview with simultaneous interpretation by a native Albanian speaker, an orthopaedic surgeon or in written Albanian form. The responses were evaluated quantitatively and qualitatively. Results 13 respondents participated in the study: 10 gave interviews and 3 provided written response; 7 were emergency care providers, 4 were emergency care consultants and 2 were health policy consultants. Emergency care priorities were defined as trauma, cardiac disease and suicide. Most respondents believed that emergency medicine as a specialised field was a post‐war development. The international community was credited with the provision of infrastructure, supplies and training. Most respondents denied any harm from international assistance. However, some respondents described instances of inappropriate international investment. Ongoing needs are training of providers and equipping of facilities and vehicles. Improved hospital management, political administration and international involvement are thought to be necessary for continued development. Conclusions Survey respondents agreed on priorities in emergency care, credited the international community with development to date, and identified administrative structures and international training support as the keys to ongoing development. PMID:17183036

  11. The emergence of trust in clinics of alternative medicine.

    PubMed

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

    2016-01-01

    Demands for alternative medicine have increased since the 1970s in nations in which western scientific evidence has become the basis for health care. This paradox has been the impetus to examine how trust emerges in clinics of alternative medicine. Alternative practitioners are self-regulated and the clients pay out of their own pockets to attend non-authorised treatments with very limited scientific evidence of their effects. Trust is a key issue in this context. However, only a few studies have dealt with the ways in which alternative practitioners win their clients' trust. Drawing on three qualitative studies and informing the empirical findings with a sociological concept of trust, this article provides new empirical insights on how trust emerges in Danish clinics of acupuncture, reflexology and homeopathy. The analysis demonstrates how trust is situational and emerges through both clients' susceptibility and practitioners' individual skill development and strategies, as well as from objects, place and space. Trust is developed on relational and bodily as well as material grounds. It is argued that the dynamics and elements of trust identified do not only minimalise uncertainties but sometimes convert these uncertainties into productive new ways for clients to address their ailments, life circumstances and perspectives. PMID:26403077

  12. Patient and public involvement in emergency care research.

    PubMed

    Hirst, Enid; Irving, Andy; Goodacre, Steve

    2016-09-01

    Patients participate in emergency care research and are the intended beneficiaries of research findings. The public provide substantial funding for research through taxation and charitable donations. If we do research to benefit patients and the public are funding the research, then patients and the public should be involved in the planning, prioritisation, design, conduct and oversight of research, yet patient and public involvement (or more simply, public involvement, since patients are also members of the public) has only recently developed in emergency care research. In this article, we describe what public involvement is and how it can help emergency care research. We use the development of a pioneering public involvement group in emergency care, the Sheffield Emergency Care Forum, to provide insights into the potential and challenges of public involvement in emergency care research. PMID:27044949

  13. Emerging applications of metabolomics in drug discovery and precision medicine.

    PubMed

    Wishart, David S

    2016-07-01

    Metabolomics is an emerging 'omics' science involving the comprehensive characterization of metabolites and metabolism in biological systems. Recent advances in metabolomics technologies are leading to a growing number of mainstream biomedical applications. In particular, metabolomics is increasingly being used to diagnose disease, understand disease mechanisms, identify novel drug targets, customize drug treatments and monitor therapeutic outcomes. This Review discusses some of the latest technological advances in metabolomics, focusing on the application of metabolomics towards uncovering the underlying causes of complex diseases (such as atherosclerosis, cancer and diabetes), the growing role of metabolomics in drug discovery and its potential effect on precision medicine. PMID:26965202

  14. Quality in paediatric emergency medicine: Measurement and reporting.

    PubMed

    Borland, Meredith L; Shepherd, Mike

    2016-02-01

    There is a clear demand for quality in the delivery of health care around the world; paediatric emergency medicine is no exception to this movement. It has been identified that gaps exist in the quality of acute care provided to children. Regulatory bodies in Australia and New Zealand are moving to mandate the implementation of quality targets and measures. Within the paediatric emergency department (ED), there is a lack of research into paediatric specific indicators. The existing literature regarding paediatric acute care quality measures has been recently summarised, and expert consensus has now been reported. It is clear that there is much work to be performed to generalise this work to ED. We review suggestions from the current literature relating to feasible indicators within the paediatric acute care setting. We propose options to develop a quality 'scorecard' that could be used to assist Australian and New Zealand EDs with quality measurement and benchmarking for their paediatric patients. PMID:27062615

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

    PubMed

    Holmboe, Eric S

    2015-11-01

    Emergency medicine (EM) has always been on the frontlines of healthcare in the United States. I experienced this reality first hand as a young general medical officer assigned to an emergency department (ED) in a small naval hospital in the 1980s. For decades the ED has been the only site where patients could not be legally denied care. Despite increased insurance coverage for millions of Americans as a result of the Affordable Care Act, ED directors report an increase in patient volumes in a recent survey.1 EDs care for patients from across the socioeconomic spectrum suffering from a wide range of clinical conditions. As a result, the ED is still one of few components of the American healthcare system where social justice is enacted on a regular basis. Constant turbulence in the healthcare system, major changes in healthcare delivery, technological advances and shifting demographic trends necessitate that EM constantly adapt and evolve as a discipline in this complex environment. PMID:26594269

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

    PubMed

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

    2016-06-01

    Value in emergency medicine is determined by both patient-important outcomes and the costs associated with achieving them. However, measuring true costs is challenging. Without an understanding of costs, emergency department (ED) leaders will be unable to determine which interventions might improve value for their patients. Although ongoing research may determine which outcomes are meaningful, an accurate costing system is also needed. This article reviews current costing mechanisms in the ED and their pitfalls. It then describes how time-driven activity-based costing may be superior to these current costing systems. Time-driven activity-based costing, in addition to being a more accurate costing system, can be used for process improvements in the ED. PMID:26365921

  17. Information technology model for evaluating emergency medicine teaching

    NASA Astrophysics Data System (ADS)

    Vorbach, James; Ryan, James

    1996-02-01

    This paper describes work in progress to develop an Information Technology (IT) model and supporting information system for the evaluation of clinical teaching in the Emergency Medicine (EM) Department of North Shore University Hospital. In the academic hospital setting student physicians, i.e. residents, and faculty function daily in their dual roles as teachers and students respectively, and as health care providers. Databases exist that are used to evaluate both groups in either academic or clinical performance, but rarely has this information been integrated to analyze the relationship between academic performance and the ability to care for patients. The goal of the IT model is to improve the quality of teaching of EM physicians by enabling the development of integrable metrics for faculty and resident evaluation. The IT model will include (1) methods for tracking residents in order to develop experimental databases; (2) methods to integrate lecture evaluation, clinical performance, resident evaluation, and quality assurance databases; and (3) a patient flow system to monitor patient rooms and the waiting area in the Emergency Medicine Department, to record and display status of medical orders, and to collect data for analyses.

  18. Human rights, public health and medicinal cannabis use

    PubMed Central

    Bone, Melissa; Seddon, Toby

    2016-01-01

    This paper explores the interplay between the human rights and drug control frameworks and critiques case law on medicinal cannabis use to demonstrate that a bona fide human rights perspective allows for a broader conception of ‘health’. This broad conception, encompassing both medicalised and social constructionist definitions, can inform public health policies relating to medicinal cannabis use. The paper also demonstrates how a human rights lens can alleviate a core tension between the State and the individual within the drug policy field. The leading medicinal cannabis case in the UK highlights the judiciary’s failure to engage with an individual’s human right to health as they adopt an arbitrary, externalist view, focussing on the legality of cannabis to the exclusion of other concerns. Drawing on some international comparisons, the paper considers how a human rights perspective can lead to an approach to medicinal cannabis use which facilitates a holistic understanding of public health. PMID:26692654

  19. Medicines management in the Philippine public sector during the response to Haiyan

    PubMed Central

    Robles, Yolanda; Loquias, Monet; Capule, Francis; Guerrero, Anna Melissa

    2015-01-01

    Introduction Health service delivery in the Philippines is constantly challenged by disasters and emergencies. This descriptive study documented existing policies for medicines management in the Philippines and then assessed these in the public sector response post-Haiyan. Method We used desk a review of existing laws, regulations and related issuances and a series of interviews of key informants from various national and local health agencies. Results We found that while numerous national policies covered critical aspects of medicines management, implementation post-Haiyan was problematic at all levels of the decentralized health-care system. We identified issues of quantification, warehousing, distribution, utilization monitoring and disposal. Donated medicines also added additional burden for storage and disposal, especially for expired and unwanted medicines. Discussion While the process of managing medicines during disasters did not differ greatly from non-emergency situations, the Haiyan experience highlighted the system’s weaknesses. With the current gaps in implementation, as well as the logistical obstacles brought about by disasters, there is a need to have integrated mechanisms for medicines management in the Philippines. This assessment provided an important opportunity to review the medicines management policies at national and local levels. PMID:26767142

  20. Afterword: elaborating health and medicine's publics.

    PubMed

    Scott, J Blake

    2014-06-01

    This essay argues that medical and health humanists interested in the rhetorical work of publics can extend their research by attending to embodiment and infrastructure. In addition to discussing how such strategies are illustrated in the essays appearing in this special issue, I relate them to the rhetorical study of personal health records (PHRs) as described in consumer-directed arguments. I conclude by posing two questions to health and medical humanists: "How do discursive constructions of publics and more specific instantiations of embodied experiences mutually shape each other?" and "What do the infrastructures of health and medical users look like and involve in their enactment?" PMID:24748109

  1. Emergency Department Performance Indexes Before and After Establishment of Emergency Medicine

    PubMed Central

    Hashemi, Behrooz; Baratloo, Alireza; Rahmati, Farhad; Forouzanfar, Mohammad Mehdi; Motamedi, Maryam; Safari, Saeed

    2013-01-01

    Introduction: Emergency department performance index (EPI) greatly influences the function of other hospital’s units and patient satisfaction. Recently, the Iranian Ministry of Health has defined specific national EPI containing five indexes. In the present study the performance indexes of emergency department (ED) in one educational hospital has been assessed before and after establishment of emergency medicine. Methods: In the present cross-sectional study the ED of Shohadaye Tajrish Hospital, Tehran, Iran was assessed during one-year period from March 2012 to February 2013. The study was divided into two six-month periods of before and after establishment of emergency medicine. Five performance indexes including: the percentage of patients were disposed during 6-hour, leaved the ED in a 12-hour, had unsuccessful cardiopulmonary resuscitations (CPR), discharged against medical advice, and the mean time of triage were calculated using data of department of medical records on daily patients’ files. Then, Mann-Whitney U test was used to make comparisons at P<0.05. Results: The average triage time decreased from 6.04 minutes in the first six months to 1.5 minutes in the second six months (P=0.06). The percentage of patients leaving the ED in a 12-hour decreased from 97.3% to 90.4% (P=0.004). However, the percentage of disposed patients during 6-hour (P=0.2), unsuccessful CPR (P=0.34) and discharged against medical advice (P=0.42) did not differ between the two periods. Conclusion: It seems that establishment of emergency medicine could be able to improve ED performances indexes such as time to triage and leave in a 12-hour period. PMID:26495331

  2. Emergency Medicine in Guyana: Lessons from Developing the Country’s First Degree-conferring Residency Program

    PubMed Central

    Forget, Nicolas P.; Rohde, John Paul; Rambaran, Navindranauth; Rambaran, Madan; Wright, Seth W.

    2013-01-01

    Introduction: Academic departments of emergency medicine are becoming increasingly involved in assisting with the development of long-term emergency medicine training programs in low and middle-income countries. This article presents our 10-year experience working with local partners to improve emergency medical care education in Guyana. Methods: The Vanderbilt Department of Emergency Medicine has collaborated with the Georgetown Public Hospital Corporation on the development of Emergency Medicine skills followed by the implementation of an emergency medicine residency training program. Residency development included a needs assessment, proposed curriculum, internal and external partnerships, University of Guyana and Ministry of Health approval, and funding. Results: In our experience, we have found that our successful program initiation was due in large part to the pre-existing interest of several local partners and followed by long-term involvement within the country. As a newer specialty without significant local expertise, resident educational needs mandated a locally present full time EM trained attending to serve as the program director. Both external and internal funding was required to achieve this goal. Local educational efforts were best supplemented by robust distance learning. The program was developed to conform to local academic standards and to train the residents to the level of consultant physicians. Despite the best preparations, future challenges remain. Conclusion: While every program has unique challenges, it is likely many of the issues we have faced are generalizable to other settings and will be useful to other programs considering or currently conducting this type of collaborative project. PMID:24106546

  3. The Role of Patients' Stories in Emergency Medicine Triage.

    PubMed

    Roscoe, Lori A; Eisenberg, Eric M; Forde, Colin

    2016-09-01

    Emergency medicine is a communicative activity, and characteristics such as incomplete information, time pressure, and the potentially serious consequences of errors complicate effective communication and decision making. The present study examined the triage process as an interpretive activity driven in part by the patient's story. Of four identified communication processes in the emergency department (ED), the "handoff" of patients between shifts has been identified as especially problematic since missing contextual details from patients' stories increased the probability of errors. The problematic nature of patient handoffs led to our interest in triage, the initial site of interpretation and decision making. Triage distinguishes patients with emergent medical conditions requiring immediate care from those who can more safely wait for medical attention. We report results from 110 hours of observing the triage process and semistructured interviews with 16 triage nurses in a Level I Trauma Center in an urban teaching hospital in the southeastern United States. Field notes and interview transcripts were analyzed and coded to explore decision rules and information sources used in triage decision making. Triage nurses generally discounted patients' stories in favor of information from visual cues and vital signs. Patients' stories tended to influence the triage process only in certain cases when the story contained information that was not readily apparent, such as a recent organ transplant. Triage nurses' reliance on "gut feeling," however, might be a kind of narrative sense-making that combines observable and measurable clinical facts with the narrative competence to utilize intuition and past experience. PMID:26882466

  4. Public health in the emergency department: surveillance, screening, and intervention--funding and sustainability.

    PubMed

    Woolard, Robert; Degutis, Linda C; Mello, Michael; Rothman, Richard; Cherpitel, Cheryl J; Post, Lori A; Hirshon, Jon Mark; Haukoos, Jason S; Hungerford, Daniel W

    2009-11-01

    This article summarizes the work and discussions of the funding and sustainability work group at the 2009 Academic Emergency Medicine consensus conference "Public Health in the ED: Surveillance, Screening, and Intervention." The funding and sustainability session participants were asked to address the following overarching question: "What are the opportunities and what is needed to encourage academic emergency medicine (EM) to take advantage of the opportunities for funding available for public health research initiatives and build stronger academic programs focusing on public health within EM?" Prior to the session, members of the group reviewed research funding for EM in public health, as well as the priorities of federal agencies and foundations. Recommendations for actions by EM summarize the findings of workshop. PMID:20053234

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

    PubMed

    Sherbino, Jonathan

    2015-11-01

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

  6. Targeted temperature management in emergency medicine: current perspectives

    PubMed Central

    Hunter, Benton R; Ellender, Timothy J

    2015-01-01

    Landmark trials in 2002 showed that therapeutic hypothermia (TH) after out-of-hospital cardiac arrest due to ventricular tachycardia or ventricular fibrillation resulted in improved likelihood of good neurologic recovery compared to standard care without TH. Since that time, TH has been frequently instituted in a wide range of cardiac arrest patients regardless of initial heart rhythm. Recent evidence has evaluated how, when, and to what degree TH should be instituted in cardiac arrest victims. We outline early evidence, as well as recent trials, regarding the use of TH or targeted temperature management in these patients. We also provide evidence-based suggestions for the institution of targeted temperature management/TH in a variety of emergency medicine settings. PMID:27147892

  7. Education Scholarship and its Impact on Emergency Medicine Education

    PubMed Central

    Sherbino, Jonathan

    2015-01-01

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

  8. Potential and limitations of e-learning in emergency medicine.

    PubMed

    Roe, David; Carley, Simon; Sherratt, Cathy

    2010-02-01

    This paper describes the potential benefits, pitfalls and barriers to adopting e-learning in emergency medicine. While the benefits relating to access, engagement and quality assurance are clear, caution is urged in embracing e-learning for e-learning's sake. It is argued that, if educational strategies are to change, this must be to the benefit of learners and not just for the convenience of access or record keeping. A variety of e-learning approaches are available, but those that promote group discussion or provide feedback from an educator are more likely to lead to successful learning than stand-alone feedback-free modules. A blended approach to learning is advocated where e-learning opportunities form an important but limited part of the overall educational experience. Shop floor and workshop-based teaching should be enhanced with e-learning, not replaced by it. PMID:20156859

  9. Academic Emergency Medicine Physicians’ Knowledge of Mechanical Ventilation

    PubMed Central

    Wilcox, Susan R.; Strout, Tania D.; Schneider, Jeffrey I.; Mitchell, Patricia M.; Smith, Jessica; Lutfy-Clayton, Lucienne; Marcolini, Evie G.; Aydin, Ani; Seigel, Todd A.; Richards, Jeremy B.

    2016-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  11. Management of Fever in Postpneumococcal Vaccine Era: Comparison of Management Practices by Pediatric Emergency Medicine and General Emergency Medicine Physicians

    PubMed Central

    Goldman, David L.; Avner, Jeffrey R.

    2014-01-01

    Background. The primary objective of this study was to compare management practices of general emergency physicians (GEMPs) and pediatric emergency medicine physicians (PEMPs) for well-appearing young febrile children. Methods. We retrospectively reviewed the charts of well-appearing febrile children aged 3–36 months who presented to a large urban children's hospital (PED), staffed by PEMPs, or a large urban general emergency department (GED), staffed by GEMPs. Demographics, immunization status, laboratory tests ordered, antibiotic usage, and final diagnoses were collected. Results. 224 cases from the PED and 237 cases from the GED were reviewed. Children seen by PEMPs had significantly less CXRs (23 (10.3%) versus 51 (21.5%), P = 0.001) and more rapid viral testing done (102 (45%) versus 40 (17%), P < 0.0001). A diagnosis of a viral infection was more common in the PED, while a diagnosis of bacterial infection (including otitis media) was more common in the GED. More GED patients were prescribed antibiotics (41% versus 27%, P = 0.002), while more PED patients were treated with oseltamivir (6.7% versus 0.4%, P < 0.001). Conclusions. Our findings identify important differences in the care of the young, well-appearing febrile child by PEMPs and GEMPs and highlight the need for standardization of care. PMID:24982807

  12. Transparency during public health emergencies: from rhetoric to reality

    PubMed Central

    O’Malley, P; Thompson, A

    2009-01-01

    Abstract Effective management of public health emergencies demands open and transparent public communication. The rationale for transparency has public health, strategic and ethical dimensions. Despite this, government authorities often fail to demonstrate transparency. A key step in bridging the gap between the rhetoric and reality is to define and codify transparency to put in place practical mechanisms to encourage open public health communication for emergencies. The authors demonstrate this approach using the example of the development and implementation process of a public health emergency information policy. PMID:19705012

  13. Assessing public health emergency preparedness: concepts, tools, and challenges.

    PubMed

    Nelson, Christopher; Lurie, Nicole; Wasserman, Jeffrey

    2007-01-01

    Policymakers are increasingly seeking to determine whether the federal government's recent investments in public health preparedness have left the public health system better prepared to respond to large-scale public health emergencies. Yet, there remain questions about how to define "public health emergency preparedness," how much preparedness is enough, and how preparedness can be measured and assessed. This chapter identifies the key challenges associated with measuring public health preparedness and reviews approaches currently in use. We also identify some emerging measurement techniques that might help address some of these challenges. PMID:17129174

  14. Policy perspectives on the emerging pathways of personalized medicine

    PubMed Central

    Downing, Gregory J.

    2009-01-01

    Remarkable advances in the fundamental knowledge about the biological basis of disease and technical advances in methods to assess genomic information have led the health care system to the threshold of personalized medicine. It is now feasible to consider strategic application of genomic information to guide patient management by being predictive, preemptive, and preventive, and enabling patient participation in medical decisions. Early evidence of this transition has some hallmarks of disruptive innovation to existing health care practices. Presented here is an examination of the changes underway to enable this new concept in health care in the United States, to improve precision and quality of care through innovations aimed at individualized approaches to medical decision making. A broad range of public policy positions will need to be considered for the health care delivery enterprise to accommodate the promise of this new science and technology for the benefit of patients. PMID:20135895

  15. Medicine and the public: the 1962 report of the Royal College of Physicians and the new public health.

    PubMed

    Berridge, Virginia

    2007-01-01

    The 1962 report of the Royal College of Physicians on smoking was a significant event in the history of smoking. Its significance was, however, more than smoking-specific: the RCP committee's appointment, its membership, its work, and the manner of its publication signified the changes within social medicine, and within the medical profession more generally, in postwar Britain. Doctors assumed the right to speak to the public and to government on matters of individual health, and a new risk-based public health was in the process of formation. A public health "policy community" formed, and governments began to assume responsibility for advising the public on health matters. The use of research in the report, and of social research in response to it, was important in the emergence of evidence-based medicine within public health. The paper argues for greater attention to the change in public health epitomized by the report in current debates on the concept of the 1960s "permissive society." It was the harbinger of a new style of "coercive permissiveness" in health. PMID:17369672

  16. The medicine and public health initiative ten years later.

    PubMed

    Beitsch, Leslie M; Brooks, Robert G; Glasser, Jay H; Coble, Yank D

    2005-08-01

    The Medicine and Public Health Initiative (MPHI) was created jointly 10 years ago by the American Medical Association and the American Public Health Association to bridge the nearly century-wide gulf between the respective disciplines. We review the history of MPHI and its growing significance in light of recent terrorism events. We report on current MPHI activities by examining three bellwether states-California, Florida, and Texas-as well as international sites. Upon its inception, MPHI was rapidly embraced and nationally disseminated. Sustainability 10 years later in the post-911 world requires renewed commitment by all collaborators. In order to meet the numerous health challenges facing our nation, from terrorism to chronic disease, and for MPHI to be successful, medicine and public health must work in tandem. PMID:16005812

  17. 21 CFR 25.16 - Public health and safety emergencies.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 1 2013-04-01 2013-04-01 false Public health and safety emergencies. 25.16 Section 25.16 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ENVIRONMENTAL IMPACT CONSIDERATIONS Agency Actions Requiring Environmental Consideration § 25.16 Public health and safety emergencies. There...

  18. 21 CFR 25.16 - Public health and safety emergencies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Public health and safety emergencies. 25.16 Section 25.16 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ENVIRONMENTAL IMPACT CONSIDERATIONS Agency Actions Requiring Environmental Consideration § 25.16 Public health and safety emergencies. There...

  19. Setting up and functioning of an Emergency Medicine Department: Lessons learned from a preliminary study

    PubMed Central

    Asish, K; Suresh, Varun

    2016-01-01

    Background and Aims: Tertiary care teaching hospitals remain referral centres for victims of trauma and mass casualty. Often specialists from various disciplines manage these crowded casualty areas. These age old casualty areas are being replaced, throughout the country by Emergency Medicine Departments (EMDs), presumed to be better planned to confront a crisis. We aimed to gather basic data contributive in setting up of an EMD at a tertiary care teaching hospital from the lessons learned from functioning existent systems. Methods: This is primarily a questionnaire-based descriptive study at tertiary care referral centres across the country, which was purposively selected. The study models included one from a hospital without designated EMD and the other four from hospitals with established EMDs. Direct observation and focus group meetings with experienced informants at these hospitals contributed to the data. In the absence of a validated hospital preparedness assessment scale, comparison was done with regard to quantitative, qualitative and corroborative parameters using descriptive analysis. Results: The EMDs at best practice models were headed by specialist in Emergency Medicine assisted by organised staff, had protocols for managing mass casualty incident (MCI), separate trauma teams, ergonomic use of infrastructure and public education programmes. In this regard, these hospitals seemed well organised to manage MCIs and disasters. Conclusion: The observation may provide a preliminary data useful in setting up an EMD. In the absence of published Indian literature, this may facilitate further research in this direction. Anaesthesiologists, presently an approved Faculty in Emergency Medicine training can provide creative input with regard to its initial organisation and functioning, thus widening our horizons in a country where there is a severe dearth of trained emergency physicians. PMID:27013749

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

    PubMed Central

    2015-01-01

    Purpose: Smartphone technology offers a multitude of applications (apps) that provide a wide range of functions for healthcare professionals. Medical trainees are early adopters of this technology, but how they use smartphones in clinical care remains unclear. Our objective was to further characterize smartphone use by medical trainees at two United States academic institutions, as well as their prior training in the clinical use of smartphones. Methods: In 2014, we surveyed 347 internal medicine and emergency medicine resident physicians at the University of Utah and Brigham and Women’s Hospital about their smartphone use and prior training experiences. Scores (0%–100%) were calculated to assess the frequency of their use of general features (email, text) and patient-specific apps, and the results were compared according to resident level and program using the Mann-Whitney U-test. Results: A total of 184 residents responded (response rate, 53.0%). The average score for using general features, 14.4/20 (72.2%) was significantly higher than the average score for using patient-specific features and apps, 14.1/44 (33.0%, P<0.001). The average scores for the use of general features, were significantly higher for year 3–4 residents, 15.0/20 (75.1%) than year 1–2 residents, 14.1/20 (70.5%, P=0.035), and for internal medicine residents, 14.9/20 (74.6%) in comparison to emergency medicine residents, 12.9/20 (64.3%, P= 0.001). The average score reflecting the use of patient-specific apps was significantly higher for year 3–4 residents, 16.1/44 (36.5%) than for year 1–2 residents, 13.7/44 (31.1%; P=0.044). Only 21.7% of respondents had received prior training in clinical smartphone use. Conclusion: Residents used smartphones for general features more frequently than for patient-specific features, but patient-specific use increased with training. Few residents have received prior training in the clinical use of smartphones. PMID:26582632

  1. An Analysis of State Public Health Emergency Declarations

    PubMed Central

    2014-01-01

    Disaster responses often involve coordination among multiple levels of government and public and private sector collaboration. When emergencies raise health concerns, governments must include public health and health care systems in their response. A state government’s declaration of “public health emergency” can provide that state’s health sector with flexibility and guidance about response parameters. Although events including Hurricanes Katrina and Sandy and the H1N1 influenza outbreak provided opportunities for states to deploy their public health emergency powers, little has been reported about how states have used their authority to declare a public health emergency. I present a systematic identification and analysis of states’ public health emergency declarations, examine why these declarations were issued, and discuss their potential value. PMID:25033156

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

    PubMed Central

    Sabzghabaei, Anita; Shojaee, Majid; Alimohammadi, Hossein; Derakhshanfar, Hojjat; Kashani, Parvin; Nassiriabrishamchi, Shohreh

    2015-01-01

    Introduction: Creating a calm and stress-free environment affects education significantly. The effects of the emergency department overcrowding (EDO) on the training of emergency medicine residents (EMR) is a highly debated subject. Therefore, this study aimed to evaluate the effect of EDO on efficiency of EMR’s education. Methods: In this cross-sectional study, the effects of overcrowding on EMR’s education in the resuscitation room and acute care unit. Data collection was done using a questionnaire, which was filled out by the second year EMRs. The crowding level was calculated based on the national emergency department overcrowding scale (NEDOCS). The relationship between the two studied variables was evaluated using independent sample t-test and SPSS 21 statistical software. Results: 130 questionnaires were filled out during 61 shifts. 47 (77.05%) shifts were overcrowded. The attend’s ability to teach was not affected by overcrowding in the resuscitation room (p=0.008). The similar results were seen regarding the attend’s training ability in the acute care unit. Conclusion: It seems that the emergency department overcrowding has no effect on the quality of education to the EMRs. PMID:26495404

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

    ERIC Educational Resources Information Center

    Morrison, Ann; Roman, Brenda; Borges, Nicole

    2012-01-01

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

  4. Workplace Violence and Harassment Against Emergency Medicine Residents

    PubMed Central

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

    2016-01-01

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

  5. Training Physician Investigators in Medicine and Public Health Research

    PubMed Central

    Jay, Melanie R.; Goldfrank, Lewis R.; Mendelsohn, Alan L.; Dreyer, Benard P.; Foltin, George L.; Lipkin, Mack; Schwartz, Mark D.

    2012-01-01

    Objectives. We have described and evaluated the impact of a unique fellowship program designed to train postdoctoral, physician fellows in research at the interface of medicine and public health. Methods. We developed a rigorous curriculum in public health content and research methods and fostered linkages with research mentors and local public health agencies. Didactic training provided the foundation for fellows’ mentored research initiatives, which addressed real-world challenges in advancing the health status of vulnerable urban populations. Results. Two multidisciplinary cohorts (6 per cohort) completed this 2-year degree-granting program and engaged in diverse public health research initiatives on topics such as improving pediatric care outcomes through health literacy interventions, reducing hospital readmission rates among urban poor with multiple comorbidities, increasing cancer screening uptake, and broadening the reach of addiction screening and intervention. The majority of fellows (10/12) published their fellowship work and currently have a career focused in public health–related research or practice (9/12). Conclusions. A fellowship training program can prepare physician investigators for research careers that bridge the divide between medicine and public health. PMID:22594745

  6. China's Social Science Publications: Emerging Trends.

    ERIC Educational Resources Information Center

    Davis-Friedmann, Deborah

    The author describes characteristics of social science publications which suggest that in the future there will be an improved research climate for Chinese scholars and improved opportunities for collaborative work between Chinese and foreign researchers. The publications used as the data base for this presentation are quarterly or bimonthly…

  7. Perception of Thromboembolism Risk: Differences between the Departments of Internal Medicine and Emergency Medicine.

    PubMed

    Vincentelli, Giovanni Maria; Monti, Manuel; Pirro, Maria Rosaria; Bertazzoni, Giuliano; Pugliese, Francesco Rocco; Ciammaichella, Maurizio; Ruggieri, Maria Pia; Landolfi, Raffaele

    2016-01-01

    The latest developments in emergency medicine (EM) have introduced new typologies of patients that have not been taken into account in previous studies of venous thromboembolism (VTE) risk. The aim of the current study was to evaluate by comparing the main international risk scores whether different perceptions of VTE risk exist in internal medicine (IM) departments and in EM departments. This cross-sectional observational study involved 23 IM and 10 EM departments of 21 different hospitals. The patient data were collected by physicians who were blinded to the purpose of the study. The data were analyzed using the main international risk scores. We analyzed 742 patients, 222 (30%) hospitalized in EM departments and the remaining 520 (70%) in IM departments. We found that fewer patients at risk for VTE were treated with low-molecular-weight heparin (LMWH) in EM departments than in IM departments. Moreover, there was significant statistical difference in the use of LMWH between IM and EM departments when the Padua score and immobilization criteria were used to assess the risk. The infrequent use of LMWH in EM patients may have several causes. For example, in EM departments, treatment of acute illness often takes higher priority than VTE risk evaluation. Moreover, immobilization criteria cannot be evaluated for all EM patients because of the intrinsic time requirements. For the aforementioned reasons, we believe that a different VTE risk score is required that takes into account the peculiarities of EM, and establishing such a score should be the object of future study. PMID:27349662

  8. Integrative Medicine Selects Best Practice from Public Health and Biomedicine

    PubMed Central

    Ryan, Terence J

    2013-01-01

    The meaning of terms Integrated and Integrative are described variously by an amalgam of latest scientific advances with ancient healing systems, of complementary medicine and biomedicine, and sexually transmitted infections and HIV/AIDS. It means seamless good quality care between hospital and primary care. They provoke approval mostly from patients and disapproval mostly from advocates of science and evidence-based medicine. The Institute of Applied Dermatology in Kasaragod, Kerala, India has championed a mix of Biomedicine, Yoga and herbals from Ayurvedic medicine, partly based on publications from the Department of Dermatology of the University of Oxford. In Oxford dermatology, acceptance of value of integrative medicine (IM) is demonstrated, especially in wound healing and the skin's blood supply. This has long featured in the university's research program. A variety of approaches to the practice of medicine are illustrated with reference to Osler, Garrod, and Doll. IM is believed to underlie contemporarily best practice. Particular emphasis is given to the control of heat, pain, redness, and swelling, all manifestations of inflammation, and the importance of emotion as a stimulus or inhibitor carried by neural pathways. These may explain some unbelievable Asian practices and one of the many roles of Yoga. The concept of Integrative is expanded to include care of the earth and nutrition, the hazards of climate change, Gardens for Health, do (k) no (w) harm as a key to good practice. PMID:23716803

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

    PubMed Central

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

    2013-01-01

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

  10. 21 CFR 25.16 - Public health and safety emergencies.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 1 2011-04-01 2011-04-01 false Public health and safety emergencies. 25.16... ENVIRONMENTAL IMPACT CONSIDERATIONS Agency Actions Requiring Environmental Consideration § 25.16 Public health... importance to the public health or safety, may make full adherence to the procedural provisions of NEPA...

  11. Public Value Mapping of Equity in Emerging Nanomedicine

    ERIC Educational Resources Information Center

    Slade, Catherine P.

    2011-01-01

    Public values failure occurs when the market and the public sector fail to provide goods and services required to achieve the core values of society such as equity (Bozeman 2007). That public policy for emerging health technologies should address intrinsic societal values such as equity is not a novel concept. However, the ways that the public…

  12. [Definition of 'quack' in the public debate on alternative medicine].

    PubMed

    Renckens, C N; van Dam, F S; van der Smagt, C P

    2001-01-20

    In May 1999 the Amsterdam Court of Justice decided that a retired internist and propagandist of his own alternative cancer therapy, could rightfully be called a quack by his critics. Recently this judgment was reversed on appeal. The first court used the medical definition of quackery: a treatment of which the supposed benefits are unsubstantiated. The court of appeal, however, took into consideration that to the general public calling someone a quack is an indication that this person is a swindler and practises medicine unlawfully. This definition is supported by the most authoritative Dutch dictionary. Apparently a different semantic interpretation of the term quack has led to these strongly diverging verdicts. The terms quack and quackery are indispensable in the public debate on alternative medicine. PMID:11206127

  13. Veterinary medicine protecting and promoting the public's health and well-being.

    PubMed

    Pappaioanou, Marguerite

    2004-03-16

    Dr. Calvin Schwabe's vision of "One Medicine" has long inspired many in the public health community to strive toward bringing human and veterinary medicine together to improve the public's health and well-being around the world. In an increasingly human-dominated world, as Dr. Schwabe suggested many years ago, human health provides the most-logical unifying or apical cause in veterinary medicine's hierarchy of values. Veterinarians in all aspects of the profession-have opportunity and responsibility to protect the health and well-being of people in all that they do, including protecting food security and safety; addressing threats to antibiotic sensitivity; preventing and controlling zoonotic emerging infectious diseases; protecting environments and ecosystems; participating in bio- and agro-terrorism preparedness and response; using their skills to confront non-zoonotic diseases (such as malaria, HIV/AIDS, vaccine preventable diseases, chronic diseases and injuries); strengthening the public-health infrastructure; and advancing medical science through research. This article provides an overview of contributions made by veterinarians in each of these areas, and discusses the challenges to be overcome and the need for strategic thinking and action to achieve the vision of "one medicine". PMID:15041202

  14. Perspectives of South American physicians hosting foreign rotators in emergency medicine

    PubMed Central

    2014-01-01

    of IHEs in Emergency Medicine from the perspective of physician hosts in several hospitals in South America. Our results suggest that IHEs function best when EM residents rotate later in residency training and when relationships are maintained and deepened among those involved including host physicians, rotators, and institutions. This leads to future rotators, project collaboration, research, and publications which not only benefit individuals involved but also the wider field of Emergency Medicine. PMID:25635188

  15. Building public confidence in emergency management.

    PubMed

    Pearce, Tony

    2016-01-01

    Over the years the State of Victoria has suffered many disasters, some of them resulting in extensive community, economic and environmental loss. A number of significant events, including the 2009 Victorian bushfires, major flood events in 2010-11 and their subsequent inquiries have resulted in the biggest overhaul of Victoria's emergency management arrangements since 1983. One significant element of the new arrangements is the inclusion of an entity whose role it is to assure the emergency management arrangements at the system level--the first time such a role has existed. This paper will describe the reform programme currently underway in Victoria, as well as the governance and structural arrangements that have been put in place, before detailing the assurance processes that are being implemented. PMID:26897618

  16. Variation in patient management based on ECG interpretation by emergency medicine and internal medicine residents.

    PubMed

    Trzeciak, Stephen; Erickson, Timothy; Bunney, E Bradshaw; Sloan, Edward P

    2002-05-01

    This study was performed to determine the impact of electrocardiogram (ECG) interpretation on urgent patient care decisions by internal medicine (IM) and emergency medicine (EM) resident physicians. Six clinical scenarios and ECGs were given to 31 IM residents and 31 EM residents at a university medical center. Based on the ECG interpretation, the residents were asked to select the best patient management from a list of choices. IM and EM residents were equally likely to choose the correct management for complete heart block (90% IM v 97% EM, P = NS), and pulseless ventricular tachycardia (VT) (94% IM v 97% EM, P = NS). IM residents were less likely to choose the correct management for acute posterior wall myocardial infarction (MI) (26% IM v 74% EM, P <.0001) and unstable supraventricular tachycardia (SVT) (87% IM v 100% EM, P <.05). Residents in both programs were equally likely to misinterpret left ventricular hypertrophy (LVH) (23% IM and 16% EM, P = NS) and benign early repolarization (BER) (48% IM and 52% EM, P = NS) as acute myocardial ischemia when presented with a clinical history not suggestive of cardiac ischemia. IM and EM residents were equally likely to choose the correct management for complete heart block and pulseless VT. Compared with EM residents, IM residents were less likely to choose the correct management of posterior wall MI and unstable SVT. Both IM and EM residents were prone to misinterpreting LVH and BER as acute myocardial ischemia. Resident education in both specialties should focus on ECG interpretation skills to improve patient management decisions. PMID:11992338

  17. European regulatory policies on medicines and public health needs.

    PubMed

    Li Bassi, Luca; Bertele, Vittorio; Garattini, Silvio

    2003-09-01

    The establishment of the EMEA has been a revolutionary step in the European pharmaceutical system. The 15 Member States of the European Union now share a common system for the evaluation of new medicinal products entering the European market. The decisions taken apply to the whole EU, with important implications for both industry and patients who may benefit from new therapies. The main immediate consequences of this system are: i) the time and effort saved by Member States in the evaluation of new drug applications; ii) more consistent and quicker availability of medicines in EU countries; iii) the establishment of a homogeneous regulatory policy throughout the EU. Public health has been presented as the fundamental concern of the EMEA, the mission statement of which is 'to promote the protection of human health ... and of consumers of medicinal products'. However, we note that there are some inconsistencies with this objective and the current system, such as those regarding drug trial requirements and the institutional location and financing of the EMEA. In this paper, some aspects of the new system are reviewed and consideration given as to how they relate to public health needs. Proposals are made for debate alternatives and improvements to the present system that would better respond to patients' health needs. PMID:14533728

  18. School Nurses on the Front Lines of Medicine: Emergencies 101 Ask the E.R. Pediatrician.

    PubMed

    Olympia, Robert P

    2016-03-01

    Pediatric emergencies, such as the exacerbation of medical conditions and injuries, may occur in the school setting. This article introduces the "School Nurses on the Front Lines of Medicine" series by discussing the incidence and the most common emergencies that occur in schools as well as published guidelines for school emergency preparedness. PMID:26847134

  19. Research on public health emergency response system platform

    NASA Astrophysics Data System (ADS)

    Li, Qi; Gan, Jie-fu; Qu, Yi-zhen

    2006-01-01

    The present public health system has continually struggled to combat ongoing and emerging public health threats and emergencies. The main impediment to improving public health readiness is the lack of an effective Public Health Emergency Response System. Although many health systems have been built and large amount of data collected, it is hard to analyze these data in depth and use them efficiently. An effective PHEMS should be able to manage data, produce information and provide services. Based on digital city, such a PHEMS has a most possible chance to be built. Detailed analysis of the architecture of the PHEMS, including (1) the surveillance system for data collection, (2) the consolidated information model based on HL7 Reference Information Model (RIM), (3) and the public health service framework, is focused in this paper. As a test-bed, the implementation of a prototype, which is a part of Digital Beijing Pilot, is illustrated. In the end, some operational and technical difficulties are discussed.

  20. Public Health, Hypertension, and the Emergency Department.

    PubMed

    Brody, Aaron; Janke, Alex; Sharma, Vineet; Levy, Phillip

    2016-06-01

    Hypertension (HTN) is the most common cardiovascular disease worldwide and is associated with severe long-term morbidity when not treated appropriately. Despite this, blood pressure (BP) control remains suboptimal, particularly among underserved populations and those who rely on emergency departments (EDs) as a source of primary care. ED providers encounter patients with severely elevated BP daily, and yet adherence to minimal standards of BP reassessment and referral to outpatient medical care, as recommended by the American College of Emergency Physicians, is limited. Barriers such as provider knowledge deficits, resource constraints, and negative attitudes towards patients who utilize EDs for nonurgent complaints are compounded by perceptions of HTN as a condition that can only be addressed in a primary care setting to contribute to this. Efforts to reduce this gap must go beyond government mandates to address systemic issues including access to care and payment models to encourage health promotion. Additionally, individual physician behavior can be shifted through targeted education, financial incentives, and the accumulation of high-quality evidence to encourage more proactive approaches to the management of uncontrolled HTN in the ED. PMID:27165429

  1. The emergence and potential impact of medicine 2.0 in the healthcare industry.

    PubMed

    Stump, Terra; Zilch, Sarah; Coustasse, Alberto

    2012-01-01

    Medicine 2.0 has emerged within healthcare information technology to enable more defined relationships among providers and patients. Physicians, hospitals, and patients are using Medicine 2.0 through social networking to maintain their foothold in the evolution of medical technologies. The authors' purpose was to determine potential improvements that Medicine 2.0 has on communication and collaboration of healthcare information. Research has shown that Medicine 2.0 has integrated into the healthcare industry and is enabling an increase in communication in healthcare matters. The provider-patient relationship is improving through the use of Medicine 2.0 and has positively impacted society so far. PMID:22671433

  2. The great opportunity: Evolutionary applications to medicine and public health.

    PubMed

    Nesse, Randolph M; Stearns, Stephen C

    2008-02-01

    Evolutionary biology is an essential basic science for medicine, but few doctors and medical researchers are familiar with its most relevant principles. Most medical schools have geneticists who understand evolution, but few have even one evolutionary biologist to suggest other possible applications. The canyon between evolutionary biology and medicine is wide. The question is whether they offer each other enough to make bridge building worthwhile. What benefits could be expected if evolution were brought fully to bear on the problems of medicine? How would studying medical problems advance evolutionary research? Do doctors need to learn evolution, or is it valuable mainly for researchers? What practical steps will promote the application of evolutionary biology in the areas of medicine where it offers the most? To address these questions, we review current and potential applications of evolutionary biology to medicine and public health. Some evolutionary technologies, such as population genetics, serial transfer production of live vaccines, and phylogenetic analysis, have been widely applied. Other areas, such as infectious disease and aging research, illustrate the dramatic recent progress made possible by evolutionary insights. In still other areas, such as epidemiology, psychiatry, and understanding the regulation of bodily defenses, applying evolutionary principles remains an open opportunity. In addition to the utility of specific applications, an evolutionary perspective fundamentally challenges the prevalent but fundamentally incorrect metaphor of the body as a machine designed by an engineer. Bodies are vulnerable to disease - and remarkably resilient - precisely because they are not machines built from a plan. They are, instead, bundles of compromises shaped by natural selection in small increments to maximize reproduction, not health. Understanding the body as a product of natural selection, not design, offers new research questions and a framework for

  3. The great opportunity: Evolutionary applications to medicine and public health

    PubMed Central

    Nesse, Randolph M; Stearns, Stephen C

    2008-01-01

    Abstract Evolutionary biology is an essential basic science for medicine, but few doctors and medical researchers are familiar with its most relevant principles. Most medical schools have geneticists who understand evolution, but few have even one evolutionary biologist to suggest other possible applications. The canyon between evolutionary biology and medicine is wide. The question is whether they offer each other enough to make bridge building worthwhile. What benefits could be expected if evolution were brought fully to bear on the problems of medicine? How would studying medical problems advance evolutionary research? Do doctors need to learn evolution, or is it valuable mainly for researchers? What practical steps will promote the application of evolutionary biology in the areas of medicine where it offers the most? To address these questions, we review current and potential applications of evolutionary biology to medicine and public health. Some evolutionary technologies, such as population genetics, serial transfer production of live vaccines, and phylogenetic analysis, have been widely applied. Other areas, such as infectious disease and aging research, illustrate the dramatic recent progress made possible by evolutionary insights. In still other areas, such as epidemiology, psychiatry, and understanding the regulation of bodily defenses, applying evolutionary principles remains an open opportunity. In addition to the utility of specific applications, an evolutionary perspective fundamentally challenges the prevalent but fundamentally incorrect metaphor of the body as a machine designed by an engineer. Bodies are vulnerable to disease – and remarkably resilient – precisely because they are not machines built from a plan. They are, instead, bundles of compromises shaped by natural selection in small increments to maximize reproduction, not health. Understanding the body as a product of natural selection, not design, offers new research questions and a

  4. 21 CFR 25.16 - Public health and safety emergencies.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 1 2012-04-01 2012-04-01 false Public health and safety emergencies. 25.16 Section 25.16 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ENVIRONMENTAL IMPACT CONSIDERATIONS Agency Actions Requiring Environmental Consideration § 25.16 Public...

  5. 21 CFR 25.16 - Public health and safety emergencies.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 1 2014-04-01 2014-04-01 false Public health and safety emergencies. 25.16 Section 25.16 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ENVIRONMENTAL IMPACT CONSIDERATIONS Agency Actions Requiring Environmental Consideration § 25.16 Public...

  6. The efficacy and value of emergency medicine: a supportive literature review

    PubMed Central

    2011-01-01

    Study objectives The goal of this study was to identify publications in the medical literature that support the efficacy or value of Emergency Medicine (EM) as a medical specialty and of clinical care delivered by trained emergency physicians. In this study we use the term "value" to refer both to the "efficacy of clinical care" in terms of achieving desired patient outcomes, as well as "efficiency" in terms of effective and/or cost-effective utilization of healthcare resources in delivering emergency care. A comprehensive listing of publications describing the efficacy or value of EM has not been previously published. It is anticipated that the accumulated reference list generated by this study will serve to help promote awareness of the value of EM as a medical specialty, and acceptance and development of the specialty of EM in countries where EM is new or not yet fully established. Methods The January 1995 to October 2010 issues of selected journals, including the EM journals with the highest article impact factors, were reviewed to identify articles of studies or commentaries that evaluated efficacy, effectiveness, and/or value related to EM as a specialty or to clinical care delivered by EM practitioners. Articles were included if they found a positive or beneficial effect of EM or of EM physician-provided medical care. Additional articles that had been published prior to 1995 or in other non-EM journals already known to the authors were also included. Results A total of 282 articles were identified, and each was categorized into one of the following topics: efficacy of EM for critical care and procedures (31 articles), efficacy of EM for efficiency or cost of care (30 articles), efficacy of EM for public health or preventive medicine (34 articles), efficacy of EM for radiology (11 articles), efficacy of EM for trauma or airway management (27 articles), efficacy of EM for using ultrasound (56 articles), efficacy of EM faculty (34 articles), efficacy of EM

  7. Using reality mining to improve public health and medicine.

    PubMed

    Pentland, Alex; Lazer, David; Brewer, Devon; Heibeck, Tracy

    2009-01-01

    We live our lives in digital networks. We wake up in the morning, check our e-mail, make a quick phone call, commute to work, buy lunch. Many of these transactions leave digital breadcrumbs--tiny records of our daily experiences. Reality mining, which pulls together these crumbs using statistical analysis and machine learning methods, offers an increasingly comprehensive picture of our lives, both individually and collectively, with the potential of transforming our understanding of ourselves, our organizations, and our society in a fashion that was barely conceivable just a few years ago. It is for this reason that reality mining was recently identified by Technology Review as one of "10 emerging technologies that could change the world". Many everyday devices provide the raw database upon which reality mining builds; sensors in mobile phones, cars, security cameras, RFID ('smart card') readers, and others, all allow for the measurement of human physical and social activity. Computational models based on such data have the potential to dramatically transform the arenas of both individual and community health. Reality mining can provide new opportunities with respect to diagnosis, patient and treatment monitoring, health services planning, surveillance of disease and risk factors, and public health investigation and disease control. Currently, the single most important source of reality mining data is the ubiquitous mobile phone. Every time a person uses a mobile phone, a few bits of information are left behind. The phone pings the nearest mobile-phone towers, revealing its location. The mobile phone service provider records the duration of the call and the number dialed. In the near future, mobile phones and other technologies will collect even more information about their users, recording everything from their physical activity to their conversational cadences. While such data pose a potential threat to individual privacy, they also offer great potential value

  8. Nonemergency Medicine-Trained Physician Coverage in Rural Emergency Departments

    ERIC Educational Resources Information Center

    Peterson, Lars E.; Dodoo, Martey; Bennett, Kevin J.; Bazemore, Andrew; Phillips, Robert L., Jr.

    2008-01-01

    Context: Rural areas have fewer physicians compared to urban areas, and rural emergency departments often rely on community or contracted providers for staffing. The emergency department workforce is composed of a variety of physician specialties and clinicians. Purpose: To determine the distribution of emergency department clinicians and the…

  9. Analytical challenges for emerging public health surveillance.

    PubMed

    Rolka, Henry; Walker, David W; English, Roseanne; Katzoff, Myron J; Scogin, Gail; Neuhaus, Elizabeth

    2012-07-27

    The root of effective disease control and prevention is an informed understanding of the epidemiology of a particular disease based on sound scientific interpretation of evidence. Such evidence must frequently be transformed from raw data into consumable information before it can be used for making decisions, determining policy, and conducting programs. However, the work of building such evidence in public health practice--doing the right thing at the right time--is essentially hidden from view. Surveillance involves acquiring, analyzing, and interpreting data and information from several sources across various systems. Achieving the goals and objectives of surveillance investments requires attention to analytic requirements of such systems. The process requires computer programming, statistical reasoning, subject matter expertise, often modeling, and effective communication skills. PMID:22832996

  10. Emerging translational research on magnetic nanoparticles for regenerative medicine.

    PubMed

    Gao, Yu; Lim, Jing; Teoh, Swee-Hin; Xu, Chenjie

    2015-10-01

    Regenerative medicine, which replaces or regenerates human cells, tissues or organs, to restore or establish normal function, is one of the fastest-evolving interdisciplinary fields in healthcare. Over 200 regenerative medicine products, including cell-based therapies, tissue-engineered biomaterials, scaffolds and implantable devices, have been used in clinical development for diseases such as diabetes and inflammatory and immune diseases. To facilitate the translation of regenerative medicine from research to clinic, nanotechnology, especially magnetic nanoparticles have attracted extensive attention due to their unique optical, electrical, and magnetic properties and specific dimensions. In this review paper, we intend to summarize current advances, challenges, and future opportunities of magnetic nanoparticles for regenerative medicine. PMID:26505058

  11. Ethical issues in the response to Ebola virus disease in United States emergency departments: a position paper of the American College of Emergency Physicians, the Emergency Nurses Association, and the Society for Academic Emergency Medicine.

    PubMed

    Venkat, Arvind; Asher, Shellie L; Wolf, Lisa; Geiderman, Joel M; Marco, Catherine A; McGreevy, Jolion; Derse, Arthur R; Otten, Edward J; Jesus, John E; Kreitzer, Natalie P; Escalante, Monica; Levine, Adam C

    2015-05-01

    The 2014 outbreak of Ebola virus disease (EVD) in West Africa has presented a significant public health crisis to the international health community and challenged U.S. emergency departments (EDs) to prepare for patients with a disease of exceeding rarity in developed nations. With the presentation of patients with Ebola to U.S. acute care facilities, ethical questions have been raised in both the press and medical literature as to how U.S. EDs, emergency physicians (EPs), emergency nurses, and other stakeholders in the health care system should approach the current epidemic and its potential for spread in the domestic environment. To address these concerns, the American College of Emergency Physicians, the Emergency Nurses Association, and the Society for Academic Emergency Medicine developed this joint position paper to provide guidance to U.S. EPs, emergency nurses, and other stakeholders in the health care system on how to approach the ethical dilemmas posed by the outbreak of EVD. This paper will address areas of immediate and potential ethical concern to U.S. EDs in how they approach preparation for and management of potential patients with EVD. PMID:25903144

  12. Public Health, Academic Medicine, and the Alcohol Industry’s Corporate Social Responsibility Activities

    PubMed Central

    Robaina, Katherine

    2013-01-01

    We explored the emerging relationships among the alcohol industry, academic medicine, and the public health community in the context of public health theory dealing with corporate social responsibility. We reviewed sponsorship of scientific research, efforts to influence public perceptions of research, dissemination of scientific information, and industry-funded policy initiatives. To the extent that the scientific evidence supports the reduction of alcohol consumption through regulatory and legal measures, the academic community has come into increasing conflict with the views of the alcohol industry. We concluded that the alcohol industry has intensified its scientific and policy-related activities under the general framework of corporate social responsibility initiatives, most of which can be described as instrumental to the industry’s economic interests. PMID:23237151

  13. Public health, academic medicine, and the alcohol industry's corporate social responsibility activities.

    PubMed

    Babor, Thomas F; Robaina, Katherine

    2013-02-01

    We explored the emerging relationships among the alcohol industry, academic medicine, and the public health community in the context of public health theory dealing with corporate social responsibility. We reviewed sponsorship of scientific research, efforts to influence public perceptions of research, dissemination of scientific information, and industry-funded policy initiatives. To the extent that the scientific evidence supports the reduction of alcohol consumption through regulatory and legal measures, the academic community has come into increasing conflict with the views of the alcohol industry. We concluded that the alcohol industry has intensified its scientific and policy-related activities under the general framework of corporate social responsibility initiatives, most of which can be described as instrumental to the industry's economic interests. PMID:23237151

  14. Essentials of Pediatric Emergency Medicine Fellowship: Part 4: Beyond Clinical Education.

    PubMed

    Wolff, Margaret; Carney, Michele; Eldridge, Charles; Zaveri, Pavan; Kou, Maybelle

    2016-08-01

    This article is the third in a 7-part series that aims to comprehensively describe the current state and future directions of pediatric emergency medicine fellowship training from the essential requirements to considerations for successfully administering and managing a program to the careers that may be anticipated upon program completion. This article focuses on the skills beyond clinical training required of pediatric emergency medicine physicians including teaching, leadership, teamwork, and communication. PMID:27490731

  15. 75 FR 58411 - Center for Veterinary Medicine eSubmitter Workshop; Public Workshop; Request for Comments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-24

    ... HUMAN SERVICES Food and Drug Administration Center for Veterinary Medicine eSubmitter Workshop; Public...: ``Center for Veterinary Medicine (CVM) eSubmitter Workshop.'' The purpose of the public workshop is to..., Center for Veterinary Medicine (HFV-100), Food and Drug Administration, 7520 Standish Pl., Rockville,...

  16. Emergency Preparedness as Public Pedagogy: The Absent-Presence of Race in "Preparing for Emergencies"

    ERIC Educational Resources Information Center

    Preston, John; Avery, Barry; Chakrabarty, Namita; Edmonds, Casey

    2011-01-01

    Emergency preparedness can be considered to be a form of lifelong learning and public pedagogy with implications for race equality. The paper is based on an ESRC project "Preparedness pedagogies and race: an interdisciplinary approach" considering the policy process around the construction of the "Preparing for Emergencies" (PFE) campaign. This…

  17. Medicinal plants: a public resource for metabolomics and hypothesis development.

    PubMed

    Wurtele, Eve Syrkin; Chappell, Joe; Jones, A Daniel; Celiz, Mary Dawn; Ransom, Nick; Hur, Manhoi; Rizshsky, Ludmila; Crispin, Matthew; Dixon, Philip; Liu, Jia; P Widrlechner, Mark; Nikolau, Basil J

    2012-01-01

    database is publicly available and can be used by researchers in medicine and plant biology. PMID:24957774

  18. Educating Emergency Medicine Residents in Emergency Department Administration and Operations: Needs and Current Practice

    PubMed Central

    Watase, Taketo; Yarris, Lalena M.; Fu, Rongwei; Handel, Daniel A.

    2014-01-01

    Background Emergency medicine (EM) residents are expected to develop competence in emergency department (ED) administration and operations. Objectives We assessed current needs and educational practices related to preparing EM residents for their role in ED operations, and explored whether there was an association between program characteristics and the presence of ED operations education in US EM residency programs. Methods We conducted a cross-sectional needs assessment, using a web-based survey sent to all US EM residency programs to assess program characteristics, provision of ED operations-related lectures, availability of an ED administrative fellowship, and presence of a formal ED operations curriculum. Logistic regression was used to determine if any program characteristics were associated with the presence of lectures and a formal operations curriculum. Results Of the 158 Accreditation Council for Graduate Medical Education–accredited EM programs, 117 (74%) responded. Of these, 109 (93%) respondents had at least 1 lecture on ED operational topics. Sixty programs (54%) measured resident productivity. Knowledge of Centers for Medicaid & Medicare Services reimbursement guidelines was significantly positively associated with presence of an ED operations curriculum (OR, 3.52, P  =  .009) and with lectures on patient satisfaction (OR, 3.99, P  =  .006). Measuring resident productivity was positively associated with having lectures on productivity (OR, 2.50, P  =  .02) and with ED throughput (OR, 2.32, P  =  .03). No 2 variables were simultaneously significant in the model. Conclusions Most EM programs had at least 1 lecture on ED operations topics. Roughly half of the programs measured resident productivity and half had a formal ED operations curriculum. PMID:26140135

  19. Communicating the threat of emerging infections to the public.

    PubMed Central

    Freimuth, V.; Linnan, H. W.; Potter, P.

    2000-01-01

    Communication theory and techniques, aided by the electronic revolution, provide new opportunities and challenges for the effective transfer of laboratory, epidemiologic, surveillance, and other public health data to the public who funds them. We review the applicability of communication theory, particularly the audience-source-message-channel meta-model, to emerging infectious disease issues. Emergence of new infectious organisms, microbial resistance to therapeutic drugs, and increased emphasis on prevention have expanded the role of communication as a vital component of public health practice. In the absence of cure, as in AIDS and many other public health problems, an effectively crafted and disseminated prevention message is the key control measure. Applying communication theory to disease prevention messages can increase the effectiveness of the messages and improve public health. PMID:10905966

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

    PubMed

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

    2015-01-01

    The 1994 Rwandan war and genocide left more than 1 million people dead; millions displaced; and the country's economic, social, and health infrastructure destroyed. Despite remaining one of the poorest countries in the world, Rwanda has made remarkable gains in health, social, and economic development over the last 20 years, but modern emergency care has been slow to progress. Rwanda has recently established the Human Resources for Health program to rapidly build capacity in multiple sectors of its healthcare delivery system, including emergency medicine. This project involves multiple medical and surgical residencies, nursing programs, allied health professional trainings, and hospital administrative support. A real strength of the program is that trainers work with international faculty at Rwanda's referral hospital, but also as emergency medicine specialty trainers when returning to their respective district hospitals. Rwanda's first emergency medicine trainees are playing a unique and important role in the implementation of emergency care systems and education in the country's district hospitals. While there has been early vital progress in building emergency medicine's foundations in Rwanda, there remains much work to be done. This will be accomplished with careful planning and strong commitment from the country's healthcare and emergency medicine leaders. PMID:26101554

  1. Alternative Medicines as Emerging Therapies for Inflammatory Bowel Diseases

    PubMed Central

    Singh, Udai P.; Singh, Narendra P.; Busbee, Brandon; Guan, H.; Singh, Balwan; Price, Robert L.; Taub, Dennis D.; Mishra, Manoj K.; Nagarkatti, Mitzi; Nagarkatti, Prakash S.

    2014-01-01

    Inflammatory bowel disease (IBD) can be divided into two major categories, ulcerative colitis (UC) and Crohn disease (CD). While the main cause(s) of IBD remain unknown, a number of interventional and preventive strategies have been proposed for use against CD and UC. Many reports have focused on the use of alternative natural medicines as potential therapeutic interventions in IBD patients with minimal side effects. While the use of alternative medicines may be effective in IBD patients that are refractory to corticosteroids or thiopurins, alternative treatment strategies are limited and require extensive clinical testing before being optimized for use in patients. PMID:22251008

  2. Recombinant Elastin-Mimetic Biomaterials: Emerging Applications in Medicine

    PubMed Central

    Kim, Wookhyun; Chaikof, Elliot L.

    2010-01-01

    Biomaterials derived from protein-based block copolymers are increasingly investigated for potential application in medicine. In particular, recombinant elastin block copolymers provide significant opportunities to modulate material microstructure and can be processed in various forms, including particles, films, gels, and fiber networks. As a consequence, biological and mechanical responses of elastin-based biomaterials are tunable through precise control of block size and amino acid sequence. In this review, the synthesis of a set of elastin-mimetic triblock copolymers and their diverse processing methods for generating material platforms currently applied in medicine will be discussed. PMID:20441783

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

    PubMed

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

    2012-01-01

    The finished version of the human genome sequence was completed in 2003, and this event initiated a revolution in medical practice, which is usually referred to as the age of genomic or personalized medicine. Genomic medicine aims to be predictive, personalized, preventive, and also participative (4Ps). It offers a new approach to several pathological conditions, although its impact so far has been more evident in mendelian diseases. This article briefly reviews the potential advantages of this approach, and also some issues that may arise in the attempt to apply the accumulated knowledge from genomic medicine to clinical practice in emerging countries. The advantages of applying genomic medicine into clinical practice are obvious, enabling prediction, prevention, and early diagnosis and treatment of several genetic disorders. However, there are also some issues, such as those related to: (a) the need for approval of a law equivalent to the Genetic Information Nondiscrimination Act, which was approved in 2008 in the USA; (b) the need for private and public funding for genetics and genomics; (c) the need for development of innovative healthcare systems that may substantially cut costs (e.g. costs of periodic medical followup); (d) the need for new graduate and postgraduate curricula in which genomic medicine is emphasized; and (e) the need to adequately inform the population and possible consumers of genetic testing, with reference to the basic aspects of genomic medicine. PMID:22584698

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

    PubMed Central

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

    2012-01-01

    The finished version of the human genome sequence was completed in 2003, and this event initiated a revolution in medical practice, which is usually referred to as the age of genomic or personalized medicine. Genomic medicine aims to be predictive, personalized, preventive, and also participative (4Ps). It offers a new approach to several pathological conditions, although its impact so far has been more evident in mendelian diseases. This article briefly reviews the potential advantages of this approach, and also some issues that may arise in the attempt to apply the accumulated knowledge from genomic medicine to clinical practice in emerging countries. The advantages of applying genomic medicine into clinical practice are obvious, enabling prediction, prevention, and early diagnosis and treatment of several genetic disorders. However, there are also some issues, such as those related to: (a) the need for approval of a law equivalent to the Genetic Information Nondiscrimination Act, which was approved in 2008 in the USA; (b) the need for private and public funding for genetics and genomics; (c) the need for development of innovative healthcare systems that may substantially cut costs (e.g. costs of periodic medical follow-up); (d) the need for new graduate and postgraduate curricula in which genomic medicine is emphasized; and (e) the need to adequately inform the population and possible consumers of genetic testing, with reference to the basic aspects of genomic medicine. PMID:22584698

  5. Insurance Exchange Marketplace: Implications for Emergency Medicine Practice

    PubMed Central

    Rankey, David S.

    2012-01-01

    The Patient Protection and Affordable Care Act of 2010 requires states to establish healthcare insurance exchanges by 2014 to facilitate the purchase of qualified health plans. States are required to establish exchanges for small businesses and individuals. A federally operated exchange will be established, and states failing to participate in any other exchanges will be mandated to join the federal exchange. Policymakers and health economists believe that exchanges will improve healthcare at lower cost by promoting competition among insurers and by reducing burdensome transaction costs. Consumers will no longer be isolated from monthly insurance premium costs. Exchanges will increase the number of patients insured with more cost-conscious managed care and high-deductible plans. These insurance plan models have historically undervalued emergency medical services, while also underinsuring patients and limiting their healthcare system access to the emergency department. This paradoxically increases demand for emergency services while decreasing supply. The continual devaluation of emergency medical services by insurance payers will result in inadequate distribution of resources to emergency care, resulting in further emergency department closures, increases in emergency department crowding, and the demise of acute care services provided to families and communities. PMID:22900107

  6. Better data, better planning: the College of Emergency Medicine sentinel sites project.

    PubMed

    Moulton, Chris; Mann, Clifford; Tempest, Michelle

    2014-11-01

    This article describes the College of Emergency Medicine's initial attempt to gather high quality data from its own 'sentinel sites' rather than relying on more comprehensive national data of dubious quality. Such information is essential to inform and guide the planning of urgent and emergency care services in the future. PMID:25383432

  7. [Emergency medicine interventions for psycho-social crisis].

    PubMed

    Pajonk, Frank-Gerald B; D'Amelio, Roberto

    2013-07-01

    Psycho-social crisis intervention has emerged to be a routine treatment application in the pre-hospital emergency medical system in Germany. It is applied to both patients with psychiatric disorders and in psycho-social crises. For the latter, a psycho-physiological reaction is typical that can be treated with the BELLA concept. Psycho-social crisis intervention for the emergency physician must be regarded as psychological first-aid and is characterised by an immediate start, a limited time frame, consideration of security aspects, flexibility and a determination to pre-set goals and their achievements. We recommend to adequately document this complex service. PMID:23929164

  8. No longer waiting for an accident to happen: Simulation in emergency medicine.

    PubMed

    Ellison, Stefanie; Sullivan, Christine; McCullough, Robert

    2013-01-01

    The practice of emergency medicine (EM) requires proficient and expert skills in multiple high risk procedures. The emergency physician in-training needs a safe and realistic environment in which to practice and perfect the skills necessary to care for patients ranging from the critically ill to the patient with difficult intravenous access. Undergraduate medical, education overall has a need for training that enables students to develop the knowledge, skills and attitudes to practice in a variety of specialties. This article provides an overview of simulation in a three-year emergency medicine residency at Truman Medical Center, in a required final year clerkship for all medical students at the University of Missouri-Kansas City, and discusses national trends for the use of simulation in emergency medicine. PMID:23724485

  9. 21 CFR 880.6260 - Filtering facepiece respirator for use by the general public in public health medical emergencies.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... general public in public health medical emergencies. 880.6260 Section 880.6260 Food and Drugs FOOD AND... Filtering facepiece respirator for use by the general public in public health medical emergencies. (a) Identification. A filtering facepiece respirator for use by the general public in public health...

  10. 21 CFR 880.6260 - Filtering facepiece respirator for use by the general public in public health medical emergencies.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... general public in public health medical emergencies. 880.6260 Section 880.6260 Food and Drugs FOOD AND... Filtering facepiece respirator for use by the general public in public health medical emergencies. (a) Identification. A filtering facepiece respirator for use by the general public in public health...

  11. 21 CFR 880.6260 - Filtering facepiece respirator for use by the general public in public health medical emergencies.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... general public in public health medical emergencies. 880.6260 Section 880.6260 Food and Drugs FOOD AND... Filtering facepiece respirator for use by the general public in public health medical emergencies. (a) Identification. A filtering facepiece respirator for use by the general public in public health...

  12. Emergency medicine as a growing career in Iran: an Internet-based survey

    PubMed Central

    Farahmand, Shervin; Karimialavijeh, Ehsan; Vahedi, Hojjat Sheikh Mottahar; Jahanshir, Amirhossein

    2016-01-01

    BACKGROUND: In Iran, few studies have evaluated emergency medicine as a career option. In the present study, we aimed to find out how Iranian emergency-medicine specialists view their specialty as a career. METHODS: Following a qualitative study, a Likert-scale questionnaire was developed. Iranian emergency physician specialists who had at least two years’ job experience were contacted via email. A uniform link to a Web-based survey and a cover letter that explained the survey were sent to the recipients. We used the Kruskal-Wallis test and post hoc analysis to determine the differences between demographic subgroups. RESULTS: A total of 109 eligible responses were received, a response rate of 72.63%. Of the responders, 57.8% were 30–40 years of age, 86.2% were male, 86.2% were single, 84.4% were faculty members and 90.8% had fewer than 10 years’ job experience. The main problems occurring during the career of Iranian emergency physicians were: insufficient income, inadequate recognition of the specialty by the community, inadequate union support, insecurity in the emergency wards, overcrowding, job stresses and night shifts. Despite insufficiency of income, Iranian emergency physicians (EPs) did not care about the financial benefits of patient care. Academic activity had positive effects on the perspectives of Iranian emergency physicians regarding their careers. CONCLUSION: Iranian emergency physicians and leaders in emergency medicine should struggle to improve the present situation, aiming at an ideal state.

  13. The Emergence of Public Health Open Educational Resources

    ERIC Educational Resources Information Center

    Angell, C.; Hartwell, H.; Hemingway, A.

    2011-01-01

    Purpose: The purpose of this paper is to identify key concepts in the literature relating to the release of open educational resources (OER), with specific reference to the emergence of public health OER. Design/methodology/approach: A review of the literature relating to the development of OER was followed by an online search for OER literature…

  14. Public health emergencies: nurses' recommendations for effective actions.

    PubMed

    O'Boyle, Carol; Robertson, Cheryl; Secor-Turner, Molly

    2006-08-01

    During a public health emergency such as an influenza pandemic or a bioterrorism attack, nurses may be at risk for exposure to lethal infectious diseases when caring for victims. The aim of this study was to identify interventions nurses believe will support their ability to cope during public health emergencies. A qualitative research design was used with 33 nurses from designated bioterrorism-receiving hospitals. Nurses recommended adequate protective equipment, education, drills, accessible information and available content experts, and available administrators. Other recommendations included increased security to protect nurses, emotional and physical support, communication with nurses' families, and commitment from institutions to care for ill or injured nurses. Preparations for emergencies should include assessments of nurses' and other stakeholders' concerns. These nurses proposed specific measures to improve safety, reduce anxiety, increase trust in hospitals, and provide physical and emotional support. PMID:16921865

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

    PubMed

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

    2014-12-01

    Title IX, the commercialization of sports, the social change in sports participation, and the response to the obesity epidemic have contributed to the rapid proliferation of participation in both competitive organized sports and nontraditional athletic events. As a consequence, emergency physicians are regularly involved in the acute diagnosis, management, disposition, and counseling of a broad range of sports-related pathology. Three important and highly publicized mechanisms of injury in sports relevant to emergency medicine (EM) include concussion, heat illness, and sudden cardiac death. In conjunction with the 2014 Academic Emergency Medicine consensus conference "Gender-specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes," a consensus group consisting of experts in EM, emergency neurology, sports medicine, and public health convened to deliberate and develop research questions that could ultimately advance the field of sports medicine and allow for meaningful application in the emergency department (ED) clinical setting. Sex differences in injury risk, diagnosis, ED treatment, and counseling are identified in each of these themes. This article presents the consensus-based priority research agenda. PMID:25420669

  16. Social Networking for Emergency Management and Public Safety

    SciTech Connect

    Lesperance, Ann M.; Olson, Jarrod; Godinez, Melanie A.

    2010-08-31

    On March 10, 2010 the workshop titled Social Networking for Emergency Management and Public Safety was held in Seattle, WA. The objective of this workshop was to showcase ways social media networking technologies can be used to support emergency management and public safety operations. The workshop highlighted the current state of social networking and where this dynamic engagement is heading, demonstrated some of the more commonly used technologies, highlighted case studies on how these tools have been used in a variety of jurisdictions and engaged the private sector on how these tools might serve as a conduit for two way communication between with the public sector to address regional recovery issues and decision making.

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

    SciTech Connect

    Rosen, P.

    1988-01-01

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

  18. Emerging strategies for exploiting cannabinoid receptor agonists as medicines.

    PubMed

    Pertwee, Roger G

    2009-02-01

    Medicines that activate cannabinoid CB(1) and CB(2) receptor are already in the clinic. These are Cesamet (nabilone), Marinol (dronabinol; Delta(9)-tetrahydrocannabinol) and Sativex (Delta(9)-tetrahydrocannabinol with cannabidiol). The first two of these medicines can be prescribed to reduce chemotherapy-induced nausea and vomiting. Marinol can also be prescribed to stimulate appetite, while Sativex is prescribed for the symptomatic relief of neuropathic pain in adults with multiple sclerosis and as an adjunctive analgesic treatment for adult patients with advanced cancer. One challenge now is to identify additional therapeutic targets for cannabinoid receptor agonists, and a number of potential clinical applications for such agonists are mentioned in this review. A second challenge is to develop strategies that will improve the efficacy and/or the benefit-to-risk ratio of a cannabinoid receptor agonist. This review focuses on five strategies that have the potential to meet either or both of these objectives. These are strategies that involve: (i) targeting cannabinoid receptors located outside the blood-brain barrier; (ii) targeting cannabinoid receptors expressed by a particular tissue; (iii) targeting up-regulated cannabinoid receptors; (iv) targeting cannabinoid CB(2) receptors; or (v) 'multi-targeting'. Preclinical data that justify additional research directed at evaluating the clinical importance of each of these strategies are also discussed. PMID:19226257

  19. Emerging strategies for exploiting cannabinoid receptor agonists as medicines

    PubMed Central

    Pertwee, Roger G

    2009-01-01

    Medicines that activate cannabinoid CB1 and CB2 receptor are already in the clinic. These are Cesamet® (nabilone), Marinol® (dronabinol; Δ9-tetrahydrocannabinol) and Sativex® (Δ9-tetrahydrocannabinol with cannabidiol). The first two of these medicines can be prescribed to reduce chemotherapy-induced nausea and vomiting. Marinol® can also be prescribed to stimulate appetite, while Sativex® is prescribed for the symptomatic relief of neuropathic pain in adults with multiple sclerosis and as an adjunctive analgesic treatment for adult patients with advanced cancer. One challenge now is to identify additional therapeutic targets for cannabinoid receptor agonists, and a number of potential clinical applications for such agonists are mentioned in this review. A second challenge is to develop strategies that will improve the efficacy and/or the benefit-to-risk ratio of a cannabinoid receptor agonist. This review focuses on five strategies that have the potential to meet either or both of these objectives. These are strategies that involve: (i) targeting cannabinoid receptors located outside the blood-brain barrier; (ii) targeting cannabinoid receptors expressed by a particular tissue; (iii) targeting up-regulated cannabinoid receptors; (iv) targeting cannabinoid CB2 receptors; or (v) ‘multi-targeting’. Preclinical data that justify additional research directed at evaluating the clinical importance of each of these strategies are also discussed. PMID:19226257

  20. Emergency medicine physician attitudes toward HPV vaccine uptake in an emergency department setting

    PubMed Central

    Hill, Mandy; Okugo, Glory

    2014-01-01

    A physician's recommendation is the most effective published method of motivating HPV vaccination initiation. The emergency department (ED) is the 'public health safety net', and often the only access to care for underserved populations. Recommendation of the HPV vaccine in the ED is a potential avenue to improve vaccination rates among sub-populations who do not have access to routine medical care. We assessed willingness of EM physicians to recommend the vaccine, target high-risk women, and disclose perceived barriers to vaccination in the ED. A cross sectional study using an 11-item survey, was used to assess physician attitudes toward recommending the HPV vaccine in an ED setting to age eligible patients. 67.4% stated they would recommend the vaccine, 23.9% were neutral, and 8.7% would not recommend the vaccine to age eligible patients in the ED. 41% noted lack of adequate reimbursement for vaccination as a barrier to vaccination in the ED (P < 0.05). Physicians were comfortable targeting women at high risk for cervical cancer for vaccination (P < 0.05). EM physicians are comfortable targeting high-risk women for HPV vaccination in an ED setting. Support of EM physicians in the national effort to improve HPV vaccine uptake is an important step in eradicating a largely preventable yet lethal cancer. PMID:25483493

  1. Study Designs and Evaluation Models for Emergency Department Public Health Research

    PubMed Central

    Broderick, Kerry B.; Ranney, Megan L.; Vaca, Federico E.; D’Onofrio, Gail; Rothman, Richard E.; Rhodes, Karin V.; Becker, Bruce; Haukoos, Jason S.

    2011-01-01

    Public health research requires sound design and thoughtful consideration of potential biases that may influence the validity of results. It also requires careful implementation of protocols and procedures that are likely to translate from the research environment to actual clinical practice. This article is the product of a breakout session from the 2009 Academic Emergency Medicine consensus conference entitled “Public Health in the ED: Screening, Surveillance, and Intervention” and serves to describe in detail aspects of performing emergency department (ED)-based public health research, while serving as a resource for current and future researchers. In doing so, the authors describe methodologic features of study design, participant selection and retention, and measurements and analyses pertinent to public health research. In addition, a number of recommendations related to research methods and future investigations related to public health work in the ED are provided. Public health investigators are poised to make substantial contributions to this important area of research, but this will only be accomplished by employing sound research methodology in the context of rigorous program evaluation. PMID:20053232

  2. The development of the specialism of emergency medicine: media and cultural influences.

    PubMed

    Timmons, Stephen; Nairn, Stuart

    2015-01-01

    In this article we analyse, via a critical review of the literature, the development of a relatively new medical specialism in the United Kingdom, that of emergency medicine. Despite the high media profile of emergency care, it is a low-status specialism within UK medicine. The creation of a specialist College in 2008 means that, symbolically, recognition as a full specialism has now been achieved. In this article, we will show, using a sociology of professions approach, how emergency medicine defined itself as a specialism, and sought to carve out a distinctive jurisdiction. While, in the context of the UK National Health Service, the state was clearly an important factor in the development of this profession, we wish to develop the analysis further than is usual in the sociology of professions. We will analyse the wider cultural context for the development of this specialism, which has benefited from its high profile in the media, through both fictional and documentary sources. PMID:24821928

  3. Public health emergencies and the public health/managed care challenge.

    PubMed

    Rosenbaum, Sara; Skivington, Skip; Praeger, Sandra

    2002-01-01

    The relationship between insurance and public health is an enduring topic in public health policy and practice. Insurers share certain attributes with public health. But public health agencies operate in relation to the entire community that they are empowered by public law to serve and without regard to the insurance status of community residents; on the other hand, insurers (whether managed care or otherwise) are risk-bearing entities whose obligations are contractually defined and limited to enrolled members and sponsors. Public insurers such as Medicare and Medicaid operate under similar constraints. The fundamental characteristics that distinguish managed care-style insurance and public health become particularly evident during periods of public health emergency, when a public health agency's basic obligations to act with speed and flexibility may come face to face with the constraints on available financing that are inherent in the structure of insurance. Because more than 70% of all personal health care in the United States is financed through insurance, public health agencies effectively depend on insurers to finance necessary care and provide essential patient-level data to the public health system. Critical issues of state and federal policy arise in the context of the public health/insurance relations during public health emergencies. These issues focus on coverage and the power to make coverage decisions, as well as the power to define service networks and classify certain data as exempt from public reporting. The extent to which a formal regulatory approach may become necessary is significantly affected by the extent to which private entities themselves respond to the problem with active efforts to redesign their services and operations to include capabilities and accountability in the realm of public health emergency response. PMID:12508505

  4. Training emergency medicine nurses and physicians in youth violence prevention.

    PubMed

    Cunningham, Rebecca M; Vaidya, Robert S; Walton, Maureen; Maio, Ronald F

    2005-12-01

    Adolescents seen in an urban Emergency Department (ED) are more likely to die from violence than from any other illness or condition for which they seek care in the ED. Most injured patients presenting to our nation's EDs are treated and released, even after a firearm-related injury. These youth who are discharged from the ED will not interface with resources on the inpatient trauma unit. The current standard of care in the ED involves no referral for violence-related prevention services. Despite the fact that ED physicians and nurses frequently medically manage victims of violent assault, there are few courses on youth violence prevention (YVP) framed from the viewpoint of emergency healthcare providers, and ED staff remain relatively uneducated as a specialty on the identification, assessment, and referral resources available for early intervention and prevention. This article focuses on the development and in-depth description of a case-based, 1-hour continuing medical education presentation for ED physicians, residents, and nursing staff on YVP. This presentation is aimed to increase awareness of the role of ED personnel in YVP and to provide basic knowledge and skills needed to begin to incorporate YVP into routine clinical practice in an Emergency Department setting. PMID:16376721

  5. Mitochondrial and nuclear genomics and the emergence of personalized medicine

    PubMed Central

    2012-01-01

    Developing early detection biosensors for disease has been the long‒held goal of the Human Genome Project, but with little success. Conversely, the biological properties of the mitochondrion coupled with the relative simplicity of the mitochondrial genome give this organelle extraordinary functionality as a biosensor and places the field of mitochondrial genomics in a position of strategic advantage to launch significant advances in personalized medicine. Numerous factors make the mitochondrion organelle uniquely suited to be an early detection biosensor with applications in oncology as well as many other aspects of human health and disease. Early detection of disease translates into more effective, less expensive treatments for disease and overall better prognoses for those at greater risk for developing diseases. PMID:23244780

  6. 76 FR 23810 - Public Safety and Homeland Security Bureau; Federal Advisory Committee Act; Emergency Response...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-28

    ... COMMISSION Public Safety and Homeland Security Bureau; Federal Advisory Committee Act; Emergency Response Interoperability Center Public Safety Advisory Committee Meeting AGENCY: Federal Communications Commission. ACTION... advises interested persons that the FCC Emergency Response Interoperability Center Public Safety...

  7. 76 FR 10898 - Public Safety and Homeland Security Bureau; Federal Advisory Committee Act; Emergency Response...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-28

    ... COMMISSION Public Safety and Homeland Security Bureau; Federal Advisory Committee Act; Emergency Response Interoperability Center Public Safety Advisory Committee Meeting AGENCY: Federal Communications Commission. ACTION... advises interested persons that the FCC Emergency Response Interoperability Center Public Safety...

  8. Space shuttle operations at the NASA Kennedy Space Center: the role of emergency medicine

    NASA Technical Reports Server (NTRS)

    Rodenberg, H.; Myers, K. J.

    1995-01-01

    The Division of Emergency Medicine at the University of Florida coordinates a unique program with the NASA John F. Kennedy Space Center (KSC) to provide emergency medical support (EMS) for the United States Space Transportation System. This report outlines the organization of the KSC EMS system, training received by physicians providing medical support, logistic and operational aspects of the mission, and experiences of team members. The participation of emergency physicians in support of manned space flight represents another way that emergency physicians provide leadership in prehospital care and disaster management.

  9. Zika virus and the never-ending story of emerging pathogens and Transfusion Medicine

    PubMed Central

    Marano, Giuseppe; Pupella, Simonetta; Vaglio, Stefania; Liumbruno, Giancarlo M.; Grazzini, Giuliano

    2016-01-01

    In the last few years, the transfusion medicine community has been paying special attention to emerging vector-borne diseases transmitted by arboviruses. Zika virus is the latest of these pathogens and is responsible for major outbreaks in Africa, Asia and, more recently, in previously infection-naïve territories of the Pacific area. Many issues regarding this emerging pathogen remain unclear and require further investigation. National health authorities have adopted different prevention strategies. The aim of this review article is to discuss the currently available, though limited, information and the potential impact of this virus on transfusion medicine. PMID:26674815

  10. Global Emergency Medicine Journal Club: A Social Media Discussion About the Lack of Association Between Press Ganey Scores and Emergency Department Analgesia.

    PubMed

    Westafer, Lauren; Hensley, Justin; Shaikh, Sameed; Lin, Michelle

    2016-01-01

    Annals of Emergency Medicine collaborated with an educational Web site, Academic Life in Emergency Medicine (ALiEM), to host a public discussion featuring the 2014 Annals article on the association between Press Ganey scores and emergency department (ED) analgesia by Schwartz et al. The objective was to curate a 14-day (December 1 through 14, 2014) worldwide academic dialogue among clinicians in regard to preselected questions about the article. Five online facilitators hosted the multimodal discussion on the ALiEM Web site, Twitter, and Google Hangout. Comments across the social media platforms were curated for this report, as framed by the 4 preselected questions. Engagement was tracked through Web analytic tools and analysis of tweets. Blog comments, tweets, and video expert commentary involving the featured article are summarized and reported. The dialogue resulted in 978 page views from 342 cities in 33 countries on the ALiEM Web site, 464,345 Twitter impressions, and 83 views of the video interview with experts. Of the unique 169 identified tweets, discussion (53.3%) and learning points (32.5%) were the most common category of tweets identified. Common themes that arose in the open-access multimedia discussions included Press Ganey data validity and the utility of patient satisfaction in determining pain treatment efficacy. This educational approach using social media technologies demonstrates a free, asynchronous means to engage a worldwide scholarly discourse. PMID:26003003

  11. Public Health Ethics Related Training for Public Health Workforce: An Emerging Need in the United States

    PubMed Central

    Kanekar, A; Bitto, A

    2012-01-01

    Background Ethics is a discipline, which primarily deals with what is moral and immoral behavior. Public Health Ethics is translation of ethical theories and concepts into practice to address complex multidimensional public health problems. The primary purpose of this paper was to conduct a narrative literature review-addressing role of ethics in developing curriculum in programs and schools of public health, ethics-related instruction in schools and programs of public health and the role of ethics in developing a competent public health workforce. Methods: An open search of various health databases including Google scholar and Ebscohost yielded 15 articles related to use of ethics in public health practice or public health training and the salient features were reported. Results: Results indicated a variable amount of ethics’ related training in schools and programs of public health along with public health practitioner training across the nation. Bioethics, medical ethics and public health ethics were found to be subspecialties’ needing separate ethical frameworks to guide decision making. Conclusions: Ethics based curricular and non-curricular training for emerging public health professionals from schools and programs of public health in the United States is extremely essential. In the current age of public health challenges faced in the United States and globally, to have an ethically untrained public health force is arguably, immoral and unethical and jeopardizes population health. There is an urgent need to develop innovative ethic based curriculums in academia as well as finding effective means to translate these curricular competencies into public health practice. PMID:23113159

  12. On the night shift: advanced nurse practice in emergency medicine.

    PubMed

    Jenkins, Jennifer

    2016-05-01

    Advanced nurse practitioners in the author's emergency department (ED) work autonomously and as part of a team to assess, diagnose and treat patients with unexplained and undiagnosed illnesses and injuries over a 24-hour cycle of care. The complexity of the role in EDs is often not fully understood, and expectations can vary between trusts and between different clinical areas within trusts. This article describes one night shift in the author's ED to explain the complexity of advanced nurse practitioners' roles in this environment. The article focuses on autonomous decision-making skills and the use of advanced clinical skills in the context of evidence-based practice. PMID:27165394

  13. Protected clinical teaching time and a bedside clinical evaluation instrument in an emergency medicine training program.

    PubMed

    Shayne, Philip; Heilpern, Katherine; Ander, Douglas; Palmer-Smith, Victoria

    2002-11-01

    In a process that has evolved over the last four years, the Emory University Emergency Medicine Education Committee has developed an "academic attending" teaching shift incorporating a formatted lecture series with a clinical evaluation exercise (CEE). The program structures the approach to clinical teaching at the bedside, provides an objective clinical evaluation tool specific to emergency medicine residents, and provides targeted learning for medical students and residents rotating in the emergency department (ED). The CEE instrument was designed to be quick and efficient, satisfy requirements of assessment of the Accreditation Council for Graduate Medical Education (ACGME) general competencies, and incorporate the language of the "Model of the Clinical Practice of Emergency Medicine." The original program called for unstructured bedside teaching three days a week, by faculty freed from clinical duties, combined with a limited series of introductory emergency medicine lectures. The program proved more successful when concentrated in a once weekly structured educational program. The prepared, repeating lecture series has been expanded to include many of the most common ED presenting chief complaints and has significantly advanced a curriculum for medical students and visiting interns. A CEE was developed to evaluate and provide immediate feedback to residents on many of the core ACGME competencies. The CEE has been successfully used to structure the bedside educational encounter. This dedicated non-clinical "teaching" shift appears effective in meeting the educational goals of the authors' academic ED. This is a description of the program and its evolution; the program has not been formally evaluated. PMID:12414493

  14. Baltimore's Unrest: Perspectives From Public Health and Emergency Physician Leaders.

    PubMed

    Khaldun, Joneigh S; Warren, Katherine E; Wen, Leana S

    2016-04-01

    The tragic April 19, 2015, death of an African American man injured while in police custody spurred several days of protest and civil unrest in Baltimore City. This article outlines the opportunity and role for a local health department during civil unrest, from the perspective of 2 emergency physicians who also led the Baltimore City Health Department through these recent events. Between April 27 and May 8, 2015, the Health Department was a lead agency in the unrest response and recovery activities. Similar to an emergency medical situation, a "public health code" is proposed as a model for centralizing, reacting to, and debriefing after situations of civil unrest. (Disaster Med Public Health Preparedness. 2016;10:293-295). PMID:26690654

  15. Emerging Roles for MicroRNAs in Perioperative Medicine

    PubMed Central

    Neudecker, Viola; Brodsky, Kelley S.; Kreth, Simone; Ginde, Adit A.; Eltzschig, Holger K.

    2016-01-01

    MicroRNAs (miRNAs) are small, non-protein-coding, single-stranded RNAs. They function as posttranscriptional regulators of gene expression by interacting with target mRNAs. This process prevents translation of target mRNAs into a functional protein. miRNAs are considered to be functionally involved in virtually all physiologic processes, including differentiation and proliferation, metabolism, hemostasis, apoptosis, and inflammation. Many of these functions have important implications for anesthesiology and critical care medicine. Studies indicate that miRNA expression levels can be used to predict the risk for eminent organ injury or sepsis. Pharmacologic approaches targeting miRNAs for the treatment of human diseases are currently being tested in clinical trials. The present review highlights the important biological functions of miRNAs and their usefulness as perioperative biomarkers and discusses the pharmacologic approaches that modulate miRNA functions for disease treatment. In addition, the authors discuss the pharmacologic interactions of miRNAs with currently used anesthetics and their potential to impact anesthetic toxicity and side effects. PMID:26632665

  16. Emerging tools for erectile dysfunction: a role for regenerative medicine.

    PubMed

    Hakim, Lukman; Van der Aa, Frank; Bivalacqua, Trinity J; Hedlund, Petter; Albersen, Maarten

    2012-09-01

    Erectile dysfunction (ED) is the most common sexual disorder reported by men to their health-care providers and the most investigated male sexual dysfunction. Currently, the treatment of ED focuses on 'symptomatic relief' of ED and, therefore, tends to provide temporary relief rather than providing a cure or reversing the cause. The identification of a large population of "difficult-to-treat" patients has triggered researchers to identify novel treatment approaches, which focus on cure and restoration of the underlying cause of ED. Regenerative medicine has developed extensively in the past few decades and preclinical trials have emphasized the benefit of growth factor therapy, gene transfer, stem cells and tissue engineering for the restoration of erectile function. Development of clinical trials involving immunomodulation in postprostatectomy ED patients and the use of maxi-K channels for gene therapy are illustrative of the advances in the field. However, the search for novel treatment targets and a wealth of preclinical studies represent a dynamic and continuing field of enquiry. PMID:22824778

  17. [Chagas disease: an emerging public health problem in Italy?].

    PubMed

    Guerri-Guttenberg, R A; Ciannameo, A; Di Girolamo, C; Milei, J J

    2009-03-01

    Chagas' disease is an endemic parasitic illness in the American continent, affecting around 16 to 18 million people. Given that 9.5% of immigrants to Italy are from Latin America and that the infection can be transmitted in non-endemic countries congenitally by organ donations and blood transfusions, Chagas disease should be regarded as an emerging public health problem in Italy. Clinical guidelines as well as health protocols are needed to deal with this rarely recognized disease. PMID:19359818

  18. Protecting public health in the age of emerging infections.

    PubMed

    Lev, Ori; Rager-Zisman, Bracha

    2014-11-01

    Emerging and re-emerging infections cause huge concern among public health workers and international and national bodies such as the World Health Organization (WHO) and the U.S. National Institutes of Health (NIH). Indeed, scientists around the world express the view that despite the danger, research on these emerging virulent pathogens is crucial and must continue. While most of the studies underway are targeted at improving and protecting public health, some studies bear potentiallyserious risks resulting from misuse. These studies are defined as dual-use research of concern (DURC), where it is not evident that the benefits outweigh the risks. The H5N1 controversy has pushed various governments to institute new policies to govern such research. We describe the regulations that govern this emerging field of research in the United States and Israel, two countries that have taken leading stands on these issues. We suggest that the existing policies are able to mitigate many of the risks that this research encapsulates, yet more work is required--especially on the global level. PMID:25558694

  19. Ten Tips for Maximizing the Effectiveness of Emergency Medicine Procedure Laboratories.

    PubMed

    Hughes, Patrick G; Crespo, Maria; Maier, Tina; Whitman, Alia; Ahmed, Rami

    2016-06-01

    Incorporating simulation-based medical education techniques is paramount to ongoing training of emergency physicians. Effective procedure laboratories give learners hands-on experience in life-saving procedures they may otherwise not have clinical exposure to and also prevent skill decay. Using procedural education, adult learning theory, deliberate practice, and mastery learning strategies, the authors offer 10 tips to educators for designing an effective emergency medicine procedure laboratory. PMID:27214775

  20. Off-label prescription of genetically modified organism medicines in europe: emerging conflicts of interest?

    PubMed

    Schagen, Frederik H E; Hoeben, Rob C; Hospers, Geke A P

    2014-10-01

    Recently, the first human medicine containing a genetically modified organism (GMO medicine) was authorized for use in the European market. Just as any medicinal product, the market authorization for a GMO medicine contains a precise description of the therapeutic use for which the medicinal product is intended. Within this use, the application of the GMO medicine is permitted, without the need for the institution to obtain a specific permit. In practice, however, medicinal products are also frequently prescribed for treatment outside the registered therapeutic use, a practice that is referred to as "off-label use." While off-label use of conventional medicines is permitted and has been very useful, the off-label use of GMO medicines is not covered in the European Union (EU) legislation or guidelines and falls under each member state's national environmental legislation. This implies that in the Netherlands and most other EU member states, an environmental permit will be required for any institution that uses the GMO medicine outside the registered application(s). In the Netherlands, this permit is identical to the permits required for the execution of clinical trials involving nonregistered GMOs. The application procedure for such permit is time-consuming. This process can therefore limit the therapeutic options for medical professionals. As a consequence, desired treatment regimens could be withheld for certain patient (groups). To make future off-label use of GMO medicines permissible in a way that is acceptable for all stakeholders, regulators should adopt a proactive attitude and formulate transparent legislative procedures for this. Only then the field can maintain the public acceptance of GMO medicines, while maintaining the freedom to operate of medical professionals. PMID:25268158

  1. Celebrating Leadership in Public Health and Medicine Friends of the National Library of Medicine (FNLM) | NIH ...

    MedlinePlus

    ... MD, Director, National Library of Medicine Distinguished Health Communications Award Eugene Braunwald, MD, Distinguished Hersey Professor of Medicine, Harvard Medical School Chairman, TIMI Study Group, Brigham and Women's Hospital ...

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

    PubMed

    Pines, Jesse M

    2006-05-01

    Emergency Medicine plays a vital role in the health care continuum in the United States. Michael Porters' five forces model of industry analysis provides an insight into the economics of emergency care by showing how the forces of supplier power, buyer power, threat of substitution, barriers to entry, and internal rivalry affect Emergency Medicine. Illustrating these relationships provides a view into the complexities of the emergency care industry and offers opportunities for Emergency Departments, groups of physicians, and the individual emergency physician to maximize the relationship with other market players. PMID:16740464

  3. Impact of the Liaison Committee on Medical Education requirements for emergency medicine education at U.S. schools of medicine.

    PubMed

    McLaughlin, Steven A; Hobgood, Cherri; Binder, Louis; Manthey, David E

    2005-10-01

    The Liaison Committee on Medical Education (LCME) accredits complete and independent medical education programs leading to the MD degree. The LCME standards for accreditation are described in the online document "Functions and Structure of a Medical School." There are ongoing minor and major changes to these standards. This article examines how the newest LCME requirements may affect emergency medicine (EM) rotations. The descriptions focus on 1) how the LCME requirements affect EM educational activities and 2) how the department of EM can help the school of medicine meet the LCME requirements. The recommendations focus on the general areas of the instructional setting, components of the educational program, resources for medical students, and faculty development. The department of EM can provide the students at the school of medicine with a number of key experiences and opportunities through its educational offerings and graduate medical education programs that will help satisfy the LCME standards. The new LCME standards will also have a significant impact on the way EM educators/clerkship directors develop curricula, assess students, provide feedback, and develop their own faculty/residents as teachers. The leadership of EM should recognize their increasingly important role within the school of medicine and be sensitive to additional requirements for faculty development and scholarship. PMID:16204146

  4. Impact of Doximity Residency Rankings on Emergency Medicine Applicant Rank Lists

    PubMed Central

    Peterson, William J.; Hopson, Laura R.; Khandelwal, Sorabh; White, Melissa; Gallahue, Fiona E.; Burkhardt, John; Rolston, Aimee M.; Santen, Sally A.

    2016-01-01

    Introduction This study investigates the impact of the Doximity rankings on the rank list choices made by residency applicants in emergency medicine (EM). Methods We sent an 11-item survey by email to all students who applied to EM residency programs at four different institutions representing diverse geographical regions. Students were asked questions about their perception of Doximity rankings and how it may have impacted their rank list decisions. Results Response rate was 58% of 1,372 opened electronic surveys. This study found that a majority of medical students applying to residency in EM were aware of the Doximity rankings prior to submitting rank lists (67%). One-quarter of these applicants changed the number of programs and ranks of those programs when completing their rank list based on the Doximity rankings (26%). Though the absolute number of programs changed on the rank lists was small, the results demonstrate that the EM Doximity rankings impact applicant decision-making in ranking residency programs. Conclusion While applicants do not find the Doximity rankings to be important compared to other factors in the application process, the Doximity rankings result in a small change in residency applicant ranking behavior. This unvalidated ranking, based principally on reputational data rather than objective outcome criteria, thus has the potential to be detrimental to students, programs, and the public. We feel it important for specialties to develop consensus around measurable training outcomes and provide freely accessible metrics for candidate education. PMID:27330670

  5. Personalized peer-comparison feedback and its effect on emergency medicine resident ultrasound scan numbers

    PubMed Central

    2014-01-01

    Background Clinician-performed ultrasound has become a widely utilized tool in emergency medicine and is a mandatory component of the residency curricula. We aimed to assess the effect of personalized peer-comparison feedback on the number of ultrasound scans performed by emergency medicine residents. Findings A personalized peer-comparison feedback was performed by sending 44 emergency medicine residents a document including personally identified scan numbers and class averages. The number of ultrasound scans per clinical shift for a 3-month period before and after the feedback intervention was calculated. The average number of ultrasound exams per shift improved from 0.39 scans/shift before to 0.61 scans/shift after feedback (p = 0.04). Among the second year residents, the scans/shift ratio improved from 0.35 to 0.87 (p = 0.07); for third year residents, from 0.51 to 0.58 (p = 0.46); and from 0.33 to 0.41 (p = 0.21) for the fourth year residents before and after the intervention, respectively. Conclusions A personalized peer-comparison feedback provided to emergency medicine residents resulted in increased ultrasound scan numbers per clinical shift. Incorporating this method of feedback may help encourage residents to scan more frequently. PMID:24422791

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

    PubMed

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

    2015-05-01

    In July to August 2014, Annals of Emergency Medicine continued a collaboration with an academic Web site, Academic Life in Emergency Medicine (ALiEM), to host an online discussion session featuring the 2014 Annals Residents' Perspective article "Integration of Social Media in Emergency Medicine Residency Curriculum" by Scott et al. The objective was to describe a 14-day worldwide clinician dialogue about evidence, opinions, and early relevant innovations revolving around the featured article and made possible by the immediacy of social media technologies. Six online facilitators hosted the multimodal discussion on the ALiEM Web site, Twitter, and YouTube, which featured 3 preselected questions. Engagement was tracked through various Web analytic tools, and themes were identified by content curation. The dialogue resulted in 1,222 unique page views from 325 cities in 32 countries on the ALiEM Web site, 569,403 Twitter impressions, and 120 views of the video interview with the authors. Five major themes we identified in the discussion included curriculum design, pedagogy, and learning theory; digital curation skills of the 21st-century emergency medicine practitioner; engagement challenges; proposed solutions; and best practice examples. The immediacy of social media technologies provides clinicians the unique opportunity to engage a worldwide audience within a relatively short time frame. PMID:25725591

  7. Methodologic standards for interpreting clinical decision rules in emergency medicine: 2014 update.

    PubMed

    Green, Steven M; Schriger, David L; Yealy, Donald M

    2014-09-01

    Clinical decision rules are increasingly prominent in medicine, particularly in emergency care. The quality, use, and impact of current published decision rules widely vary, requiring clinicians to be critical consumers. We present an approach to assist in the appraisal of clinical decision rules and in judging when to use such rules. PMID:24530108

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

    ERIC Educational Resources Information Center

    Chapman, Dane M.; And Others

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

  9. Community Assessment Tool for Public Health Emergencies Including Pandemic Influenza

    SciTech Connect

    HCTT-CHE

    2011-04-14

    The Community Assessment Tool (CAT) for Public Health Emergencies Including Pandemic Influenza (hereafter referred to as the CAT) was developed as a result of feedback received from several communities. These communities participated in workshops focused on influenza pandemic planning and response. The 2008 through 2011 workshops were sponsored by the Centers for Disease Control and Prevention (CDC). Feedback during those workshops indicated the need for a tool that a community can use to assess its readiness for a disaster—readiness from a total healthcare perspective, not just hospitals, but the whole healthcare system. The CAT intends to do just that—help strengthen existing preparedness plans by allowing the healthcare system and other agencies to work together during an influenza pandemic. It helps reveal each core agency partners' (sectors) capabilities and resources, and highlights cases of the same vendors being used for resource supplies (e.g., personal protective equipment [PPE] and oxygen) by the partners (e.g., public health departments, clinics, or hospitals). The CAT also addresses gaps in the community's capabilities or potential shortages in resources. While the purpose of the CAT is to further prepare the community for an influenza pandemic, its framework is an extension of the traditional all-hazards approach to planning and preparedness. As such, the information gathered by the tool is useful in preparation for most widespread public health emergencies. This tool is primarily intended for use by those involved in healthcare emergency preparedness (e.g., community planners, community disaster preparedness coordinators, 9-1-1 directors, hospital emergency preparedness coordinators). It is divided into sections based on the core agency partners, which may be involved in the community's influenza pandemic influenza response.

  10. A bibliometric analysis in the fields of preventive medicine, occupational and environmental medicine, epidemiology, and public health

    PubMed Central

    Soteriades, Elpidoforos S; Falagas, Matthew E

    2006-01-01

    Background Research in the fields of Preventive Medicine, Occupational/Environmental Medicine, Epidemiology and Public Health play an important role in the advancement of knowledge. In order to map the research production around the world we performed a bibliometric analysis in the above fields. Methods All articles published by different world regions in the above mentioned scientific fields and cited in the Journal Citation Reports (JCR) database of the Institute for Scientific Information (ISI) during the period 1995 and 2003, were evaluated. The research production of different world regions was adjusted for: a) the gross domestic product in 1995 US dollars, and b) the population size of each region. Results A total of 48,861 articles were retrieved and categorized. The USA led the research production in all three subcategories. The percentage of articles published by USA researchers was 43%, 44% and 61% in the Preventive Medicine, Epidemiology, and Public Health subcategories, respectively. Canada and Western Europe shared the second position in the first two subcategories, while Oceania researchers ranked second in the field of Public Health. Conclusion USA researchers maintain a leadership position in the production of scientific articles in the fields of Preventive Medicine, Occupational/Environmental Medicine and Epidemiology, at a level similar to other scientific disciplines, while USA contribution to science in the field of Public Health is by all means outstanding. Less developed regions would need to support their researchers in the above fields in order to improve scientific production and advancement of knowledge in their countries. PMID:17173665

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

    PubMed

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

    2014-04-01

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

  12. Evaluation of Social Media Use by Emergency Medicine Residents and Faculty

    PubMed Central

    Pearson, David; Bond, Michael C.; Kegg, Jason; Pillow, Tyson; Hopson, Laura; Cooney, Robert; Garg, Manish; Khadpe, Jay; Runyon, Michael; Patterson, Leigh

    2015-01-01

    Introduction Clinicians and residency programs are increasing their use of social media (SM) websites for educational and promotional uses, yet little is known about the use of these sites by residents and faculty. The objective of the study is to assess patterns of SM use for personal and professional purposes among emergency medicine (EM) residents and faculty. Methods In this multi-site study, an 18-question survey was sent by e-mail to the residents and faculty in 14 EM programs and to the Council of Emergency Medicine Residency Directors (CORD) listserv via the online tool SurveyMonkey™. We compiled descriptive statistics, including assessment with the chi-square test or Fisher’s exact test. StatsDirect software (v 2.8.0, StatsDirect, Cheshire, UK) was used for all analyses. Results We received 1,314 responses: 63% of respondents were male, 40% were <30 years of age, 39% were between the ages 31 and 40, and 21% were older than 40. The study group consisted of 772 residents and 542 faculty members (15% were program directors, 21% were assistant or associate PDs, 45% were core faculty, and 19% held other faculty positions. Forty-four percent of respondents completed residency more than 10 years ago. Residents used SM markedly more than faculty for social interactions with family and friends (83% vs 65% [p<0.0001]), entertainment (61% vs 47% [p<0.0001]), and videos (42% vs 23% [p=0.0006]). Residents used Facebook™ and YouTube™ more often than faculty (86% vs 67% [p<0.001]; 53% vs 46% [p=0.01]), whereas residents used Twitter™ (19% vs 26% [p=0.005]) and LinkedIn™ (15% vs 32% [p<0.0001]) less than faculty. Overall, residents used SM sites more than faculty, notably in daily use (30% vs 24% [p<0.001]). For professional use, residents were most interested in its use for open positions/hiring (30% vs 18% [p<0.0001]) and videos (33% vs 26% [p=0.005]) and less interested than faculty with award postings (22% vs 33% [p<0.0001]) or publications (30% vs 38% [p

  13. Public Health in the Emergency Department: Overcoming Barriers to Implementation and Dissemination

    PubMed Central

    McKay, Mary Pat; Vaca, Federico E.; Field, Craig; Rhodes, Karin

    2011-01-01

    This article is the outcome of a consensus building workshop entitled, “Overcoming Barriers to Implementation and Dissemination” convened at the 2009 Academic Emergency Medicine Consensus Conference, “Public Health in the ED: Surveillance, Screening, and Intervention.” The participants were asked to address potential methods for overcoming barriers to the dissemination and implementation in the emergency department (ED) of evidenced-based practices to improve public health. The panel discussed three broad areas of interest including methods for disseminating evidence-based practices, barriers encountered during the process of implementation, and the importance of involvement in activities outside the ED including engagement in policy development and improvement. Four recommendations were discussed in detail and consensus was reached. The recommendations included 1) researchers and advocates should disseminate findings through multiple forums beyond peer-reviewed publications when an ED-based public health intervention has enough evidence to support integration into the routine practice of emergency care; 2) local barriers to implementation of public health interventions should be recognized and well understood from multiple perspectives prior to implementation; 3) innovation must be put into place and adapted based on local institutional context and culture as barriers and the best methods for overcoming them will vary across institutions; and 4) use of legislation, regulation, and incentives outside of the ED should support and strengthen ED-based interventions. For each area of interest, research dimensions to extend the current understanding of methods for effectively and efficiently implementing evidence-based public health interventions in the ED were discussed and consensus was achieved. PMID:20053233

  14. Useulness of B Natriuretic Peptides and Procalcitonin in Emergency Medicine.

    PubMed

    Delerme, S; Chenevier-Gobeaux, C; Doumenc, B; Ray, P

    2008-01-01

    Congestive heart failure (CHF) is the main cause of acute dyspnea in patients presented to an emergency department (ED), and it is associated with high morbidity and mortality. B-type natriuretic peptide (BNP) is a polypeptide, released by ventricular myocytes directly proportional to wall tension, for lowering renin-angiotensin-aldosterone activation. For diagnosing CHF, both BNP and the biologically inactive NT-proBNP have similar accuracy. Threshold values are higher in elderly population, and in patients with renal dysfunction. They might have also a prognostic value. Studies demonstrated that the use of BNP or NT-proBNP in dyspneic patients early in the ED reduced the time to discharge, total treatment cost. BNP and NT-proBNP should be available in every ED 24 hours a day, because literature strongly suggests the beneficial impact of an early appropriate diagnosis and treatment in dyspneic patients.Etiologic diagnosis of febrile patients who present to an ED is complex and sometimes difficult. However, new evidence showed that there are interventions (including early appropriate antibiotics), which could reduce mortality rate in patients with sepsis. For diagnosing sepsis, procalcitonin (PCT) is more accurate than C-reactive protein. Thus, because of its excellent specificity and positive predictive value, an elevated PCT concentration (higher than 0.5 ng/mL) indicates ongoing and potentially severe systemic infection, which needs early antibiotics (e.g. meningitis). In lower respiratory tract infections, CAP or COPD exacerbation, PCT guidance reduced total antibiotic exposure and/or antibiotic treatment duration. PMID:19578505

  15. Ethics of Clinical Science in a Public Health Emergency: Drug Discovery at the Bedside

    PubMed Central

    2013-01-01

    Clinical research under the usual regulatory constraints may be difficult or even impossible in a public health emergency. Regulators must seek to strike a good balance in granting as wide therapeutic access to new drugs as possible at the same time as gathering sound evidence of safety and effectiveness. To inform current policy, I reexamine the philosophical rationale for restricting new medicines to clinical trials, at any stage and for any population of patients (which resides in the precautionary principle), to show that its objective to protect public health, now or in the future, could soon be defeated in a pandemic. Providing wider therapeutic access and coordinating observations and natural experiments, including service delivery by cluster (wedged cluster trials), may provide such a balance. However, there are important questions of fairness to resolve before any such research can proceed. PMID:23952822

  16. Can You Multitask? Evidence and Limitations of Task Switching and Multitasking in Emergency Medicine.

    PubMed

    Skaugset, L Melissa; Farrell, Susan; Carney, Michele; Wolff, Margaret; Santen, Sally A; Perry, Marcia; Cico, Stephen John

    2016-08-01

    Emergency physicians work in a fast-paced environment that is characterized by frequent interruptions and the expectation that they will perform multiple tasks efficiently and without error while maintaining oversight of the entire emergency department. However, there is a lack of definition and understanding of the behaviors that constitute effective task switching and multitasking, as well as how to improve these skills. This article reviews the literature on task switching and multitasking in a variety of disciplines-including cognitive science, human factors engineering, business, and medicine-to define and describe the successful performance of task switching and multitasking in emergency medicine. Multitasking, defined as the performance of two tasks simultaneously, is not possible except when behaviors become completely automatic; instead, physicians rapidly switch between small tasks. This task switching causes disruption in the primary task and may contribute to error. A framework is described to enhance the understanding and practice of these behaviors. PMID:26585046

  17. Generational influences in academic emergency medicine: structure, function, and culture (Part II).

    PubMed

    Mohr, Nicholas M; Smith-Coggins, Rebecca; Larrabee, Hollynn; Dyne, Pamela L; Promes, Susan B

    2011-02-01

    Strategies for approaching generational issues that affect teaching and learning, mentoring, and technology in emergency medicine (EM) have been reported. Tactics to address generational influences involving the structure and function of the academic emergency department (ED), organizational culture, and EM schedule have not been published. Through a review of the literature and consensus by modified Delphi methodology of the Society for Academic Emergency Medicine Aging and Generational Issues Task Force, the authors have developed this two-part series to address generational issues present in academic EM. Understanding generational characteristics and mitigating strategies can address some common issues encountered in academic EM. By understanding the differences and strengths of each of the cohorts in academic EM departments and considering simple mitigating strategies, faculty leaders can maximize their cooperative effectiveness and face the challenges of a new millennium. PMID:21314780

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

    PubMed

    Gordon, James A

    2012-12-01

    In just a few decades, emergency medicine (EM) has assumed a leadership role in medical education across many academic medical centers. This rapid evolution suggests medical education as a natural priority area for EM scholarship. This year's Academic Emergency Medicine consensus conference provides an ideal forum to focus on educational research as a core element of the specialty's academic portfolio. PMID:23216790

  19. A qualitative study exploring medicines use pattern and practice among general public in Malaysia

    PubMed Central

    2016-01-01

    Objective: The objective of this study is to explore the pattern and practice of medicine use among the general public; and to explore the key factors influencing medicine use among medicine users. Methods: A qualitative approach using focus group discussions was conducted to get in-depth information about medicines use pattern and practice from the general public. Adult people who reported using medicines at the time of study or in the previous month were approached. Two focus group discussions were audio-recorded and transcribed verbatim. The obtained data were analysed using thematic content analysis. Results: This study found that there are some misunderstanding about the appropriate use of medicines. The majority of the participants reported that they were complying with their medication regimen. However, forgetting to take medicines was stated by 4 participants while 2 participants stopped taking medicines when they felt better. In addition, 10 participants reporting using medicines according to their own knowledge and past experience. Whereas 4 participants took medicines according to other informal resources such as family, friends or the media. Seven participants have experienced side effects with using medicines, 4 of them informed their doctor while 3 participants stopped taking medicines without informing their doctor. Conclusion: There was a misunderstanding about medicines use in terms of medication compliance, self-management of the illness and the resources of information about using medicines. Many efforts are still needed from health care professionals to provide sufficient information about medicines use in order to decrease the risk of inappropriate use of medicines and to achieve better therapeutic outcome. PMID:27382428

  20. Gender Differences in Acute and Chronic Pain in the Emergency Department: Results of the 2014 Academic Emergency Medicine Consensus Conference Pain Section

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2014-12-01

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

  2. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health.

    PubMed

    Trzeciak, S; Rivers, E P

    2003-09-01

    Numerous reports have questioned the ability of United States emergency departments to handle the increasing demand for emergency services. Emergency department (ED) overcrowding is widespread in US cities and has reportedly reached crisis proportions. The purpose of this review is to describe how ED overcrowding threatens patient safety and public health, and to explore the complex causes and potential solutions for the overcrowding crisis. A review of the literature from 1990 to 2002 identified by a search of the Medline database was performed. Additional sources were selected from the references of the articles identified. There were four key findings. (1) The ED is a vital component of America's health care "safety net". (2) Overcrowding in ED treatment areas threatens public health by compromising patient safety and jeopardising the reliability of the entire US emergency care system. (3) Although the causes of ED overcrowding are complex, the main cause is inadequate inpatient capacity for a patient population with an increasing severity of illness. (4) Potential solutions for ED overcrowding will require multidisciplinary system-wide support. PMID:12954674

  3. Incommensurable worldviews? Is public use of complementary and alternative medicines incompatible with support for science and conventional medicine?

    PubMed

    Stoneman, Paul; Sturgis, Patrick; Allum, Nick; Sibley, Elissa

    2013-01-01

    Proponents of controversial Complementary and Alternative Medicines, such as homeopathy, argue that these treatments can be used with great effect in addition to, and sometimes instead of, 'conventional' medicine. In doing so, they accept the idea that the scientific approach to the evaluation of treatment does not undermine use of and support for some of the more controversial CAM treatments. For those adhering to the scientific canon, however, such efficacy claims lack the requisite evidential basis from randomised controlled trials. It is not clear, however, whether such opposition characterises the views of the general public. In this paper we use data from the 2009 Wellcome Monitor survey to investigate public use of and beliefs about the efficacy of a prominent and controversial CAM within the United Kingdom, homeopathy. We proceed by using Latent Class Analysis to assess whether it is possible to identify a sub-group of the population who are at ease in combining support for science and conventional medicine with use of CAM treatments, and belief in the efficacy of homeopathy. Our results suggest that over 40% of the British public maintain positive evaluations of both homeopathy and conventional medicine simultaneously. Explanatory analyses reveal that simultaneous support for a controversial CAM treatment and conventional medicine is, in part, explained by a lack of scientific knowledge as well as concerns about the regulation of medical research. PMID:23382836

  4. Incommensurable Worldviews? Is Public Use of Complementary and Alternative Medicines Incompatible with Support for Science and Conventional Medicine?

    PubMed Central

    Stoneman, Paul; Sturgis, Patrick; Allum, Nick; Sibley, Elissa

    2013-01-01

    Proponents of controversial Complementary and Alternative Medicines, such as homeopathy, argue that these treatments can be used with great effect in addition to, and sometimes instead of, ‘conventional’ medicine. In doing so, they accept the idea that the scientific approach to the evaluation of treatment does not undermine use of and support for some of the more controversial CAM treatments. For those adhering to the scientific canon, however, such efficacy claims lack the requisite evidential basis from randomised controlled trials. It is not clear, however, whether such opposition characterises the views of the general public. In this paper we use data from the 2009 Wellcome Monitor survey to investigate public use of and beliefs about the efficacy of a prominent and controversial CAM within the United Kingdom, homeopathy. We proceed by using Latent Class Analysis to assess whether it is possible to identify a sub-group of the population who are at ease in combining support for science and conventional medicine with use of CAM treatments, and belief in the efficacy of homeopathy. Our results suggest that over 40% of the British public maintain positive evaluations of both homeopathy and conventional medicine simultaneously. Explanatory analyses reveal that simultaneous support for a controversial CAM treatment and conventional medicine is, in part, explained by a lack of scientific knowledge as well as concerns about the regulation of medical research. PMID:23382836

  5. Emerging Aeromonas Species Infections and Their Significance in Public Health

    PubMed Central

    Igbinosa, Isoken H.; Igumbor, Ehimario U.; Aghdasi, Farhad; Tom, Mvuyo; Okoh, Anthony I.

    2012-01-01

    Aeromonas species are ubiquitous bacteria in terrestrial and aquatic milieus. They are becoming renowned as enteric pathogens of serious public health concern as they acquire a number of virulence determinants that are linked with human diseases, such as gastroenteritis, soft-tissue, muscle infections, septicemia, and skin diseases. Proper sanitary procedures are essential in the prevention of the spread of Aeromonas infections. Oral fluid electrolyte substitution is employed in the prevention of dehydration, and broad-spectrum antibiotics are used in severe Aeromonas outbreaks. This review presents an overview of emerging Aeromonas infections and proposes the need for actions necessary for establishing adequate prevention measures against the infections. PMID:22701365

  6. 75 FR 26773 - Public Readiness and Emergency Preparedness Act Countermeasures Injury Compensation Program...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-12

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Public Readiness and Emergency Preparedness... CICP administers the compensation program authorized by the Public Readiness and Emergency...

  7. The Society of Behavioral Medicine (SBM) and public policy advocacy: a call to action.

    PubMed

    Estabrooks, Paul; Pagoto, Sherry; Otten, Jennifer; Pbert, Lori; Stone, Amy; King, Abby; Goggin, Kathy; Emmons, Karen

    2011-09-01

    In 2010, the Society of Behavioral Medicine heightened its priority to take an even more active role in influencing health-related public policy. Here we discuss the importance of behavioral medicine presence in public policy initiatives, review a brief history of SBM's involvement in public policy, describe steps SBM is now taking to increase its involvement in health-related public policy, and finally, put forth a call to action for SBM members to increase their awareness of and become involved in public policy initiatives. PMID:24073068

  8. Investigation on Legal Problems Encountered by Emergency Medicine Physicians in Turkey

    PubMed Central

    Kayipmaz, Afsin Emre; Giray, Tufan Akin; Yesilagac, Hasan; Ozel, Betul Akbuga; Celikel, Elif; Karagun, Ozlem

    2015-01-01

    Background Medicine is a profession that carries certain risks. One risky area of practice is the emergency department. Emergency physicians diagnose and treat a high volume of patients, and are also responsible for preparing reports for forensic cases. In this study, we aim to investigate emergency physicians’ legal-administrative problems and reveal their level of understanding on forensic cases. Methods An electronic questionnaire form was prepared after the approval of an ethical committee. This form was sent to the residents, specialists and academicians of emergency medicine by e-mail. The physicians were asked to fill out the form online. All the gathered data was analyzed. Descriptive statistics were presented as frequency percentages with mean and standard deviation. Chi-square tests were used to compare the groups. Correlation between number of complaint cases and age, sex, career, institution, and duration of service in emergency department were investigated. p<0.05 was considered statistically significant. Results 294 physicians participated in the questionnaire. According to the questionnaire, 170 of the physicians were reported to the patient communication units due to medical malpractice. Mean number of compliant reports was 3.20±3.5. 29 of the physicians received administrative penalties. 42 of the physicians were judged in the court for medical malpractice. 1 physician was fined 5000 Turkish Liras as a result of these judgments. Conclusion We found that the number of complaint reports is negatively correlated with duration of service in emergency medicine and age. There was a significant difference between number of complaint reports and career (p<0.05). The physicians’ level of awareness on forensic cases was found to be insufficient. Lack of legislation knowledge may be an important cause of complaint reports concerning emergency physicians, who have a high load of patients. Thus, we think that increasing the frequency of post

  9. How Much are Emergency Medicine Specialists’ Decisions Reliable in the Diagnosis and Treatment of Pediatric Fractures?

    PubMed Central

    Mardani-Kivi, Mohsen; Zohrevandi, Behzad; Saheb-Ekhtiari, Khashayar; Hashemi-Motlagh, Keyvan

    2016-01-01

    Background: Considering the importance of an early diagnosis and proper decision-making in regards to the treatment of pediatric distal radius and elbow fractures, this study examines emergency medicine specialists’ accuracy in the diagnosis and treatment of these patients. Methods: From 2012 and 2013, children less than 14 years old who were referred to an academic hospital emergency department with elbow or distal radius fractures were enrolled. Initially, patients were examined by an emergency medicine specialist and then they were referred to an orthopedic surgeon. Type of fracture and the proposed treatment of two specialists were compared. Results: In total, there were 108 patients (54 patients in each group) with a mean age of 8.1±3.3 years. Identical diagnosis in 48 cases (88.9%) of distal radius and 36 cases (66.7%) of elbow trauma were observed. We found a difference between diagnosis of the two specialists in diagnosing lateral condyle of the humerus fracture in the elbow group and growth plate fracture in the distal radius fracture group, but the differences were not significant. Among 108 patients, 70 patients (64.8%) received identical treatment. Conclusion: Although the emergency medicine specialists responded similarly to the orthopedic specialists in the diagnosis of pediatric distal radius and elbow fractures, diagnosis of more complicated fractures such as lateral condylar humoral fractures, distal radius growth plate and for choosing the proper treatment option, merits further education. PMID:26894221

  10. The public health aspects of complex emergencies and refugee situations.

    PubMed

    Toole, M J; Waldman, R J

    1997-01-01

    Populations affected by armed conflict have experienced severe public health consequences mediated by population displacement, food scarcity, and the collapse of basic health services, giving rise to the term complex humanitarian emergencies. These public health effects have been most severe in underdeveloped countries in Africa, Asia, and Latin America. Refugees and internally displaced persons have experienced high mortality rates during the period immediately following their migration. In Africa, crude mortality rates have been as high as 80 times baseline rates. The most common causes of death have been diarrheal diseases, measles, acute respiratory infections, and malaria. High prevalences of acute malnutrition have contributed to high case fatality rates. In conflict-affected European countries, such as the former Yugoslavia, Georgia, Azerbaijan, and Chechnya, war-related injuries have been the most common cause of death among civilian populations; however, increased incidence of communicable diseases, neonatal health problems, and nutritional deficiencies (especially among the elderly) have been documented. The most effective measures to prevent mortality and morbidity in complex emergencies include protection from violence; the provision of adequate food rations, clean water and sanitation; diarrheal disease control; measles immunization; maternal and child health care, including the case management of common endemic communicable diseases; and selective feeding programs, when indicated. PMID:9143721

  11. 78 FR 32296 - Second Allocation of Public Transportation Emergency Relief Funds in Response to Hurricane Sandy...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-29

    ... Federal Transit Administration Second Allocation of Public Transportation Emergency Relief Funds in... Administration (FTA) announces the allocation of $3.7 billion under the Public Transportation Emergency Relief... costs after an emergency or major disaster that affects public transportation systems. The...

  12. Towards medicines regulatory authorities' quality performance improvement: value for public health.

    PubMed

    Pejović, Gordana; Filipović, Jovan; Tasić, Ljiljana; Marinković, Valentina

    2016-01-01

    The purpose of this article is to explore the possibility of implementing total quality management (TQM) principles in national medicines regulatory authorities in Europe to achieve all public health objectives. Bearing in mind that medicines regulation is a governmental function that serves societal objectives to protect and promote public health, measuring the effective achievement of quality objectives related to public health is of utmost importance. A generic TQM model for meeting public health objectives was developed and was tested on 10 European national medicines regulatory authorities with different regulatory performances. Participating national medicines regulatory authorities recognised all TQM factors of the proposed model in implemented systems with different degrees of understanding. An analysis of responses was performed within the framework of two established criteria-the regulatory authority's category and size. The value of the paper is twofold. First, the new generic TQM model proposes to integrate four public health objectives with six TQM factors. Second, national medicines regulatory authorities were analysed as public organisations and health authorities to develop a proper tool for assessing their regulatory performance. The paper emphasises the importance of designing an adequate approach to performance measurement of quality management systems in medicines regulatory authorities that will support their public service missions. PMID:24986713

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

    PubMed

    Halamka, J D

    1998-01-01

    The American Heritage dictionary defines the word "web" as "something intricately contrived, especially something that ensnares or entangles." The wealth of medical resources on the World Wide Web is now so extensive, yet disorganized and unmonitored, that such a definition seems fitting. In emergency medicine, for example, a field in which accurate and complete information, including patients' records, is urgently needed, more than 5000 Web pages are available today, whereas fewer than 50 were available in December 1994. Most sites are static Web pages using the Internet to publish textbook material, but new technology is extending the scope of the Internet to include online medical education and secure exchange of clinical information. This article lists some of the best Web sites for use in emergency medicine and then describes a project in which the Web is used for transmission and protection of electronic medical records. PMID:9673087

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

    PubMed

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

    2011-02-01

    For the first time in history, four generations are working together-traditionalists, baby boomers, generation Xers (Gen Xers), and millennials. Members of each generation carry with them a unique perspective of the world and interact differently with those around them. Through a review of the literature and consensus by modified Delphi methodology of the Society for Academic Emergency Medicine Aging and Generational Issues Task Force, the authors have developed this two-part series to address generational issues present in academic emergency medicine (EM). Understanding generational characteristics and mitigating strategies can help address some common issues encountered in academic EM. Through recognition of the unique characteristics of each of the generations with respect to teaching and learning, mentoring, and technology, academicians have the opportunity to strategically optimize interactions with one another. PMID:21314779

  15. Generational Influences in Academic Emergency Medicine: Teaching and Learning, Mentoring, and Technology (Part I)

    PubMed Central

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

    2010-01-01

    For the first time in history, four generations are working together – Traditionalists, Baby Boomers, Generation Xers, and Millennials. Members of each generation carry with them a unique perspective of the world and interact differently with those around them. Through a review of the literature and consensus by modified Delphi methodology of the Society for Academic Emergency Medicine (SAEM) Aging and Generational Issues Task Force, the authors have developed this two-part series to address generational issues present in academic emergency medicine (EM). Understanding generational characteristics and mitigating strategies can help address some common issues encountered in academic EM. Through recognition of the unique characteristics of each of the generations with respect to teaching and learning, mentoring, and technology, academicians have the opportunity to strategically optimize interactions with one another. PMID:21314779

  16. EM Talk: communication skills training for emergency medicine patients with serious illness.

    PubMed

    Grudzen, Corita R; Emlet, Lillian L; Kuntz, Joanne; Shreves, Ashley; Zimny, Erin; Gang, Maureen; Schaulis, Monique; Schmidt, Scott; Isaacs, Eric; Arnold, Robert

    2016-06-01

    The emergency department visit for a patient with serious illness represents a sentinel event, signalling a change in the illness trajectory. By better understanding patient and family wishes, emergency physicians can reinforce advance care plans and ensure the hospital care provided matches the patient's values. Despite their importance in care at the end of life, emergency physicians have received little training on how to talk to seriously ill patients and their families about goals of care. To expand communication skills training to emergency medicine, we developed a programme to give emergency medicine physicians the ability to empathically deliver serious news and to talk about goals of care. We have built on lessons from prior studies to design an intervention employing the most effective pedagogical techniques, including the use of simulated patients/families, role-playing and small group learning with constructive feedback from master clinicians. Here, we describe our evidence-based communication skills training course EM Talk using simulation, reflective feedback and deliberate practice. PMID:26762163

  17. Underwater medicine: a neglected area in Accident and Emergency specialist training.

    PubMed Central

    Braatvedt, G D; Mathew, B G; Corrall, R J

    1991-01-01

    We have evaluated the available medical care to sports divers by a postal questionnaire sent to consultants and senior registrars in Accident and Emergency medicine in the UK, assessing their training in underwater medicine. Replies were received from 60 of 96 consultants (63%) and 32 of 58 (55%) senior registrars. Thirty-two per cent of consultants and 50% of senior registrars had previous personal experience in managing an underwater diving accident. Thirty per cent of consultants and only 19% of senior registrars had prior formal postgraduate training in underwater medicine. Twenty-seven per cent of consultants and 13% of senior registrars replying did not know the pattern of referral for specialist advice nor where the nearest recompression chamber was to be found. We believe that more formal postgraduate training in underwater medicine is needed by A and E medical staff. Furthermore, clear guidelines about emergency management and patterns of referral for diving accidents should be displayed prominently in all A and E departments. PMID:1751890

  18. Essentials of Pediatric Emergency Medicine Fellowship: Part 3: Clinical Education and Experience.

    PubMed

    Mittiga, Matthew R; Nagler, Joshua; Eldridge, Charles D; Ishimine, Paul; Zuckerbraun, Noel S; McAneney, Constance M

    2016-07-01

    This article is the third in a 7-part series that aims to comprehensively describe the current state and future directions of pediatric emergency medicine fellowship training from the essential requirements to considerations for successfully administering and managing a program to the careers that may be anticipated upon program completion. This article focuses on the clinical aspects of fellowship training including the impact of the clinical environment, modalities for teaching and evaluation, and threats and opportunities in clinical education. PMID:27380607

  19. Tweeting the meeting: A comparative analysis of an Australian emergency medicine conference over four years

    PubMed Central

    Udovicich, Cristian; Barberi, Anthony; Perera, Kalpa

    2016-01-01

    Objective: Social media allows user-generated content and dialog between users and has also entered into the domain of healthcare. The purpose of this study was to compare the use of Twitter at the Australasian College of Emergency Medicine Annual Scientific Meeting (ACEM ASM) from 2011 to 2014 and analyze its ability to spread emergency medicine education. Materials and Methods: Retrospectively, TweetReach was utilized to analyze relevant tweets. Each Annual Scientific Meeting (ASM) had an associated Twitter account/s from, which data were collected. Duplicate tweets were excluded from the analysis. Information on the number of total tweets (regular tweets, retweets, and replies) and contributors was gathered. The potential audience, the reach, was calculated. Results: From 2011 to 2014 the number of tweets rose from 460 to 4694, a 920% increase. Only 54 Twitter users contributed to the 2011 ASM. This rose to 252 (2012), 291 (2013) and 572 (2014). The average number of tweets per contributor ranged from 8.2 to 10.9. The reach, the potential number of Twitter users exposed to posts, rose >30 times from 2011 (15,502 users) to 2014 (471,166). Conclusion: The use of Twitter at the ACEM ASM rose significantly from 2011 to 2014. It is a highly useful tool for the dissemination of emergency medicine education. Twitter has been harnessed by the ASM to enhance the conference experience by further generating interaction between delegates as well as those worldwide. PMID:26957823

  20. Lessons learned in public health emergency management: personal reflections.

    PubMed

    Kizer, K W

    2000-01-01

    Multiple environmental, ecological, and socio-political forces are converging to increase the occurrence of both natural and technological disasters. Ten forces are of most concern in this regard. These are: 1) global warming, with its consequent weather extremes and climate changes; 2) continued rapid human population growth and concomitant increased urbanization; 3) decreased bio-diversity and consequent ecological fragility; 4) deforestation and loss of natural habitat for animal species, with resultant greater overlap of human and animal habitats, human exposure to animal pathogens, and other ecological perturbations; 5) increased technological development throughout the world (especially in developing countries with their typically immature safety programs); 6) globalization and increased population mobility; 7) sub-national religious and ethnic conflicts, and their potential for conflict escalation and large scale displacement of populations; 8) the collapse of several major countries and consequent unraveling of national identity and social order; 9) the rise of terrorism; and 10) dramatic advances in the science and technology of computing, communications, biotechnology, and genomics. This paper describes 10 lessons learned relative to the public health aspects of emergency management, especially as they pertain to disasters. 1) Planning pays; 2) A bad situation can be made worse by inappropriate responses; 3) Most life saving interventions will occur before the disaster happens and immediately afterwards by local action; 4) Public health emergency management is not a democratic process; 5) Psychological impacts are usually greater than anticipated; 6) Communications and information management are vital, but often are the weak link in the response chain; 7) Collaboration and partnerships are essential; 8) Unsolicited volunteers and aid are inevitable and must be planned for and managed; 9) Never assume anything, and always expect the unexpected; and 10

  1. Osteopathic Medicine and Primary Care completes first year of publication.

    PubMed

    Licciardone, John C; Cardarelli, Roberto

    2008-01-01

    Osteopathic Medicine and Primary Care affords authors the opportunity for rapid and universal dissemination of their work. We are keen to receive author manuscripts and reader comments on articles during 2008. A journal fund has been established to offset the cost of article processing charges for eligible authors who submit qualified manuscripts. PMID:18218102

  2. Public-private collaborations and partnerships in stratified medicine: making sense of new interactions.

    PubMed

    Chataway, Joanna; Fry, Caroline; Marjanovic, Sonja; Yaqub, Ohid

    2012-09-15

    The field of personalised or stratified medicine is evolving alongside the formation of a plethora of public/private partnerships and collaborations. These new institutional forms, or 'social technologies', are varied and emerge in response to several drivers, including the need to draw on a broader base of data inputs relating to genomics, patient behaviour and healthcare system differentiation. This paper discusses some of these drivers of partnerships and collaborations. Although the number of such partnerships is growing, their rationale and basis for collaboration remains unclear. Public-private collaborations are at the core of the set of new life sciences policies in the UK but there is little indication in the policy documents of clear boundaries for these partnerships. In part, this is due to the lack of empirical evidence at the system level for conceptualising what is still a relatively new approach. The collection of evidence in the form of broad evaluations, rather than tightly focused theoretical studies, is more likely to be related back to systems and be of more use for formulating policy rationales. PMID:22446473

  3. [Emerging and re-emerging infectious diseases--a challenge for public health].

    PubMed

    Do, P H; Caumes, E; Bricaire, F

    2000-01-20

    We have recently seen a worldwide explosion of infectious diseases: emerging diseases like the HIV/AIDS pandemic, or old diseases like cholera, tuberculosis, diphteria, plague, yellow fever, dengue, or malaria. These reemerging diseases are on the surge because of multiple factors: environmental changes, transformation of ecosystems, ongoing socioeconomic degradation and deterioration of public health systems in many countries. The increasing bacterial resistance to antibiotics or virologic resistance to antiviral drugs are becoming a serious problem today. This global danger needs a global response. There must be a cooperation between the different actors in the field of public health. The general practitioner should look for good therapeutic compliance, control vaccinations, and give his patients health education, including prevention of HIV and other sexually transmitted diseases. PMID:10686805

  4. Preparedness and Emergency Response Research Centers: Using a Public Health Systems Approach to Improve All-Hazards Preparedness and Response

    PubMed Central

    Leinhos, Mary; Williams-Johnson, Mildred

    2014-01-01

    In 2008, at the request of the Centers for Disease Control and Prevention (CDC), the Institute of Medicine (IOM) prepared a report identifying knowledge gaps in public health systems preparedness and emergency response and recommending near-term priority research areas. In accordance with the Pandemic and All-Hazards Preparedness Act mandating new public health systems research for preparedness and emergency response, CDC provided competitive awards establishing nine Preparedness and Emergency Response Research Centers (PERRCs) in accredited U.S. schools of public health. The PERRCs conducted research in four IOM-recommended priority areas: (1) enhancing the usefulness of public health preparedness and response (PHPR) training, (2) creating and maintaining sustainable preparedness and response systems, (3) improving PHPR communications, and (4) identifying evaluation criteria and metrics to improve PHPR for all hazards. The PERRCs worked closely with state and local public health, community partners, and advisory committees to produce practice-relevant research findings. PERRC research has generated more than 130 peer-reviewed publications and nearly 80 practice and policy tools and recommendations with the potential to significantly enhance our nation's PHPR to all hazards and that highlight the need for further improvements in public health systems. PMID:25355970

  5. Emerging arboviruses and public health challenges in Brazil

    PubMed Central

    Lima-Camara, Tamara Nunes

    2016-01-01

    ABSTRACT Environmental modification by anthropogenic actions, disordered urban growth, globalization of international exchange and climate change are some factors that help the emergence and dissemination of human infectious diseases transmitted by vectors. This review discusses the recent entry of three arboviruses in Brazil: Chikungunya, West Nile, and Zika virus, focusing on the challenges for the Country’s public health. The Brazilian population is exposed to infections caused by these three arboviruses widely distributed on the national territory and associated with humans. Without effective vaccine and specific treatment, the maintainance and integration of a continuos entomological and epidemiological surveillance are important so we can set methods to control and prevent these arboviruses in the Country. PMID:27355468

  6. Electronic media, violence, and adolescents: an emerging public health problem.

    PubMed

    David-Ferdon, Corinne; Hertz, Marci Feldman

    2007-12-01

    Adolescents' access to and use of new media technology (e.g., cell phone, personal data assistant, computer for Internet access) are on the rise, and this explosion of technology brings with it potential benefits and risks. Attention is growing about the risk of adolescents to become victims of aggression perpetrated by peers with new technology. In September 2006, the Centers for Disease Control and Prevention convened a panel of experts in technology and youth aggression to examine this specific risk. This special issue of the Journal of Adolescent Health presents the data and recommendations for future directions discussed at the meeting. The articles in the Journal support the argument that electronic aggression is an emerging public health problem in need of additional prevalence and etiological research to support the development and evaluation of effective prevention programs. PMID:18047940

  7. Critical Care Medicine and Infectious Diseases: An Emerging Combined Subspecialty in the United States

    PubMed Central

    Kadri, Sameer S.; Rhee, Chanu; Fortna, Gregory S.; O'Grady, Naomi P.

    2015-01-01

    The recent rise in unfilled training positions among infectious diseases (ID) fellowship programs nationwide indicates that ID is declining as a career choice among internal medicine residency graduates. Supplementing ID training with training in critical care medicine (CCM) might be a way to regenerate interest in the specialty. Hands-on patient care and higher salaries are obvious attractions. High infection prevalence and antibiotic resistance in intensive care units, expanding immunosuppressed host populations, and public health crises such as the recent Ebola outbreak underscore the potential synergy of CCM-ID training. Most intensivists receive training in pulmonary medicine and only 1% of current board-certified intensivists are trained in ID. While still small, this cohort of CCM-ID certified physicians has continued to rise over the last 2 decades. ID and CCM program leadership nationwide must recognize these trends and the merits of the CCM-ID combination to facilitate creation of formal dual-training opportunities. PMID:25944345

  8. Optimizing global health experiences in emergency medicine residency programs: a consensus statement from the Council of Emergency Medicine Residency Directors 2011 Academic Assembly global health specialty track

    PubMed Central

    2012-01-01

    Background An increasing number of emergency medicine (EM) residency training programs have residents interested in participating in clinical rotations in other countries. However, the policies that each individual training program applies to this process are different. To our knowledge, little has been done in the standardization of these experiences to help EM residency programs with the evaluation, administration and implementation of a successful global health clinical elective experience. The objective of this project was to assess the current status of EM global health electives at residency training programs and to establish recommendations from educators in EM on the best methodology to implement successful global health electives. Methods During the 2011 Council of Emergency Medicine Residency Directors (CORD) Academic Assembly, participants met to address this issue in a mediated discussion session and working group. Session participants examined data previously obtained via the CORD online listserve, discussed best practices in global health applications, evaluations and partnerships, and explored possible solutions to some of the challenges. In addition a survey was sent to CORD members prior to the 2011 Academic Assembly to evaluate the resources and processes for EM residents’ global experiences. Results Recommendations included creating a global health working group within the organization, optimizing a clearinghouse of elective opportunities for residents and standardizing elective application materials, site evaluations and resident assessment/feedback methods. The survey showed that 71.4% of respondents have global health partnerships and electives. However, only 36.7% of programs require pre-departure training, and only 20% have formal competency requirements for these global health electives. Conclusions A large number of EM training programs have global health experiences available, but these electives and the trainees may benefit from

  9. Public health and complex emergencies: new issues, new conditions.

    PubMed Central

    Waldman, R; Martone, G

    1999-01-01

    Public health practice in complex emergencies has become increasingly sophisticated and well informed over the course of the past quarter century. Humanitarian relief organizations have learned many lessons in the areas of food, water and sanitation, shelter, and primary health. However, closer scrutiny from the media and funding agencies, together with changing conditions and an increasingly insecure environment, will require that changes be made. First and foremost, nongovernmental organizations must recognize that an increasing proportion of morbidity and mortality is the consequence of widespread human rights abuses. These organizations should become more familiar with international human rights and humanitarian law, and their personnel should receive clear guidance as to how to recognize and report violations. At the same time, nongovernmental organizations will have to work more closely with military forces that have a very different organizational culture. In addition, as emergencies become more complex, nongovernmental organizations should do more to attract and retain seasoned professionals. Finally, advances in both technical and operational areas will occur only through carefully designed and implemented research. PMID:10511827

  10. The Women in Emergency Medicine Mentoring Program: An Innovative Approach to Mentoring

    PubMed Central

    Welch, Julie L.; Jimenez, Heather L.; Walthall, Jennifer; Allen, Sheryl E.

    2012-01-01

    Background Women in medicine report many gender-specific barriers to their career success and satisfaction, including a lack of mentors and role models. The literature calls for innovative strategies to enhance mentorship for women in medicine. Objective To describe the content, perceived value, and ongoing achievements of a mentoring program for women in emergency medicine. Methods The program offered mentoring for female faculty and residents in an academic emergency medicine department. Volunteers participated in group mentoring sessions using a mosaic of vertical and peer mentoring. Sessions focused on topics specific to women in medicine. An anonymous, electronic survey was sent to women who participated during 2004–2010 to assess the perceived value of the program and to collect qualitative feedback. Preliminary achievements fulfilling the program's goals were tracked. Results A total of 46 women (64%) completed the survey. The results showed a positive perceived value of the program (average, 4.65 on a 5-point Likert scale) in providing mentors and role models (4.41), in offering a supportive environment (4.39), in providing discussions pertinent to both personal (4.22) and professional development (4.22), while expanding networking opportunities (4.07). Notable achievements included work on the creation of a family leave policy, establishing lactation space, collaboration on projects, awards, and academic advancement. Conclusion This innovative model for mentoring women is perceived as a valuable asset to the academic department and residency. It offers the unique combination of expanding a female mentor pool by recruiting alumni and using a mosaic of vertical and peer mentoring. PMID:23997883

  11. Road Traffic Accident: An Emerging Public Health Problem in Assam

    PubMed Central

    Bhuyan, Pranab Jyoti; Ahmed, Faruquddin

    2013-01-01

    Background: In the northern states, there is hardly any scientific study except road traffic accidents (RTAs) statistics obtained by the Ministry of Home whereas the main way of transportation is by road. There is the increasing load of motor vehicles on the already dilapidated roadways which has resulted in the increasing trend of RTAs in Assam. Objectives: To find out the prevalence, probable epidemiological factors and morbidity and mortality pattern due to RTAs in Dibrugarh district. Materials and Methods: Descriptive study was carried out in Dibrugarh district from September 1998 to August 1999 under the department of Community Medicine. The information was collected from Assam Medical College and Hospital and cross checked with the police report. A medical investigation including interview, clinical and radiological investigation was carried out; in case of fatality, post-mortem examination was examined in details. An on the spot investigation was carried out in accessible RTAs to collect the probable epidemiological factors. Results: RTAs affected mainly the people of productive age group which were predominantly male. Majority of the RTAs were single vehicle accidents and half of the victims were passengers. Accident rate was maximum in twilight and winter season demanding high morbidity and mortality. Head and neck, U.limb and L.limb were commonly involved. Conclusion: RTAs is a major public health problem in Assam which needs more scientific study. PMID:23878423

  12. Community Assessment Tool for Public Health Emergencies Including Pandemic Influenza

    SciTech Connect

    ORAU's Oak Ridge Institute for Science Education

    2011-04-14

    The Community Assessment Tool (CAT) for Public Health Emergencies Including Pandemic Influenza (hereafter referred to as the CAT) was developed as a result of feedback received from several communities. These communities participated in workshops focused on influenza pandemic planning and response. The 2008 through 2011 workshops were sponsored by the Centers for Disease Control and Prevention (CDC). Feedback during those workshops indicated the need for a tool that a community can use to assess its readiness for a disaster - readiness from a total healthcare perspective, not just hospitals, but the whole healthcare system. The CAT intends to do just that - help strengthen existing preparedness plans by allowing the healthcare system and other agencies to work together during an influenza pandemic. It helps reveal each core agency partners (sectors) capabilities and resources, and highlights cases of the same vendors being used for resource supplies (e.g., personal protective equipment [PPE] and oxygen) by the partners (e.g., public health departments, clinics, or hospitals). The CAT also addresses gaps in the community's capabilities or potential shortages in resources. This tool has been reviewed by a variety of key subject matter experts from federal, state, and local agencies and organizations. It also has been piloted with various communities that consist of different population sizes, to include large urban to small rural communities.

  13. Public Private Partnerships for Emergency Obstetric Care: Lessons from Maharashtra

    PubMed Central

    Chaturvedi, Sarika; Randive, Bharat

    2011-01-01

    Background: The National Rural Health Mission of India advocates public private partnerships (PPPs) to meet its “service guarantee” of Emergency obstetric care (EmOC) provision. The Janani Suraksha Yojana (JSY) has a provision of Rs. 1500 for contracting in obstetric specialists. Objectives: The study aimed to understand the issues in the design and implementation of the PPPs for EmOC under the JSY in Maharashtra and how they affect the availability of EmOC services to women. Materials and Methods: A cross-sectional study using the rapid assessment approach was conducted in Ahmednagar district of Maharashtra spanning 1-year duration ending in June 2009. Primary data were obtained through interviews with women, providers, and administrators at various levels. Data were analyzed thematically. Results: The PPP scheme for EmOC is restricted to deliveries by Caesarean section.The administrators prefer subsidization of costs for services in private facilities to contracting in. There are no PPPs executed in the study district. This study identifies barriers to women in accessing the benefit and the difficulties faced by administrators in implementing the scheme. Conclusion: The PPPs for EmOC under the JSY have minimally influenced the out-of-pocket payments for EmOC. Infrastructural inadequacies and passive support of the implementers are major barriers to the implementation of contracting-in model of PPPs. Capacities in the public health system are inadequate to design and manage PPPs. PMID:21687376

  14. Transnational medicine in public arenas: AIDS treatments in the South.

    PubMed

    Dodier, Nicolas

    2005-09-01

    This article looks at the AIDS-related controversy surrounding the experiments on and the availability of medicines in southern countries. It situates these debates in a longer-term history of transnational medicine. It highlights the rise of international therapeutic modernity at the beginning of the 1990s, based on the strict regulation of clinical trials and on the formalization of the international ethical rules governing experiments. This rise helped to change radically the reception of experiments conducted in southern countries around AIDS. With regard to this new ethics applied to clinical trials in southern countries, this article goes on to demonstrate the confrontation at the end of the 1990s between two different approaches to the universalization of healthcare. Finally, it shows how new laws on international trade have reinitiated this confrontation. Through this story, the article suggests in what sense the study of the political transformations of transnational medicine could offer a new field of investigation for the social sciences. PMID:16404688

  15. [Organizational forms of emergency medicine from the perspective of DIVI. Discipline-specific or interdisciplinary?].

    PubMed

    Quintel, M; Kumle, B

    2011-04-01

    Modern processes in the organization in German hospitals are decisive to the development of emergency departments and as these represent the interface between outpatient and inpatient care, they have been identified as a strategic success factor. In larger hospitals emergency departments are generally run as independent units with their own management. The growing number of patients in emergency rooms each year demonstrates the future importance of these structures and successful hospital management has to face and handle this challenge. Clear job profiles for the leadership, staff members and structures of these units are needed. This article highlights the requirements for these structures from the perspective of the German Interdisciplinary Association of Critical Care Medicine (DIVI). PMID:21424295

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

    PubMed

    Miles, Andrew

    2013-01-01

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

  17. How we developed a comprehensive resuscitation-based simulation curriculum in emergency medicine.

    PubMed

    Dagnone, Jeffrey Damon; McGraw, Robert; Howes, Daniel; Messenger, David; Bruder, Eric; Hall, Andrew; Chaplin, Timothy; Szulewski, Adam; Kaul, Tom; O'Brien, Terrence

    2016-01-01

    Over the past decade, simulation-based education has emerged as a new and exciting adjunct to traditional bedside teaching and learning. Simulation-based education seems particularly relevant to emergency medicine training where residents have to master a very broad skill set, and may not have sufficient real clinical opportunities to achieve competence in each and every skill. In 2006, the Emergency Medicine program at Queen's University set out to enhance our core curriculum by developing and implementing a series of simulation-based teaching sessions with a focus on resuscitative care. The sessions were developed in such as way as to satisfy the four conditions associated with optimum learning and improvement of performance; appropriate difficulty of skill, repetitive practice, motivation, and immediate feedback. The content of the sessions was determined with consideration of the national training requirements set out by the Royal College of Physicians & Surgeons of Canada. Sessions were introduced in a stepwise fashion, starting with a cardiac resuscitation series based on the AHA ACLS guidelines, and leading up to a more advanced resuscitation series as staff became more adept at teaching with simulation, and as residents became more comfortable with this style of learning. The result is a longitudinal resuscitation curriculum that begins with fundamental skills of resuscitation and crisis resource management (CRM) in the first 2 years of residency and progresses through increasingly complex resuscitation cases where senior residents are expected to play a leadership role. This paper documents how we developed, implemented, and evaluated this resuscitation-based simulation curriculum for Emergency Medicine postgraduate trainees, with discussion of some of the challenges encountered. PMID:25410350

  18. PACS workstations in the emergency department: impact on workflow in radiology and emergency medicine

    NASA Astrophysics Data System (ADS)

    Horii, Steven C.; Kundel, Harold L.; Redfern, Regina O.; Lowe, Robert A.; Nodine, Calvin F.; Abbuhl, Stephanie B.; Phelan, Megan; Arnold, Deborah; Myers, Melissa; Brikman, Inna; Mezrich, Reuben S.

    2000-05-01

    A study of timings of different events from the scheduling of an Emergency Department (ED) examination to the final reporting of it and review by the ED physician showed some expected and unexpected findings. Both computed radiography (CR) on film and CR using PACS were studied. The move of daytime reading of ED radiographs out of the Radiology reading area in the ED to a reading room in Radiology lengthened the time from when the request was sent to the time when the images were reviewed by the ED physician (1.02 hours to 1.29 hours). Despite anecdotal reports of increased reading time at workstations, the radiologists' use of PACS for reading ED radiographs resulted in a slight improvement in the time between the examination completion and report dictation (0.43 hours to 0.3 hours). Recently, we have found that there may be a workload effect on this time and this is presently being analyzed. The time from the sending of the request for an examination to the first review of the images by the ED physician was shortened with implementation of a PACS workstation in the clinical area of the ED (1.35 hours to 0.92 hours). A surprising finding was the impact the change to PACS had on the time between sending the request and the technologist's completion of the requested examination. The time increased with PACS from 0.45 hours for film-based CR to 0.8 hours for PACS. Several studies are ongoing to determine the causes of this increase.

  19. 78 FR 19357 - Allocation of Public Transportation Emergency Relief Funds in Response to Hurricane Sandy

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-29

    ... Federal Transit Administration Allocation of Public Transportation Emergency Relief Funds in Response to...,000 under the Public Transportation Emergency Relief Program (Emergency Relief Program, Catalogue of... Funds published in the Federal Register on February 6, 2013 (78 FR 8691), and consistent with...

  20. [First scientific research and publications on occupational medicine in Russia].

    PubMed

    Shigan, E E

    2016-01-01

    The article covers data on first in Russian Empire research works and publications on workers' health, occupation-related diseases occurrence, prevention and treatment of such diseases, prophylactic methods. PMID:27164753

  1. A bibliometric study of publication patterns in access to medicines research in developing countries

    PubMed Central

    Ritz, Lindsay Sarah; Adam, Taghreed; Laing, Richard

    2010-01-01

    Objectives: Developing countries face considerable problems in both accessing and properly utilizing essential medicines. One challenge to achieving these goals in resource-poor settings is a limited knowledge base as to what works to improve the selection, access and use of essential medicines including; ways to ensure affordable prices, increase sustainable financing, and strengthen reliable supply systems that are relevant to these settings. The objective of this study was to search the existing evidence base on access to medicine issues in developing countries and to assess publication patterns regarding the nature of topics studied, areas where gaps of information exist and the general trends in publications in this area. Methods: A PubMed search was conducted to retrieve publications on access to medicines in developing countries between 1999-2008. Our search strategy builds and expands on a search strategy developed for a Cochrane review to include a wider range of topics related to access to medicines and pharmaceutical policy. Retrieved articles were categorized by research topics, year of publication, study area, and country of residence of corresponding author to establish patterns in publications with respect to these categories over the past 10 years. Results: Medicine selection, intellectual property rights, and monitoring and quality assurance were among the top topics studied over the last 10 years. Corresponding authors residing in high-income countries represented around 50% of all publications relative to low-income (18%) and middle-income countries (32%). Although an increasing trend in the number of publications per year was found, the increase was relatively small and variable over a 10-year period. Conclusions: There are few peer-reviewed publications on access to medicines in developing countries with an average of only 76 publications per year over the past 10 years. Increasing the local evidence base as to what works to improve access to

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

    PubMed

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

    2015-08-01

    The number of online resources read by and pertinent to clinicians has increased dramatically. However, most healthcare professionals still use mainstream search engines as their primary port of entry to the resources on the Internet. These search engines use algorithms that do not make it easy to find clinician-oriented resources. FOAMSearch, a custom search engine (CSE), was developed to find relevant, high-quality online resources for emergency medicine and critical care (EMCC) clinicians. Using Google™ algorithms, it searches a vetted list of >300 blogs, podcasts, wikis, knowledge translation tools, clinical decision support tools and medical journals. Utilisation has increased progressively to >3000 users/month since its launch in 2011. Further study of the role of CSEs to find medical resources is needed, and it might be possible to develop similar CSEs for other areas of medicine. PMID:25939364

  3. Public-private partnerships in translational medicine: concepts and practical examples.

    PubMed

    Luijten, Peter R; van Dongen, Guus A M S; Moonen, Chrit T; Storm, Gert; Crommelin, Daan J A

    2012-07-20

    The way forward in multidisciplinary research according to former NIH's director Elias Zerhouni is to engage in predictive, personalized, preemptive and participatory medicine. For the creation of the optimal innovation climate that would allow for such a strategy, public-private partnerships have been widely proposed as an important instrument. Public-private partnerships have become an important instrument to expedite translational research in medicine. The Netherlands have initiated three large public-private partnerships in the life sciences and health area to facilitate the translation of valuable basic scientific concepts to new products and services in medicine. The focus of these partnerships has been on drug development, improved diagnosis and regenerative medicine. The Dutch model of public-private partnership forms the blueprint of a much larger European initiative called EATRIS. This paper will provide practical examples of public-private partnerships initiated to expedite the translation of new technology for drug development towards the clinic. Three specific technologies are in focus: companion diagnostics using nuclear medicine, the use of ultra high field MRI to generate sensitive surrogate endpoints based on endogenous contrast, and MRI guidance for High Intensity Focused Ultrasound mediated drug delivery. PMID:22465390

  4. Post-war Kosovo: Part 2. Assessment of emergency medicine leadership development strategy.

    PubMed

    Eliades, M J; Lis, J; Barbosa, J; VanRooyen, M J

    2001-01-01

    Since the return of the refugee population to Kosovo, attempts at development of an emergency medical system in Kosovo have met with varied success, and have been hampered by unforeseen barriers. These barriers have been exacerbated by the lack of detailed health system assessments. A multimodal approach of data collection and analysis was used to identify potential barriers, and determine the appropriate level of intervention for emergency medicine (EM) development in Kosovo. The four step, multi-modal, data collection tool utilized: 1) demographic and health systems data; 2) focus group discussions with health-care workers; 3) individual interviews with key individuals in EM development; and 4) Q-Analysis of the attitudes and opinions of EM leaders. Results indicated that Emergency Medicine in Kosovo is under-developed. This method of combined quantitative and qualitative analysis identified a number of developmental needs in the Kosovar health system. There has been little formal training, the EMS system lacks organization, equipment, and a reliable communication system, and centralized emergency centers, other than the center at Prishtina Hospital, are inadequate. Group discussions and interviews support the desire by Kosovar health-care workers to establish EM, and highlight a number of concerns. A Q-methodology analysis of the attitudes of potential leaders in the field, supported these concerns and identified two attitudinal groups with deeper insights into their opinions on the development of such a system. This study suggests that a multi-modal assessment of health systems can provide important information about the need for emergency health system improvements in Kosovo. This methodology may serve as a model for future, system-wide assessments in post-conflict health system reconstruction. PMID:12090209

  5. Racial and ethnic disparities in the clinical practice of emergency medicine.

    PubMed

    Richardson, Lynne D; Babcock Irvin, Charlene; Tamayo-Sarver, Joshua H

    2003-11-01

    There is convincing evidence that racial and ethnic disparities exist in the provision of health care, including the provision of emergency care; and that stereotyping, biases, and uncertainty on the part of health care providers all contribute to unequal treatment. Situations, such as the emergency department (ED), that are characterized by time pressure, incomplete information, and high demands on attention and cognitive resources increase the likelihood that stereotypes and bias will affect diagnostic and treatment decisions. It is likely that there are many as-yet-undocumented disparities in clinical emergency practice. Racial and ethnic disparities may arise in decisions made by out-of-hospital personnel regarding ambulance destination, triage assessments made by nursing personnel, diagnostic testing ordered by physicians or physician-extenders, and in disposition decisions. The potential for disparate treatment includes the timing and intensity of ED therapy as well as patterns of referral, prescription choices, and priority for hospital admission and bed assignment. At a national roundtable discussion, strategies suggested to address these disparities included: increased use of evidence-based clinical guidelines; use of continuous quality improvement methods to document individual and institutional disparities in performance; zero tolerance for stereotypical remarks in the workplace; cultural competence training for emergency providers; increased workforce diversity; and increased epidemiologic, clinical, and services research. Careful scrutiny of the clinical practice of emergency medicine and diligent implementation of strategies to prevent disparities will be required to eliminate the individual behaviors and systemic processes that result in the delivery of disparate care in EDs. PMID:14597493

  6. A new entity for the negotiation of public procurement prices for patented medicines in Mexico

    PubMed Central

    Wirtz, Veronika J; Reich, Michael R; Terrazas, Paulina; Ortiz, Maki

    2012-01-01

    Abstract Problem As countries expand health insurance coverage, their expenditures on medicines increase. To address this problem, WHO has recommended that every country draw up a list of essential medicines. Although most medicines on the list are generics, in many countries patented medicines represent a substantial portion of pharmaceutical expenditure. Approach To help control expenditure on patented medicines, in 2008 the Mexican Government created the Coordinating Commission for Negotiating the Price of Medicines and other Health Inputs (CCPNM), whose role, as the name suggests, is to enter into price negotiations with drug manufacturers for patented drugs on Mexico’s list of essential medicines. Local setting Mexico’s public expenditure on pharmaceuticals has increased substantially in the past decade owing to government efforts to achieve universal health-care coverage through Seguro Popular, an insurance programme introduced in 2004 that guarantees access to a comprehensive package of health services and medicines. Relevant changes Since 2008, the CCPNM has improved procurement practices in Mexico’s public health institutions and has achieved significant price reductions resulting in substantial savings in public pharmaceutical expenditure. Lessons learnt The CCPNM has successfully changed the landscape of price negotiation for patented medicines in Mexico. However, it is also facing challenges, including a lack of explicit indicators to assess CCPNM performance; a shortage of permanent staff with sufficient technical expertise; poor coordination among institutions in preparing background materials for the annual negotiation process in a timely manner; insufficient communication among committees and institutions; and a lack of political support to ensure the sustainability of the CCPNM. PMID:23109747

  7. 77 FR 74024 - Notice of Proposed Information Collection for Public Comment; Emergency Solutions Grant Data...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-12

    ... URBAN DEVELOPMENT Notice of Proposed Information Collection for Public Comment; Emergency Solutions...: Emergency Solutions Grants Program Record Keeping Requirements. Description of the need for the information... Solutions Grants (ESG) program recipients will be expected to implement and retain. This submission...

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

    PubMed Central

    Stoneking, LR; Waterbrook, AL; Garst Orozco, J; Johnston, D; Bellafiore, A; Davies, C; Nuño, T; Fatás-Cabeza, J; Beita, O; Ng, V; Grall, KH; Adamas-Rappaport, W

    2016-01-01

    Background After emergency department (ED) discharge, Spanish-speaking patients with limited English proficiency are less likely than English-proficient patients to be adherent to medical recommendations and are more likely to be dissatisfied with their visit. Objectives To determine if integrating a longitudinal medical Spanish and cultural competency curriculum into emergency medicine residency didactics improves patient satisfaction and adherence to medical recommendations in Spanish-speaking patients with limited English proficiency. Methods Our ED has two Emergency Medicine Residency Programs, University Campus (UC) and South Campus (SC). SC program incorporates a medical Spanish and cultural competency curriculum into their didactics. Real-time Spanish surveys were collected at SC ED on patients who self-identified as primarily Spanish-speaking during registration and who were treated by resident physicians from both residency programs. Surveys assessed whether the treating resident physician communicated in the patient’s native Spanish language. Follow-up phone calls assessed patient satisfaction and adherence to discharge instructions. Results Sixty-three patients self-identified as primarily Spanish-speaking from August 2014 to July 2015 and were initially included in this pilot study. Complete outcome data were available for 55 patients. Overall, resident physicians spoke Spanish 58% of the time. SC resident physicians spoke Spanish with 66% of the patients versus 45% for UC resident physicians. Patients rated resident physician Spanish ability as very good in 13% of encounters – 17% for SC versus 5% for UC. Patient satisfaction with their ED visit was rated as very good in 35% of encounters – 40% for SC resident physicians versus 25% for UC resident physicians. Of the 13 patients for whom Spanish was the language used during the medical encounter who followed medical recommendations, ten (77%) of these encounters were with SC resident physicians

  9. Travel medicine physician adherence to guidelines for the emergency self treatment of malaria.

    PubMed

    Flaherty, Gerard T; Walden, Lucas M; Townend, Michael

    2016-05-01

    Few studies have examined emergency self treatment (EST) antimalarial prescribing patterns. 110 physician-members of the Travel Medicine Society of Ireland and British Global and Travel Health Association participated in this study. There was a trend towards the prescription of EST for travel to remote low-risk malaria areas; for long-term residents living in low-risk areas; and for frequent travellers to low-risk areas. This study provides insights into the use of EST in travellers' malaria. PMID:27279126

  10. Ethics and public health emergencies: restrictions on liberty.

    PubMed

    Wynia, Matthew K

    2007-02-01

    Responses to public health emergencies can entail difficult decisions about restricting individual liberties to prevent the spread of disease. The quintessential example is quarantine. While isolating sick patients tends not to provoke much concern, quarantine of healthy people who only might be infected often is controversial. In fact, as the experience with severe acute respiratory syndrome (SARS) shows, the vast majority of those placed under quarantine typically don't become ill. Efforts to enforce involuntary quarantine through military or police powers also can backfire, stoking both panic and disease spread. Yet quarantine is part of a limited arsenal of options when effective treatment or prophylaxis is not available, and some evidence suggests it can be effective, especially when it is voluntary, home-based and accompanied by extensive outreach, communication and education efforts. Even assuming that quarantine is medically effective, however, it still must be ethically justified because it creates harms for many of those affected. Moreover, ethical principles of reciprocity, transparency, non-discrimination and accountability should guide any implementation of quarantine. PMID:17366181

  11. Saving lives: a computer simulation game for public education about emergencies

    SciTech Connect

    Morentz, J.W.

    1985-01-01

    One facet of the Information Revolution in which the nation finds itself involves the utilization of computers, video systems, and a variety of telecommunications capabilities by those who must cope with emergency situations. Such technologies possess a significant potential for performing emergency public education and transmitting key information that is essential for survival. An ''Emergency Public Information Competitive Challenge Grant,'' under the aegis of the Federal Emergency Management Agency (FEMA), has sponsored an effort to use computer technology - both large, time-sharing systems and small personal computers - to develop computer games which will help teach techniques of emergency management to the public at large. 24 references.

  12. School Emergency Preparedness in North Dakota Public School Districts

    ERIC Educational Resources Information Center

    Swiontek, Steven Wayne

    2009-01-01

    The basis for this study was to determine: (1) If school districts in North Dakota have an emergency response plan; (2) How comprehensive their emergency response plan is; (3) How well prepared school districts in North Dakota are for any type of disaster; and (4) The extent to which North Dakota LEAD Center school emergency response training and…

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

    PubMed Central

    DelliFraine, Jami; Langabeer, James; King, Brent

    2010-01-01

    Objective To assess academic emergency medicine (EM) chairs’ perceptions of quality improvement (QI) training programs. Methods A voluntary anonymous 20 item survey was distributed to a sample of academic chairs of EM through the Association of Academic Chairs of Emergency Medicine. Data was collected to assess the percentage of academic emergency physicians who had received QI training, the type of training they received, their perception of the impact of this training on behavior, practice and outcomes, and any perceived barriers to implementing QI programs in the emergency department. Results The response rate to the survey was 69% (N = 59). 59.3% of respondents report that their hospital has a formal QI program for physicians. Chairs received training in a variety of QI programs. The type of QI program used by respondents was perceived as having no impact on goals achieved by QI (χ2 = 12.382; p = 0.260), but there was a statistically significant (χ2 = 14.383; p = 0.006) relationship between whether or not goals were achieved and academic EM chairs’ perceptions about return on investment for QI training. Only 22% of chairs responded that they have already made changes as a result of the QI training. 78.8% of EM chairs responded that quality programs could have a significant positive impact on their practice and the healthcare industry. Chairs perceived that QI programs had the most potential value in the areas of understanding and reducing medical errors and improving patient flow and throughput. Other areas of potential value of QI include improving specific clinical indicators and standardizing physician care. Conclusion Academic EM chairs perceived that QI programs were an effective way to drive needed improvements. The results suggest that there is a high level of interest in QI but a low level of adoption of training and implementation. PMID:21293770

  14. Clinical medicine, public health and ecological health: a new basis for education and prevention?

    PubMed Central

    Schaller, Bernhard; Sandu, Nora

    2011-01-01

    In contrast to public health and the resolution to further increase the health care of the whole community in regions worldwide, current clinical medicine has its limits. Further improvement in public health – rather than individual diseases – can only be achieved by integrating new views into treatment. Some years ago, the concept of biopsychosocial medicine was integrated into patient treatment and is now generally accepted. Therefore the author describes here a new dimension to treatment and presents substantial evidence to include ecological health in this already existing concept. The problem of community education is discussed. PMID:22291784

  15. Emerging arboviruses and public health challenges in Brazil.

    PubMed

    Lima-Camara, Tamara Nunes

    2016-06-27

    Environmental modification by anthropogenic actions, disordered urban growth, globalization of international exchange and climate change are some factors that help the emergence and dissemination of human infectious diseases transmitted by vectors. This review discusses the recent entry of three arboviruses in Brazil: Chikungunya, West Nile, and Zika virus, focusing on the challenges for the Country's public health. The Brazilian population is exposed to infections caused by these three arboviruses widely distributed on the national territory and associated with humans. Without effective vaccine and specific treatment, the maintainance and integration of a continuos entomological and epidemiological surveillance are important so we can set methods to control and prevent these arboviruses in the Country. RESUMO A modificação do ambiente por ações antrópicas, o crescimento urbano desordenado, o processo de globalização do intercâmbio internacional e as mudanças climáticas são alguns fatores que vêm facilitando a emergência e disseminação de doenças infecciosas humanas transmitidas por vetores. Este comentário aborda a recente entrada de três arbovírus no Brasil, Chikungunya (CHIKV), West Nile (WNV) e Zika (ZIKV), com enfoque nos desafios para a Saúde Pública do País. Transmitidos por mosquitos vetores amplamente distribuídos no território nacional e associados ao homem, a população brasileira encontra-se exposta à infecção por esses três arbovírus. Na ausência de vacina eficaz e tratamento específico, são importantes a manutenção e integração de uma vigilância entomológica e epidemiológica contínua, a fim de direcionarmos métodos de controle e prevenção contra essas arboviroses no País. PMID:27355468

  16. 75 FR 80503 - Emergency Clearance; Public Information Collection Requirements Submitted to the Office of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-22

    ... HUMAN SERVICES Emergency Clearance; Public Information Collection Requirements Submitted to the Office of Management and Budget (OMB) AGENCY: Office of Consumer Information and Insurance Oversight, HHS... Human Services, is publishing the following summary of proposed collections for public...

  17. 75 FR 70928 - Emergency Clearance: Public Information Collection Requirements Submitted to the Office of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-19

    ... HUMAN SERVICES Centers for Medicare and Medicaid Services Emergency Clearance: Public Information... and Human Services, is publishing the following summary of proposed collections for public comment... Strategic Operations and Regulatory Affairs, Division of Regulations Development, Attention:...

  18. Emerging Infectious Diseases in 2012: 20 Years after the Institute of Medicine Report

    PubMed Central

    Morens, David M.; Fauci, Anthony S.

    2012-01-01

    ABSTRACT Twenty years ago (1992), a landmark Institute of Medicine report entitled “Emerging Infections: Microbial Threats to Health in the United States” underscored the important but often underappreciated concept of emerging infectious diseases (EIDs). A review of the progress made and setbacks experienced over the past 2 decades suggests that even though many new diseases have emerged, such as SARS (severe acute respiratory syndrome) and the 2009 pandemic influenza, significant advances have occurred in EID control, prevention, and treatment. Among many elements of the increase in the capacity to control EIDs are genomics-associated advances in microbial detection and treatment, improved disease surveillance, and greater awareness of EIDs and the complicated variables that underlie emergence. In looking back over the past 20 years, it is apparent that we are in a time of great change in which both the challenge of EIDs and our responses to them are being transformed. Recent advances support guarded optimism that further breakthroughs lie ahead. PMID:23232716

  19. E-learning as educational tool in emergency and disaster medicine teaching.

    PubMed

    Della Corte, F; La Mura, F; Petrino, R

    2005-05-01

    E-learning is a new project for education based on the adoption of new computerised, multimedia and telematic technologies. Its application has deeply changed the concept of a teacher-based teaching to a student-centred educational project. It offers a great flexibility in the educational methodology, in the administration of contents, in the synchronous and/or asynchronous interaction between teachers and students, in the organisation and in the structure of the course, in the educational plans, in the support, the tracking and the evaluation of the student. E-learning could represent a great resource and a possible revolution in the concept of education and in the field of medical education as well. In some specific fields of application, as Emergency and Disaster Medicine, where the interaction between the student, the teacher and the patient, even if of great importance, are difficult to obtain in a quiet setting and have a lot of organizing, technical and economic troubles, e-learning approach could find a fertile field of application. In this paper we present a new program of educational activities we started in the field of Emergency and Disaster Medicine together with a review of the history of the instructional design and related technologies, ranging from the development of computer aided instruction to modern e-learning applications as teaching methodologies, and their impact on pedagogic and operative aspects. PMID:15834347

  20. Improving interunit transitions of care between emergency physicians and hospital medicine physicians: a conceptual approach.

    PubMed

    Beach, Christopher; Cheung, Dickson S; Apker, Julie; Horwitz, Leora I; Howell, Eric E; O'Leary, Kevin J; Patterson, Emily S; Schuur, Jeremiah D; Wears, Robert; Williams, Mark

    2012-10-01

    Patient care transitions across specialties involve more complexity than those within the same specialty, yet the unique social and technical features remain underexplored. Further, little consensus exists among researchers and practitioners about strategies to improve interspecialty communication. This concept article addresses these gaps by focusing on the hand-off process between emergency and hospital medicine physicians. Sensitivity to cultural and operational differences and a common set of expectations pertaining to hand-off content will more effectively prepare the next provider to act safely and efficiently when caring for the patient. Through a consensus decision-making process of experienced and published authorities in health care transitions, including physicians in both specialties as well as in communication studies, the authors propose content and style principles clinicians may use to improve transition communication. With representation from both community and academic settings, similarities and differences between emergency medicine and internal medicine are highlighted to heighten appreciation of the values, attitudes, and goals of each specialty, particularly pertaining to communication. The authors also examine different communication media, social and cultural behaviors, and tools that practitioners use to share patient care information. Quality measures are proposed within the structure, process, and outcome framework for institutions seeking to evaluate and monitor improvement strategies in hand-off performance. Validation studies to determine if these suggested improvements in transition communication will result in improved patient outcomes will be necessary. By exploring the dynamics of transition communication between specialties and suggesting best practices, the authors hope to strengthen hand-off skills and contribute to improved continuity of care. PMID:23035952

  1. [Responsibilities of the German public health service with regard to environmental medicine].

    PubMed

    Thriene, B; Oppermann, H

    2005-10-01

    In 1999, the Special Committee for Environmental Medicine affiliated to the Federal Association of Doctors in the German public health service, prepared a consensus paper on the latter's request entitled "Environmental medicine in the public health service -- a social role and its consequences: propositions with regard to the situation, aims, strategies, and opportunities for action". The propositions provide guidelines to public health departments for implementing the "Environment and Health" action programme launched by the Federal Ministry of Environmental Protection and the Federal Ministry of Health. Joint action by health and environmental authorities on the municipal, state and federal levels is considered essential. Furthermore, the comprehensive knowledge and expertise available within the public health service, including its in-depth knowledge of local and regional environmental pollution, should be further utilized in order to clarify cause and effect relationships and to initiate necessary action for minimizing any imminent risks. Environment-related public health protection is one of the major responsibilities of the public health departments within their general responsibility to provide public health care and ensure disease prevention. Doctors in private practices specializing in environmental medicine and public health departments' counselling centres for environmental medicine work closely together in terms of patient care and citizens' counselling in order to identify potential causes of environment-related health problems in the population. They issue recommendations on how to live a healthy life. Furthermore, they utilize available data and information for health policy directions. In this regard, health and environmental findings provide an important basis for an appropriate response to current developments based on the correct assessment of a particular situation, and for raising public awareness of preventive measures. PMID:16172787

  2. [Changes in public health awareness of traditional Chinese medicine in Shanghai in the late Qing Dynasty].

    PubMed

    Xiao, Mei-hua; Tang, Xiao-juan

    2011-06-01

    Public health awareness existed in the practice of traditional Chinese medicine (TCM) long ago. In the process of Shanghai's modernization and in competition with Western medicine, TCM in Shanghai has gradually accepted the modern public health awareness, fostering its strengths, circumventing its weaknesses and playing an important role in the local public health service. To study the vicissitude of TCM public health awareness at this time will be helpful to further understand the modern history of TCM and also provide useful reference for further participation of TCM in modern public health enterprise. In this paper, the authors used literature analysis and historical research to analyze the medical practice and writings of representative TCM practitioners, medical groups and journals. The results showed that the public health awareness of TCM in Shanghai has evolved from its traditional pattern to the modern pattern seen today; the traditional pattern was characterized by individual health care and some degree of medical collaboration, whereas the modern pattern is characterized by public health education. This process was propelled forward throughout by intense national spirit. TCM has made significant contributions to the local public health service in Shanghai in the late Qing Dynasty, which promoted the modernization of public health awareness of TCM in the People's Republic of China. The authors also found that one of the ways of modernizing TCM is to diversify the ways of publicizing TCM and make it easily understood, which can shed a new light on promoting the development of TCM. PMID:21669173

  3. A report on the Academic Emergency Medicine 2015 consensus conference "Diagnostic imaging in the emergency department: a research agenda to optimize utilization".

    PubMed

    Gunn, Martin L; Marin, Jennifer R; Mills, Angela M; Chong, Suzanne T; Froemming, Adam T; Johnson, Jamlik O; Kumaravel, Manickam; Sodickson, Aaron D

    2016-08-01

    In May 2015, the Academic Emergency Medicine consensus conference "Diagnostic imaging in the emergency department: a research agenda to optimize utilization" was held. The goal of the conference was to develop a high-priority research agenda regarding emergency diagnostic imaging on which to base future research. In addition to representatives from the Society of Academic Emergency Medicine, the multidisciplinary conference included members of several radiology organizations: American Society for Emergency Radiology, Radiological Society of North America, the American College of Radiology, and the American Association of Physicists in Medicine. The specific aims of the conference were to (1) understand the current state of evidence regarding emergency department (ED) diagnostic imaging utilization and identify key opportunities, limitations, and gaps in knowledge; (2) develop a consensus-driven research agenda emphasizing priorities and opportunities for research in ED diagnostic imaging; and (3) explore specific funding mechanisms available to facilitate research in ED diagnostic imaging. Through a multistep consensus process, participants developed targeted research questions for future research in six content areas within emergency diagnostic imaging: clinical decision rules; use of administrative data; patient-centered outcomes research; training, education, and competency; knowledge translation and barriers to imaging optimization; and comparative effectiveness research in alternatives to traditional computed tomography use. PMID:27234978

  4. [Methicillin-resistant Staphylococcus aureus (MRSA) in veterinary medicine: a "new emerging pathogen"?].

    PubMed

    Walther, Birgit; Friedrich, Alexander W; Brunnberg, Leo; Wieler, Lothar H; Lübke-Becker, Antina

    2006-01-01

    The problem of nosocomial infections is of increasing importance in veterinary medicine. As an example, this review summarizes current knowledge regarding methicillin-resistant Staphylococcus aureus (MRSA) as a typical example, as these pathogens are the most important agents of nosocomial infections in human medicine worldwide and are being increasingly reported in veterinary medicine. MRSA are classified by their ability to be resistant against oxacillin/methicillin, this feature being confered by mecA, a gene which was acquired by horizontal gene transfer of the staphylococcal gene cassette (SCCmec). It is this genetic information that enables MRSA to be resistant against all penicillins, cehalosporins and carbapenems. In addition, MRSA are often resistant against a variety of other antiinfectives, i.e. aminoglycosides, macrolides, lincosamide, streptomycins, tetracyclin, chloramphenicol, but also against fluorquinolones and rifampicin. Presumably, these highly adapted strains are particularly able to acquire resistance genes located on plasmids or transposons. They are also able to develop point mutations, further leading to resistant phenotypes. If these pathogens are leading to infectious diseases, veterinarians may be confronted with a worst-case scenario, being left without any antiinfective therapeutic. As Staphylococcus aureus is highly tenacid, professional hygiene management is of utmost importance. The increasing number of published sporadic MRSA infections, MRSA-infectious diseases as well as MRSA outbreaks in veterinary medicine justifies their recognition as a "New Emerging Pathogen". So far, horses and dogs are mostly affected by MRSA. Although transmission between humans and animals has been reported occasionally, the sources, routes of transmission or the epidemiological relevance of MRSA infections in animals are far from being understood. Therefore, epidemiological investigations utilizing molecular typing tools are mandatory. Typing tools like

  5. Undergraduate Public Health Majors: Why They Choose Public Health or Medicine?

    ERIC Educational Resources Information Center

    Hilton, Warren

    2013-01-01

    This mixed methods study examined the relationship between the motivations for attending college of undergraduate students with a focus on students with a public health major, and their desire to pursue graduate training in public health and subsequently, public health careers. The study highlighted the current public health workforce shortage and…

  6. Radiation dose awareness and disclosure practice in paediatric emergency medicine: how far have we come?

    PubMed

    Boutis, Kathy; Thomas, Karen E

    2016-05-01

    The past decade has brought increasing coverage in the medical literature and lay media of the potential association between low-level radiation from diagnostic imaging and an increased lifetime cancer risk. Both physician and public opinion increasingly favour a greater discussion of benefit and risk with patients and their families when such imaging is being considered. Particular attention has been directed towards CT, its use in children and the emergency department setting. We will review the evolution of radiation dose awareness and knowledge among emergency physicians (EPs) alongside the parallel increase in public awareness. We will then discuss expectations for risk disclosure and the challenges faced by EPs and radiologists as we strive to provide this in a clinically balanced and meaningful way. PMID:26828973

  7. Emergency medicine in Ukraine: challenges in the post-Soviet era.

    PubMed

    Wright, S W; Stack, L B; McMurray, B R; Bolyukh, S

    2000-11-01

    The practice of emergency medicine in Ukraine is markedly different from the practice in North America. The emergency physician counterpart in Ukraine attends 6 years of medical school then 18 months of prehospital physician training at an EMS base station. Once trained, prehospital physicians work 160 hours/month in 24-hour shifts at the base station as part of a physician-nurse team which answers ambulance requests. Most patients are seen and treated on site of the ambulance call. Patients are transported to the hospital only 20% of the time. Prehospital physicians can expect to earn $35 to $65 per month. Nearly all prehospital physicians are government employees. Since becoming an independent democratic republic, Ukraine's turbulent economy has negatively affected health care. Deaths from infectious diseases, including vaccine-preventable illnesses are 10-fold to that of Western countries. A 90% income tax discourages the private practice of medicine. Medical care is provided free of charge, however, if a patient wants a higher standard of care, they may have to pay an attending physician up to $200. Most medications used to treat emergencies are free, but if thrombolytics are required, the patient will have to pay for them before they are administered. Budgetary constraints limit equipment and technology. The disparity between urban and rural resources is striking as even the most basic equipment is antiquated and in need of repair. Despite the economic challenges facing Ukranian physicians, they are enthusiastic about the care and services they provide. EMS is well organized and offers services not seen in the United States. Prehospital physicians in Ukraine are viewed as an integral part of the health care system by their hospital-based colleagues. PMID:11103739

  8. Trends in publication of evidence-based Traditional Iranian medicine in endocrinology and metabolic disorders

    PubMed Central

    2013-01-01

    Traditional Iranian medicine (TIM) is a main part of complementary and alternative medicine (CAM). The popularity and use of alternative therapies are increasing due to adverse effects and ineffectiveness of pharmacologic treatments in some cases. Herbal medicine is one of the methods of traditional therapy that plays a key role in the treatment of various diseases specifically in diabetes mellitus, hyperlipidemia and obesity that are growing rapidly in the world. In this article, trends of scientific publications of Iranian medicine in endocrinology and metabolic disorders have been investigated. Our data show that the numbers of related researches have uptrend from 2000 till now. These data are valuable to pharmaceutical companies to get the idea to invest and produce effective drugs. PMID:24355592

  9. A quiet revolution in global public health: The World Health Organization's Prequalification of Medicines Programme.

    PubMed

    't Hoen, Ellen F M; Hogerzeil, Hans V; Quick, Jonathan D; Sillo, Hiiti B

    2014-05-01

    Problems with the quality of medicines abound in countries where regulatory and legal oversight are weak, where medicines are unaffordable to most, and where the official supply often fails to reach patients. Quality is important to ensure effective treatment, to maintain patient and health-care worker confidence in treatment, and to prevent the development of resistance. In 2001, the WHO established the Prequalification of Medicines Programme in response to the need to select good-quality medicines for UN procurement. Member States of the WHO had requested its assistance in assessing the quality of low-cost generic medicines that were becoming increasingly available especially in treatments for HIV/AIDS. From a public health perspective, WHO PQP's greatest achievement is improved quality of life-saving medicines used today by millions of people in developing countries. Prequalification has made it possible to believe that everyone in the world will have access to safe, effective, and affordable medicines. Yet despite its track record and recognized importance to health, funding for the programme remains uncertain. PMID:24430804

  10. Transforming Epidemiology for 21st Century Medicine and Public Health

    PubMed Central

    Khoury, Muin J.; Lam, Tram Kim; Ioannidis, John P.A.; Hartge, Patricia; Spitz, Margaret R.; Buring, Julie E.; Chanock, Stephen J.; Croyle, Robert T.; Goddard, Katrina A.; Ginsburg, Geoffrey S.; Herceg, Zdenko; Hiatt, Robert A.; Hoover, Robert N.; Hunter, David J.; Kramer, Barnet S.; Lauer, Michael S.; Meyerhardt, Jeffrey A.; Olopade, Olufunmilayo I.; Palmer, Julie R.; Sellers, Thomas A.; Seminara, Daniela; Ransohoff, David F.; Rebbeck, Timothy R.; Tourassi, Georgia; Winn, Deborah M.; Zauber, Ann; Schully, Sheri D.

    2013-01-01

    In 2012, the National Cancer Institute (NCI) engaged the scientific community to provide a vision for cancer epidemiology in the 21st century. Eight overarching thematic recommendations, with proposed corresponding actions for consideration by funding agencies, professional societies, and the research community emerged from the collective intellectual discourse. The themes are (i) extending the reach of epidemiology beyond discovery and etiologic research to include multilevel analysis, intervention evaluation, implementation, and outcomes research; (ii) transforming the practice of epidemiology by moving towards more access and sharing of protocols, data, metadata, and specimens to foster collaboration, to ensure reproducibility and replication, and accelerate translation; (iii) expanding cohort studies to collect exposure, clinical and other information across the life course and examining multiple health-related endpoints; (iv) developing and validating reliable methods and technologies to quantify exposures and outcomes on a massive scale, and to assess concomitantly the role of multiple factors in complex diseases; (v) integrating “big data” science into the practice of epidemiology; (vi) expanding knowledge integration to drive research, policy and practice; (vii) transforming training of 21st century epidemiologists to address interdisciplinary and translational research; and (viii) optimizing the use of resources and infrastructure for epidemiologic studies. These recommendations can transform cancer epidemiology and the field of epidemiology in general, by enhancing transparency, interdisciplinary collaboration, and strategic applications of new technologies. They should lay a strong scientific foundation for accelerated translation of scientific discoveries into individual and population health benefits. PMID:23462917

  11. Transforming Epidemiology for 21st Century Medicine and Public Health

    SciTech Connect

    Khoury, Muin J; Lam, Tram Kim; Ioannidis, John; Hartge, Patricia; Spitz, Margaret R.; Buring, Julie E.; Chanock, Stephen J.; Tourassi, Georgia; Zauber, Ann; Schully, Sheri D

    2013-01-01

    n 2012, the National Cancer Institute (NCI) engaged the scientific community to provide a vision for cancer epidemiology in the 21st century. Eight overarching thematic recommendations, with proposed corresponding actions for consideration by funding agencies, professional societies, and the research community emerged from the collective intellectual discourse. The themes are (i) extending the reach of epidemiology beyond discovery and etiologic research to include multilevel analysis, intervention evaluation, implementation, and outcomes research; (ii) transforming the practice of epidemiology by moving toward more access and sharing of protocols, data, metadata, and specimens to foster collaboration, to ensure reproducibility and replication, and accelerate translation; (iii) expanding cohort studies to collect exposure, clinical, and other information across the life course and examining multiple health-related endpoints; (iv) developing and validating reliable methods and technologies to quantify exposures and outcomes on a massive scale, and to assess concomitantly the role of multiple factors in complex diseases; (v) integrating big data science into the practice of epidemiology; (vi) expanding knowledge integration to drive research, policy, and practice; (vii) transforming training of 21st century epidemiologists to address interdisciplinary and translational research; and (viii) optimizing the use of resources and infrastructure for epidemiologic studies. These recommendations can transform cancer epidemiology and the field of epidemiology, in general, by enhancing transparency, interdisciplinary collaboration, and strategic applications of new technologies. They should lay a strong scientific foundation for accelerated translation of scientific discoveries into individual and population health benefits.

  12. Global Emergency Medicine Journal Club: A Social Media Discussion About the Outpatient Management of Patients With Spontaneous Pneumothorax by Using Pigtail Catheters.

    PubMed

    Trueger, N Seth; Murray, Heather; Kobner, Scott; Lin, Michelle

    2015-10-01

    Annals of Emergency Medicine collaborated with an educational Web site, Academic Life in Emergency Medicine (ALiEM) to host a public discussion featuring the 2014 Annals article on the outpatient management of patients with a spontaneous pneumothorax by using pigtail catheters. The objective was to curate a 14-day (November 10 to 23, 2014) worldwide academic dialogue among clinicians about the article. Four online facilitators hosted the multimodal discussion on the ALiEM Web site, Twitter, and Google Hangout. Comments across the social media platforms were curated for this report, as framed by 4 preselected questions. Engagement was tracked through Web analytic tools. Blog comments, tweets, and video expert commentary involving the featured article are summarized and reported. The dialogue resulted in 1,023 page views from 347 cities in 49 countries on the ALiEM Web site, 279,027 Twitter impressions, and 88 views of the video interview with experts. This Global Emergency Medicine Journal Club created a virtual community of practice from around the world and identified common themes around the management of spontaneous pneumothorax, which included substantial practice variation in regard to inpatient versus outpatient management, location of chest tube, the use of aspiration, and chest radiography after placement. PMID:26059486

  13. African American and Latino Enrollment Trends among Medicine, Law, Business, and Public Affairs Graduate Programs

    ERIC Educational Resources Information Center

    de la Garza, Rodolfo; Moghadam, Sepehr Hejazi

    2008-01-01

    The purpose of this Tomas Rivera Policy Institute (TRPI) report is twofold: to provide an analysis of the enrollment trends for African American and Latino students among graduate professional programs in the fields of medicine, business, law, and public affairs, and to present other relevant data pertaining to African American and Latino students…

  14. 78 FR 33467 - Second Allocation of Public Transportation Emergency Relief Funds in Response to Hurricane Sandy...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-04

    ... City Department of Transportation. Therefore, FR Doc. 2013-12766 is corrected as follows: 1. On page... Federal Transit Administration Second Allocation of Public Transportation Emergency Relief Funds in... the Public Transportation Emergency Relief Program to the four FTA recipients most severely...

  15. Developing a Research Agenda to Optimize Diagnostic Imaging in the Emergency Department: An Executive Summary of the 2015 Academic Emergency Medicine Consensus Conference.

    PubMed

    Marin, Jennifer R; Mills, Angela M

    2015-12-01

    The 2015 Academic Emergency Medicine consensus conference, "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization" was held on May 12, 2015, with the goal of developing a high-priority research agenda on which to base future research. The specific aims of the conference were to (1) understand the current state of evidence regarding emergency department (ED) diagnostic imaging use and identify key opportunities, limitations, and gaps in knowledge; (2) develop a consensus-driven research agenda emphasizing priorities and opportunities for research in ED diagnostic imaging; and (3) explore specific funding mechanisms available to facilitate research in ED diagnostic imaging. Over a 2-year period, the executive committee and other experts in the field convened regularly to identify specific areas in need of future research. Six content areas within emergency diagnostic imaging were identified before the conference and served as the breakout groups on which consensus was achieved: clinical decision rules; use of administrative data; patient-centered outcomes research; training, education, and competency; knowledge translation and barriers to imaging optimization; and comparative effectiveness research in alternatives to traditional computed tomography use. The executive committee invited key stakeholders to assist with the planning and to participate in the consensus conference to generate a multidisciplinary agenda. There were a total of 164 individuals involved in the conference and spanned various specialties, including general emergency medicine, pediatric emergency medicine, radiology, surgery, medical physics, and the decision sciences. PMID:26626899

  16. Experiences with and Preparedness for Emergencies and Disasters among Public Schools in California

    ERIC Educational Resources Information Center

    Kano, Megumi; Bourque, Linda B.

    2007-01-01

    This study assesses schools' experiences with, and preparedness for, emergencies and disasters. Data are collected by mail survey from 157 public schools in California. The majority of schools have experienced emergencies in recent years. Although respondents generally feel their school is well prepared for future emergencies, limitations are…

  17. Medication Overdoses at a Public Emergency Department in Santiago, Chile

    PubMed Central

    Aguilera, Pablo; Garrido, Marcela; Lessard, Eli; Swanson, Julian; Mallon, William K.; Saldias, Fernando; Basaure, Carlos; Lara, Barbara; Swadron, Stuart P.

    2016-01-01

    Introduction While a nationwide poison control registry exists in Chile, reporting to the center is sporadic and happens at the discretion of the treating physician or by patients’ self-report. Moreover, individual hospitals do not monitor accidental or intentional poisoning in a systematic manner. The goal of this study was to identify all cases of intentional medication overdose (MO) that occurred over two years at a large public hospital in Santiago, Chile, and examine its epidemiologic profile. Methods This study is a retrospective, explicit chart review conducted at Hospital Sótero del Rio from July 2008 until June 2010. We included all cases of identified intentional MO. Alcohol and recreational drugs were included only when they were ingested with other medications. Results We identified 1,557 cases of intentional MO and analyzed a total of 1,197 cases, corresponding to 0.51% of all emergency department (ED) presentations between July 2008 and June 2010. The median patient age was 25 years. The majority was female (67.6%). Two peaks were identified, corresponding to the spring of each year sampled. The rate of hospital admission was 22.2%. Benzodiazepines, selective serotonin reuptake inhibitors, and tricyclic antidepressants (TCA) were the causative agents most commonly found, comprising 1,044 (87.2%) of all analyzed cases. Acetaminophen was involved in 81 (6.8%) cases. More than one active substance was involved in 35% of cases. In 7.3% there was ethanol co-ingestion and in 1.0% co-ingestion of some other recreational drug (primarily cocaine). Of 1,557 cases, six (0.39%) patients died. TCA were involved in two of these deaths. Conclusion Similar to other developed and developing nations, intentional MO accounts for a significant number of ED presentations in Chile. Chile is unique in the region, however, in that its spectrum of intentional overdoses includes an excess burden of tricyclic antidepressant and benzodiazepine overdoses, a relatively low rate

  18. Enhancing the Relevance of Incident Management Systems in Public Health Emergency Preparedness: A Novel Conceptual Framework.

    PubMed

    Bochenek, Richard; Grant, Moira; Schwartz, Brian

    2015-08-01

    We outline a conceptual framework developed to meet the needs of public health professionals in the province of Ontario for incident management system-related education and training. By using visual models, this framework applies a public health lens to emergency management, introducing concepts relevant to public health and thereby shifting the focus of emergency preparedness from a strict "doctrine" to a more dynamic and flexible approach grounded in the traditional principles of incident management systems. These models provide a foundation for further exploration of the theoretical foundations for public health emergency preparedness in practice. PMID:25991506

  19. It's Academic: Public Policy Activities Among Faculty Members in a Department of Medicine

    PubMed Central

    Jacobs, Douglas B.; Greene, Meredith; Bindman, Andrew B.

    2014-01-01

    Problem To investigate whether and how faculty members in a Department of Medicine are engaged in public policy activities. Approach Between February and April 2011 the authors conducted a cross-sectional web-based survey of all active Department of Medicine (DOM) faculty members at the University of California, San Francisco (UCSF). Survey questions covered demographics, academic role, academic rank, and participation in three specific public policy activities during the past five years: (1) policy related research, (2) expert advice to government officials, and (3) public policy advocacy in collaboration with organizations outside government. Outcomes Two hundred twenty of 553 faculty (40%) responded to the survey. One hundred twenty-four faculty members (56% of respondents and 22% of total active faculty) reported that they were engaged in at least one of the three types of policy related activities: 51 (23%) conducted policy related research, 67 (30%) provided expert advice to government officials, and 93 (42%) collaborated with organizations to advocate for public policy. Higher faculty rank was significantly associated with faculty members reporting that they were involved in one or more of the three policy activities (P = .04). Next Steps Academic departments should identify public policy expertise among their faculty and leverage this expertise by facilitating opportunities to develop a shared faculty awareness of their public policy activities, by supporting the establishment of mentoring relationships for less experienced faculty in the area of public policy, and by incorporating standards of excellence for work in public policy into the promotions process. PMID:23969373

  20. Application of nanomedicine in emergency medicine; Point-of-care testing and drug delivery in twenty - first century

    PubMed Central

    2012-01-01

    Abstract The application of emerging nanotechnology to the practice of medicine represents a frontier of nanomedicine. Nanomedicine has been defined as a science which emphasizes the use of nanoscale tools in conjunction with background knowledge of the human body for medical diagnosis and treatment. Application of nanomedicine in EM may give EM providers the opportunity to diagnose and treat life-threatening diseases in a shorter period of time. These applications include diagnostic utilities, preventive medicine, targeted pharmacotherapy, and tissue regeneration. PMID:23351236

  1. Avicenna's Canon of Medicine: a look at health, public health, and environmental sanitation.

    PubMed

    Saffari, Mohsen; Pakpour, Amir H

    2012-12-01

    Avicenna, a renowned Persian Muslim scientist has written numerous scientific papers and valuable medical books that are respected worldwide. For centuries his masterpiece, the "Canon of Medicine", has been used as a major medical reference. The Canon, as a prime encyclopedia on medicine is comprised of five books. In the introduction to the Canon, Avicenna has described the purpose of medicine as the preservation of health if it is already attained and its restoration when it is lost. He defines health as a trait or state, which results in the normal functioning of the human body and presumes that health is a steady state, whilst disease is more of a variable concept. Thus whenever we depart from a healthy state, we approach disease. A comparison of current views regarding definitions of health, disease and their components as defined by Avicenna could open new horizons for ancient, traditional medicine. The Canon contains numerous implications concerning the infrastructures of public health-related issues. For example the specifications of healthy water and air are well described in the "Canon of Medicine". To enable a better understanding of Avicenna's viewpoints about public health, we have briefly reviewed his perspective on the topics of health, disease, and environmental sanitation concerning water and air. PMID:23199255

  2. EMERGENCY RESPONSE FOR PUBLIC WATER SUPPLIES AFTER HURRICANE KATRINA

    EPA Science Inventory

    Hurricane Katrina resulted in damage and destruction to local water supplies in Mississippi and Louisiana affecting millions of people. Immediately following the devastation, a multidisciplinary team of 30 EPA emergency response, research, and water program personnel joined force...

  3. Overtesting and the Downstream Consequences of Overtreatment: Implications of "Preventing Overdiagnosis" for Emergency Medicine.

    PubMed

    Carpenter, Christopher R; Raja, Ali S; Brown, Michael D

    2015-12-01

    Overtesting, the downstream consequences of overdiagnosis, and overtreatment of some patients are topics of growing debate within emergency medicine (EM). The "Preventing Overdiagnosis" conference, hosted by The Dartmouth Institute for Health Policy and Clinical Practice, with sponsorship from consumer organizations, medical journals, and academic institutions, is evidence of an expanding interest in this topic. However, EM represents a compellingly unique environment, with increased decision density tied to high stakes for patients and providers with missed or delayed diagnoses in a professional atmosphere that does not tolerate mistakes. This article reviews the relevance of this reductionist paradigm to EM, provides a first-hand synopsis of the first "Preventing Overdiagnosis" conference, and assesses barriers to moving the concept of less test ordering to reality. PMID:26568269

  4. [Emergency medicine after a catastrophic disaster: from a view of geriatrics and gerontology].

    PubMed

    Okinaga, Shoji; Daito, Hisayoshi; Suzuki, Motoi; Shiihara, Jun; Arai, Hiroyuki

    2013-06-01

    The megathrust earthquake and the towering tsunami hit the east coast of Japan on March 11th of 2011 after intervals of 1,142 years. About 90 % of nearly 20,000 victims were drowned in devastating waves, while every town and city along the coast turned out to be a ruin. Over 400,000 people were forced to move to the evacuation centers where the evacuees slept on the floor without electricity, running water or heating systems at freezing nights. Emergency medicine, therefore, was more required during the evacuation phase than during the acute phase of the tsunami disaster. Here discussed is the phenomenon that the events happened mostly to the elderly evacuees especially in the swept area by silty polluted seawater. PMID:23855220

  5. Helicopter Evacuation Following a Rural Trauma: An Emergency Medicine Simulation Scenario Using Innovative Simulation Technology.

    PubMed

    Whalen, Desmond; Harty, Chris; Ravalia, Mohamed; Renouf, Tia; Alani, Sabrina; Brown, Robert; Dubrowski, Adam

    2016-01-01

    The relevance of simulation as a teaching tool for medical professionals working in rural and remote contexts is apparent when low-frequency, high-risk situations are considered. Simulation training has been shown to enhance learning and improve patient outcomes in urban settings. However, there are few simulation scenarios designed to teach rural trauma management during complex medical transportation. In this technical report, we present a scenario using a medevac helicopter (Replica of Sikorsky S-92 designed by Virtual Marine Technology, St. John's, NL) at a rural community. This case can be used for training primary care physicians who are working in a rural or remote setting, or as an innovative addition to emergency medicine and pre-hospital care training programs. PMID:27081585

  6. Filovirus Emergence and Vaccine Development: A Perspective for Health Care Practitioners in Travel Medicine

    PubMed Central

    Sarwar, Uzma N.; Sitar, Sandra; Ledgerwood, Julie E.

    2010-01-01

    Recent case reports of viral hemorrhagic fever in Europe and the United States have raised concerns about the possibility for increased importation of filoviruses to non-endemic areas. This emerging threat is concerning because of the increase in global air travel and the rise of tourism in central and eastern Africa and the greater dispersion of military troops to areas of infectious disease outbreaks. Marburg viruses (MARV) and Ebola viruses (EBOV) have been associated with outbreaks of severe hemorrhagic fever involving high mortality (25 – 90% case fatality rates). First recognized in 1967 and 1976 respectively, subtypes of MARV and EBOV are the only known viruses of the Filoviridae family, and are among the world’s most virulent pathogens. This article focuses on information relevant for health care practitioners in travel medicine to include, the epidemiology and clinical features of filovirus infection and efforts toward development of a filovirus vaccine. PMID:21208830

  7. Helicopter Evacuation Following a Rural Trauma: An Emergency Medicine Simulation Scenario Using Innovative Simulation Technology

    PubMed Central

    Whalen, Desmond; Harty, Chris; Ravalia, Mohamed; Renouf, Tia; Alani, Sabrina; Brown, Robert

    2016-01-01

    The relevance of simulation as a teaching tool for medical professionals working in rural and remote contexts is apparent when low-frequency, high-risk situations are considered. Simulation training has been shown to enhance learning and improve patient outcomes in urban settings. However, there are few simulation scenarios designed to teach rural trauma management during complex medical transportation. In this technical report, we present a scenario using a medevac helicopter (Replica of Sikorsky S-92 designed by Virtual Marine Technology, St. John's, NL) at a rural community. This case can be used for training primary care physicians who are working in a rural or remote setting, or as an innovative addition to emergency medicine and pre-hospital care training programs. PMID:27081585

  8. Teaching and evaluating multitasking ability in emergency medicine residents - what is the best practice?

    PubMed Central

    2014-01-01

    Multitasking is an essential skill to develop during Emergency Medicine (EM) residency. Residents who struggle to cope in a multitasking environment risk fatigue, stress, and burnout. Improper management of interruption has been causally linked with medical errors. Formal teaching and evaluation of multitasking is often lacking in EM residency programs. This article reviewed the literature on multitasking in EM to identify best practices for teaching and evaluating multitasking amongst EM residents. With the advancement in understanding of what multitasking is, deliberate attempts should be made to teach residents pitfalls and coping strategies. This can be taught through a formal curriculum, role modeling by faculty, and simulation training. The best way to evaluate multitasking ability in residents is by direct observation. The EM Milestone Project provides a framework by which multitasking can be evaluated. EM residents should be deployed in work environments commiserate with their multitasking ability and their progress should be graduated after identified deficiencies are remediated. PMID:25635201

  9. Antiviral therapies against Ebola and other emerging viral diseases using existing medicines that block virus entry.

    PubMed

    Long, Jason; Wright, Edward; Molesti, Eleonora; Temperton, Nigel; Barclay, Wendy

    2015-01-01

    Emerging viral diseases pose a threat to the global population as intervention strategies are mainly limited to basic containment due to the lack of efficacious and approved vaccines and antiviral drugs. The former was the only available intervention when the current unprecedented Ebolavirus (EBOV) outbreak in West Africa began. Prior to this, the development of EBOV vaccines and anti-viral therapies required time and resources that were not available. Therefore, focus has turned to re-purposing of existing, licenced medicines that may limit the morbidity and mortality rates of EBOV and could be used immediately. Here we test three such medicines and measure their ability to inhibit pseudotype viruses (PVs) of two EBOV species, Marburg virus (MARV) and avian influenza H5 (FLU-H5). We confirm the ability of chloroquine (CQ) to inhibit viral entry in a pH specific manner. The commonly used proton pump inhibitors, Omeprazole and Esomeprazole were also able to inhibit entry of all PVs tested but at higher drug concentrations than may be achieved in vivo. We propose CQ as a priority candidate to consider for treatment of EBOV. PMID:26069727

  10. Antiviral therapies against Ebola and other emerging viral diseases using existing medicines that block virus entry

    PubMed Central

    Long, Jason; Wright, Edward; Molesti, Eleonora; Temperton, Nigel; Barclay, Wendy

    2015-01-01

    Emerging viral diseases pose a threat to the global population as intervention strategies are mainly limited to basic containment due to the lack of efficacious and approved vaccines and antiviral drugs. The former was the only available intervention when the current unprecedented Ebolavirus (EBOV) outbreak in West Africa began. Prior to this, the development of EBOV vaccines and anti-viral therapies required time and resources that were not available. Therefore, focus has turned to re-purposing of existing, licenced medicines that may limit the morbidity and mortality rates of EBOV and could be used immediately. Here we test three such medicines and measure their ability to inhibit pseudotype viruses (PVs) of two EBOV species, Marburg virus (MARV) and avian influenza H5 (FLU-H5). We confirm the ability of chloroquine (CQ) to inhibit viral entry in a pH specific manner. The commonly used proton pump inhibitors, Omeprazole and Esomeprazole were also able to inhibit entry of all PVs tested but at higher drug concentrations than may be achieved in vivo. We propose CQ as a priority candidate to consider for treatment of EBOV. PMID:26069727

  11. Funding Research in Emergency Diagnostic Imaging: Summary of a Panel Discussion at the 2015 Academic Emergency Medicine Consensus Conference.

    PubMed

    Cherney, Alan R; Marin, Jennifer R; Brown, Jeremy; Anise, Ayodola; Krosnick, Steven; Henriksen, Kerm; Lewis, Roger J; Mills, Angela M

    2015-12-01

    As part of the 2015 Academic Emergency Medicine consensus conference "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization," a panel of representatives from the National Institute of Health's Office of Emergency Care Research, the National Institute of Biomedical Imaging and Bioengineering, the Agency for Healthcare Research and Quality, and the Patient-Centered Outcomes Research Institute was assembled to discuss future opportunities for funding research in this particular area of interest. Representatives from these agencies and organizations discussed their missions and priorities and how they distribute funding. They also addressed questions on mechanisms for new and established researchers to secure future funding. PMID:26567519

  12. 21 CFR 880.6260 - Filtering facepiece respirator for use by the general public in public health medical emergencies.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Filtering facepiece respirator for use by the general public in public health medical emergencies. 880.6260 Section 880.6260 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital...

  13. 21 CFR 880.6260 - Filtering facepiece respirator for use by the general public in public health medical emergencies.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Filtering facepiece respirator for use by the general public in public health medical emergencies. 880.6260 Section 880.6260 Food and Drugs FOOD AND... with a minimum filtration efficiency classification of N95, in accordance with 42 CFR part 84. (2)...

  14. Florida International University: development and accreditation of Miami's Public College of Medicine.

    PubMed

    Rock, John A; Simpson, Joe Leigh; Dambach, George; O'Leary, J Patrick; Markham, Sanford; Bagby, Larry; Seecharan, Khaleel; Berkman, Ronald M

    2009-10-01

    Anticipating pressing health care needs in the region, Florida International University (FIU) proposed the FIU College of Medicine (COM), which was approved by the Florida Board of Governors in March 2006. The FIU COM provides a program of study enabling graduates to pursue a wide spectrum of professional careers. This includes careers in general and subspecialty private practice, academic medicine, public service, health care, and public policy leadership. Irrespective of career choice, the special emphasis of the FIU COM mission is its focus on community health in a diverse metropolitan region. Clinical facilities are met through a public partner and multiple private hospital affiliations. Educational objectives are organized into five strands reflecting the breadth of medical education and running concurrently through the four-year curriculum: (1) human biology, (2) disease, illness, and injury, (3) clinical medicine, (4) professional development, and (5) medicine and society. Founding teaching faculty with expertise in the core basic sciences will not only introduce core scientific concepts during the initial seven months but reinforce these same concepts during organ system integrated courses and clerkships. The Neighborhood Health Education Learning Program is an FIU COM innovation in which each medical student is a member of a team that throughout the four-year curriculum identifies and addresses health care needs and factors affecting health outcomes. Preliminary approval of FIU COM was conferred in February 2008, with the first cohort of 40 students matriculating in August 2009. PMID:19881442

  15. The monitoring medicines project: a multinational pharmacovigilance and public health project.

    PubMed

    Pal, Shanthi N; Olsson, Sten; Brown, Elliot G

    2015-04-01

    The Monitoring Medicines project (MM), funded by the FP-7 EU framework, was carried out between 2009 and 2013 by a consortium of 11 partners. The objectives were to support and strengthen consumer reporting of adverse drug reactions (ADRs); expand the role and scope of national pharmacovigilance centres concerning medication errors; promote improved use of pharmacovigilance data; and develop methods to complement spontaneous reporting. The work was organised into four themes: patient reporting; medication errors; drug dependence, counterfeit and substandard medicines and clinical risk estimation; and active and targeted spontaneous pharmacovigilance. MM differed from some other major pharmacovigilance initiatives by having participants from developing countries in Asia and Africa and in leaning towards public health and communicable diseases. MM brought together stakeholders including WHO, drug regulators, pharmacovigilance centres, consumers, public health and disease specialists and patient safety networks. Resources and methodologies developed directly by, or with support from, MM include electronic systems/tools for consumer ADR reporting and cohort event monitoring; publication by WHO of handbooks on consumer reporting, medication errors and pharmacovigilance for TB medicines; methodologies for detecting drug dependence and substandard or counterfeit medicines in ADR databases; and a database on HIV treatment risks with a risk assessment tool. MM enabled stakeholders to achieve more than if they had worked alone in pursuit of patient safety. PMID:25829215

  16. Integrating quantitative and qualitative methodologies for the assessment of health care systems: emergency medicine in post-conflict Serbia

    PubMed Central

    Nelson, Brett D; Dierberg, Kerry; Šćepanović, Milena; Mitrović, Mihajlo; Vuksanović, Miloš; Milić, Ljiljana; VanRooyen, Michael J

    2005-01-01

    Background Due to the complexity of health system reform in the post-conflict, post-disaster, and development settings, attempts to restructure health services are fraught with pitfalls that are often unanticipated because of inadequate preliminary assessments. Our proposed Integrated Multimodal Assessment – combining quantitative and qualitative methodologies – may provide a more robust mechanism for identifying programmatic priorities and critical barriers for appropriate and sustainable health system interventions. The purpose of this study is to describe this novel multimodal assessment using emergency medicine in post-conflict Serbia as a model. Methods Integrated quantitative and qualitative methodologies – system characterization and observation, focus group discussions, free-response questionnaires, and by-person factor analysis – were used to identify needs, problems, and potential barriers to the development of emergency medicine in Serbia. Participants included emergency and pre-hospital personnel from all emergency medical institutions in Belgrade. Results Demographic data indicate a loosely ordered network of part-time emergency departments supported by 24-hour pre-hospital services and an academic emergency center. Focus groups and questionnaires reveal significant impediments to delivery of care and suggest development priorities. By-person factor analysis subsequently divides respondents into distinctive attitudinal types, compares participant opinions, and identifies programmatic priorities. Conclusions By combining quantitative and qualitative methodologies, our Integrated Multimodal Assessment identified critical needs and barriers to emergency medicine development in Serbia and may serve as a model for future health system assessments in post-conflict, post-disaster, and development settings. PMID:15715917

  17. Sources and magnitude of occupational and public exposures from nuclear medicine procedures

    SciTech Connect

    1996-03-11

    This Report addresses the sources of exposures incurred in the practice of nuclear medicine and provides the necessary data to evaluate the magnitude of exposures to those directly associated with that practice and to those who provide nursing care to the patients containing radiopharmaceuticals. Exposure to members of the public are also addressed. The primary emphasis of this Report is on these individuals and not on the patient, since the patient receives the direct benefit from the nuclear medicine procedure. It is recognized that the patient also receives the bulk of any potential radiation decrement.

  18. Publication Productivity of Faculty of Medicine, Mansoura University Indexed in PubMed

    PubMed Central

    Helal, RM; Abou-ElWafa, HS; El-Gilany, AH

    2014-01-01

    Background: Analysis of PubMed publications as an indicator of the research productivity of individual countries, regions, or institutions has recently become a field of interest. Aim: The aim was to assess the past trends in PubMed-indexed medical publications from Mansoura Faculty of Medicine and to have an idea about the current situation in medical research. Materials and Methods: PubMed was searched for publications affiliated to Mansoura from the end of the calendar year 2012 and earlier. Results: Of 2798 papers related to Mansoura, 1756 publications were included in the analysis, and 1042 publications were excluded (false positives). The highest number of publications was in 2011 (10.6%, 187/1756) followed by 2012 (10.2%, 179/1756). There was an increase of the publication rate over 5-years period until it reaches 47.0% (826/1756) during the period from 2008 to 2012. The main high-producing department was Urology and Nephrology, which accounted for 35.9% (631/1756) of the total publications followed by Pediatrics and Parasitology. The median number of authors participated in the researches was four ranging from 1 to 23. Most of the publications were in the form of intervention/clinical trials (38.4%, 662/1756) followed by descriptive/cross-sectional study (38.3%, 659/1756). The median of the impact factor was 1.99 ranging from 0.27 to 53.3. Conclusion: The publication productivity of Mansoura Faculty of Medicine showed fluctuating pattern from the end of the calendar year 2012 and earlier. Future prospects for increasing research productivity should be considered to increase the number and quality of publications and academic staff participating in high-quality international researches. PMID:25364602

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

    PubMed Central

    Lamba, Sangeeta; Wilson, Bryan; Natal, Brenda; Nagurka, Roxanne; Anana, Michael; Sule, Harsh

    2016-01-01

    Background An increasing number of students rank Emergency Medicine (EM) as a top specialty choice, requiring medical schools to provide adequate exposure to EM. The Core Entrustable Professional Activities (EPAs) for Entering Residency by the Association of American Medical Colleges combined with the Milestone Project for EM residency training has attempted to standardize the undergraduate and graduate medical education goals. However, it remains unclear as to how the EPAs correlate to the milestones, and who owns the process of ensuring that an entering EM resident has competency at a certain minimum level. Recent trends establishing specialty-specific boot camps prepare students for residency and address the variability of skills of students coming from different medical schools. Objective Our project’s goal was therefore to perform a needs assessment to inform the design of an EM boot camp curriculum. Toward this goal, we 1) mapped the core EPAs for graduating medical students to the EM residency Level 1 milestones in order to identify the possible gaps/needs and 2) conducted a pilot procedure workshop that was designed to address some of the identified gaps/needs in procedural skills. Methods In order to inform the curriculum of an EM boot camp, we used a systematic approach to 1) identify gaps between the EPAs and EM milestones (Level 1) and 2) determine what essential and supplemental competencies/skills an incoming EM resident should ideally possess. We then piloted a 1-day, three-station advanced ABCs procedure workshop based on the identified needs. A pre-workshop test and survey assessed knowledge, preparedness, confidence, and perceived competence. A post-workshop survey evaluated the program, and a posttest combined with psychomotor skills test using three simulation cases assessed students’ skills. Results Students (n=9) reported increased confidence in the following procedures: intubation (1.5–2.1), thoracostomy (1.1–1.9), and central venous

  20. Kidney bioengineering in regenerative medicine: An emerging therapy for kidney disease.

    PubMed

    Lin, Yi-Qian; Wang, Li-Ren; Pan, Liang-Liang; Wang, Hui; Zhu, Gui-Qi; Liu, Wen-Yue; Wang, Jiang-Tao; Braddock, Martin; Zheng, Ming-Hua

    2016-02-01

    The prevalence of end-stage renal disease is emerging as a serious worldwide public health problem because of the shortage of donor organs and the need to take lifelong immunosuppressive medication in patients who receive a transplanted kidney. Recently, tissue bioengineering of decellularization and recellularization scaffolds has emerged as a novel strategy for organ regeneration, and we review the critical technologies supporting these methods. We present a summary of factors associated with experimental protocols that may shed light on the future development of kidney bioengineering and we discuss the cell sources and bioreactor techniques applied to the recellularization process. Finally, we review some artificial renal engineering technologies and their future prospects, such as kidney on a chip and the application of three-dimensional and four-dimensional printing in kidney tissue engineering. PMID:26596504

  1. Assigning Residents of Emergency Medicine to Screen Patients Before Admission: a Strategy to Overcome Overcrowding

    PubMed Central

    Javadzadeh, Hamid Reza; Davoudi, Amir; Davoudi, Farnoush; Mahmoodi, Sadrollah; Ghane, Mohammad Reza; Goodarzi, Hasan; Faraji, Mehrdad

    2012-01-01

    Background: The overcrowded hospital is an unsafe one. Overcrowding the emergency department (ED) results in increased patient suffering, prolonged waiting time, deteriorating level of service, and on occasion, a worsened medical condition or even death. Objectives: This study proposes a strategy to overcome ED overcrowding. Materials and Methods: The proportion of acute area admitted patients to screened patients (A/S), and the proportion of patients who were finally transferred to inpatient wards (W/A) to those admitted in ED acute area were investigated during 6 consecutive months. Emergency medicine residents were assigned to screen patients before ED admission and afterwards. Results: The average A/S changed from 82.4% to 44.2% (P = 0.028), and the average W/A changed from 28.3% to 51.48% (P = 0.028) before and after screening patients respectively. The initiative resulted in 97 less patients in the acute area per day. Conclusions: Decreased number of acute area admitted patients, and increase W/A proportion showed that the initiative was successful in obviating ED overcrowding while provision of care to those most in need was not altered. PMID:24749100

  2. Cancer: an emergent property of disturbed resource-rich environments? Ecology meets personalized medicine

    PubMed Central

    Ducasse, Hugo; Arnal, Audrey; Vittecoq, Marion; Daoust, Simon P; Ujvari, Beata; Jacqueline, Camille; Tissot, Tazzio; Ewald, Paul; Gatenby, Robert A; King, Kayla C; Bonhomme, François; Brodeur, Jacques; Renaud, François; Solary, Eric; Roche, Benjamin; Thomas, Frédéric

    2015-01-01

    For an increasing number of biologists, cancer is viewed as a dynamic system governed by evolutionary and ecological principles. Throughout most of human history, cancer was an uncommon cause of death and it is generally accepted that common components of modern culture, including increased physiological stresses and caloric intake, favor cancer development. However, the precise mechanisms for this linkage are not well understood. Here, we examine the roles of ecological and physiological disturbances and resource availability on the emergence of cancer in multicellular organisms. We argue that proliferation of ‘profiteering phenotypes’ is often an emergent property of disturbed, resource-rich environments at all scales of biological organization. We review the evidence for this phenomenon, explore it within the context of malignancy, and discuss how this ecological framework may offer a theoretical background for novel strategies of cancer prevention. This work provides a compelling argument that the traditional separation between medicine and evolutionary ecology remains a fundamental limitation that needs to be overcome if complex processes, such as oncogenesis, are to be completely understood. PMID:26136819

  3. A Delphi Method Analysis to Create an Emergency Medicine Educational Patient Satisfaction Survey

    PubMed Central

    London, Kory S.; Singal, Bonita; Fowler, Jennifer; Prepejchal, Rebecca; Simmons, Stefanie; Finefrock, Douglas

    2015-01-01

    Introduction Feedback on patient satisfaction (PS) as a means to monitor and improve performance in patient communication is lacking in residency training. A physician’s promotion, compensation and job satisfaction may be impacted by his individual PS scores, once he is in practice. Many communication and satisfaction surveys exist but none focus on the emergency department setting for educational purposes. The goal of this project was to create an emergency medicine-based educational PS survey with strong evidence for content validity. Methods We used the Delphi Method (DM) to obtain expert opinion via an iterative process of surveying. Questions were mined from four PS surveys as well as from group suggestion. The DM analysis determined the structure, content and appropriate use of the tool. The group used four-point Likert-type scales and Lynn’s criteria for content validity to determine relevant questions from the stated goals. Results Twelve recruited experts participated in a series of seven surveys to achieve consensus. A 10-question, single-page survey with an additional page of qualitative questions and demographic questions was selected. Thirty one questions were judged to be relevant from an original 48-question list. Of these, the final 10 questions were chosen. Response rates for individual survey items was 99.5%. Conclusion The DM produced a consensus survey with content validity evidence. Future work will be needed to obtain evidence for response process, internal structure and construct validity. PMID:26759663

  4. Assessment of general public perceptions toward traditional medicines used for aphrodisiac purpose in state of Penang, Malaysia.

    PubMed

    Hassali, Mohamed Azmi; Saleem, Fahad; Shafie, Asrul Akmal; Al-Qazaz, Harith Khalid; Farooqui, Maryam; Aljadhey, Hisham; Atif, Muhammad; Masood, Imran

    2012-11-01

    The study aims to evaluate general public perceptions regarding the use of Traditional and Complementary Medicines (TCM) for aphrodisiac purposes. A questionnaire based, cross-sectional study was undertaken. Respondents were selected in the state of Penang, Malaysia. A total of 392 respondents were included in the study. Descriptive statistics were used for data analysis. Chi Square/Fischer Exact tests were used where appropriate. Out of 392 respondents, 150 (38.26%) reported using specific Traditional medicines for aphrodisiac purposes. Most respondents (46.94%) agreed that aphrodisiac medicines were easily available t. Moreover, 40.31% of the respondents reported that traditional aphrodisiac medicines were cheaper than modern (prescription) medicines. This study highlights limited public knowledge regarding the use of traditional aphrodisiac medicine. Healthcare professionals should be aware of informal TCM usage when prescribing allopathic medicines. PMID:23059442

  5. Creation and Assessment of a Bad News Delivery Simulation Curriculum for Pediatric Emergency Medicine Fellows.

    PubMed

    Chumpitazi, Corrie E; Rees, Chris A; Chumpitazi, Bruno P; Hsu, Deborah C; Doughty, Cara B; Lorin, Martin I

    2016-01-01

    Background  Bad news in the context of health care has been broadly defined as significant information that negatively alters people's perceptions of the present or future. Effectively delivering bad news (DBN) in the setting of the emergency department requires excellent communication skills. Evidence shows that bad news is frequently given inadequately. Studies show that trainees need to devote more time to developing this skill through formalized training. This program's objectives were to utilize trained standardized patients in a simulation setting to assist pediatric emergency medicine (PEM) fellows in the development of effective, sensitive, and compassionate communication with patients and family members when conveying bad news, and to recognize and respond to the patient/parent's reaction to such news. Methods PEM fellows participated in a novel curriculum utilizing simulated patients (SPs) acting as the patient's parent and immersive techniques in a realistic and supportive environment. A baseline survey was conducted to ascertain participant demographics and previous experience with simulation and DBN. Experienced, multi-disciplinary faculty participated in a training workshop with the SPs one week prior to course delivery. Three scenarios were developed for bad news delivery. Instructors watched via remote video feed while the fellows individually interacted with the SPs and then participated in a confidential debriefing. Fellows later joined for group debriefing. Fellow characteristics, experience, and self-perceived comfort pre/post-course were collected.   Results Baseline data demonstrated that 78% of fellows reported DBN two or more times per month. Ninety-three percent of fellows in this study were present during the delivery of news about the death of a child to a parent or family member in the six-month period preceding this course. Fellows' self-reported comfort level in DBN to a patient/family and dealing with patient and parent emotions

  6. Creation and Assessment of a Bad News Delivery Simulation Curriculum for Pediatric Emergency Medicine Fellows

    PubMed Central

    Rees, Chris A; Chumpitazi, Bruno P; Hsu, Deborah C; Doughty, Cara B; Lorin, Martin I

    2016-01-01

    Background  Bad news in the context of health care has been broadly defined as significant information that negatively alters people’s perceptions of the present or future. Effectively delivering bad news (DBN) in the setting of the emergency department requires excellent communication skills. Evidence shows that bad news is frequently given inadequately. Studies show that trainees need to devote more time to developing this skill through formalized training. This program’s objectives were to utilize trained standardized patients in a simulation setting to assist pediatric emergency medicine (PEM) fellows in the development of effective, sensitive, and compassionate communication with patients and family members when conveying bad news, and to recognize and respond to the patient/parent’s reaction to such news. Methods PEM fellows participated in a novel curriculum utilizing simulated patients (SPs) acting as the patient’s parent and immersive techniques in a realistic and supportive environment. A baseline survey was conducted to ascertain participant demographics and previous experience with simulation and DBN. Experienced, multi-disciplinary faculty participated in a training workshop with the SPs one week prior to course delivery. Three scenarios were developed for bad news delivery. Instructors watched via remote video feed while the fellows individually interacted with the SPs and then participated in a confidential debriefing. Fellows later joined for group debriefing. Fellow characteristics, experience, and self-perceived comfort pre/post-course were collected.   Results Baseline data demonstrated that 78% of fellows reported DBN two or more times per month. Ninety-three percent of fellows in this study were present during the delivery of news about the death of a child to a parent or family member in the six-month period preceding this course. Fellows’ self-reported comfort level in DBN to a patient/family and dealing with patient and parent

  7. Postgraduate training in public health medicine: St George's Hospital Medical School Library public health information service.

    PubMed

    Rook, R; Adshead, F

    2001-03-01

    This article examines the development of the St George's Hospital Medical School Library public health information service. Begun in 1997 as a pilot project to support Public Health Specialist Registrars in South Thames West, it is now an established part of postgraduate training in the region. An outline of the service is described, including the evolution of the post of Public Health Librarian. Issues influencing the development of the service, and the establishment of the Librarian as part of the public health network are discussed. This is a transferable model of public health information provision, which as a centralized resource makes best use of available funding. As a LIS model it is an effective and efficient way of maximizing resources, and delivering a service to a specialist user group that is spread across a wide geographical area. PMID:11260291

  8. Theory-based approaches to understanding public emergency preparedness: implications for effective health and risk communication.

    PubMed

    Paek, Hye-Jin; Hilyard, Karen; Freimuth, Vicki; Barge, J Kevin; Mindlin, Michele

    2010-06-01

    Recent natural and human-caused disasters have awakened public health officials to the importance of emergency preparedness. Guided by health behavior and media effects theories, the analysis of a statewide survey in Georgia reveals that self-efficacy, subjective norm, and emergency news exposure are positively associated with the respondents' possession of emergency items and their stages of emergency preparedness. Practical implications suggest less focus on demographics as the sole predictor of emergency preparedness and more comprehensive measures of preparedness, including both a person's cognitive stage of preparedness and checklists of emergency items on hand. We highlight the utility of theory-based approaches for understanding and predicting public emergency preparedness as a way to enable more effective health and risk communication. PMID:20574880

  9. One world--one medicine--one health: emerging veterinary challenges and opportunities.

    PubMed

    Osburn, B; Scott, C; Gibbs, P

    2009-08-01

    The interdependence of humans, animals, and their environment has never been more important than now. The most prominent issues putting pressure on global health today include the dramatic emergence and spread of zoonotic diseases, contamination of food, water and soil, bioterrorist events, and degradation of resources and habitats. Current global health challenges have prompted a call for more holistic, collaborative, action-oriented approaches toward the goal of logical and practical solutions. Veterinarians have pivotal obligations, opportunities, and contributions to make in enhancing public health, recognising and responding to zoonotic disease transmission, maintaining food and water quality, and promoting wildlife and ecosystem health. PMID:20128454

  10. [Environmental medicine in public health service--a social responsibility and its consequences].

    PubMed

    Thriene, B

    2001-02-01

    The special committee for "Environmental Medicine" established by the Federal Association of Doctors in the German Public Health Service presents its paper entitled "Environmental Medicine in the Public Health Service--A Social Responsibility and its Consequences: Propositions with regard to the situation, aims, strategies, and opportunities for action". The paper includes core ideas and responsibilities in the public health service. It aims at providing a number of guidelines for implementing "Environment and Health" ("Umwelt und Gesundheit"), an action programme by the Federal Ministry of Environmental Protection and the Ministry of Health, as well as "Health 21" ("Gesundheit 21"), the framework concept "Health for all" for the WHO's European Region. The paper also aims at initiating and facilitating steps for joint action by the Public Health Service. These theses were passed on to Mrs. Andrea Fischer, the Federal Minister of Health, during a meeting with the Board of the Association. In Germany, environment-related public health protection is well established in the Public Health Departments and state institutes/departments within the scope of public health provision and disease prevention. Typical responsibilities include environmental hygiene and environment-related medical services which have increased in importance. The range of responsibilities and its current political importance are a result of environment-related public health risks, the social situation of the population, also with regard to health issues, and the scope of responsibilities and competencies by doctors and staff in the public health departments. With the people's demands for health, quality of life and life expectancy, this need for action increases. In this paper, judicial, professional, and personal consequence are presented which arise as public health authorities assume these responsibilities. PMID:11285752

  11. The changing nature and scope of public health emergencies in response to annual flu.

    PubMed

    Hodge, James G

    2013-06-01

    The rapid spread of influenza during the 2012-13 season brought a series of public health challenges and corresponding response efforts. For decades, responses to annual flu have been undertaken routinely without extensive legal intervention. With the recent declaration of states of public health emergencies in Boston (January 9, 2013) and New York State (January 12, 2013), however, the legal baseline is changing. Propelled by a slate of state and local emergency declarations during the 2009-10 H1N1 pandemic, public officials are beginning to show cause for the issuance of formal emergency declarations in support of flu response efforts. The legal effects of these types of declarations are profound. Public and private actors are given significant, expedited public health powers. Scarce resources like vaccines can be more efficiently allocated. Laws relating to licensure, scope of practice, and liability can be effectively waived. Though originally conceptualized and once reserved for catastrophic, long-term health-related or bioterrorism events, public health emergency declarations are evolving to address temporary impacts on health care and public health services arising annually from flu outbreaks. This commentary explores the changing nature of public health emergencies and their current and potential impact on the provision of healthcare services in response to national or regional threats to the public's health. PMID:23641729

  12. Hereditary Cancer: Example of a Public Health Approach to Ensure Population Health Benefits of Genetic Medicine

    PubMed Central

    Cragun, Deborah; Lewis, Courtney; Camperlengo, Lucia; Pal, Tuya

    2016-01-01

    This article introduces the identification, prevention, and treatment of hereditary cancer as an important public health concern. Hereditary cancer research and educational outreach activities are used to illustrate how public health functions can help to achieve health benefits of genetic and genomic medicine. First, we evaluate genetic service delivery through triangulating patient and provider survey results which reveal variability among providers in hereditary cancer knowledge and genetic service provision. Second, we describe efforts we have made to assure competency among healthcare providers and to inform, educate and empower patients with regard to the rapidly evolving field of genomics and hereditary cancer. Lastly, key policy-issues raised by our experiences are discussed in the context of how they may help us to more effectively translate future genomic technologies into practice in order to attain population health benefits from genetic and genomic medicine.

  13. [Medical decision in a very elderly patient: a case report of application of the Leonetti law in emergency medicine].

    PubMed

    Burnod, A; Choquet, C; Houissa, H; Danis, J; Pellenc, Q; Duchateau, F X

    2014-05-01

    Advanced care decision in emergency medicine is difficult for the elderly. How to be fair, avoiding an unreasonable obstinacy? Based on the case of very old person, we show how an optimal management can be decided in accordance with the spirit of the law. PMID:24821341

  14. Emerging markets for satellite data communications in the public service

    NASA Technical Reports Server (NTRS)

    Potter, J. G.

    1978-01-01

    The paper discusses some of the current and potential markets for satellite data communications as projected by the Public Service Satellite Consortium (PSSC). Organizations in the public service sector are divided into three categories, depending on their expected benefits and organizational changes due to increased satellite telecommunications use: A - modest institutional adjustments are necessary and significant productivity gains are likely; B - institutional requirements picture is promising, but more information is needed to assess benefits and risk; and C - major institutional adjustments are needed, risks are high but possible benefits are high. These criteria are applied to the U.S. health care system, continuing education, equipment maintenance, libraries, environmental monitoring, and other potential markets. The potential revenues are seen to be significant, but what is needed is a cooperative effort by common carriers and major public service institutions to aggregate the market.

  15. The Public Benefits of Cleaned Water: Emerging Greenway Opportunities.

    ERIC Educational Resources Information Center

    Deardorff, Howard

    Highlighted are opportunities for greenway development and protection. It encourages careful management in the use of waterfront land, early planning for public access and enjoyment of cleaned rivers, streams, and harbors, and efforts to ensure that these bodies of water are not repolluted by new, indiscriminate development attracted to their…

  16. Multiple Antimicrobial Resistance in Plague: An Emerging Public Health Risk

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Antimicrobial resistance in Yersinia pestis is rare, yet constitutes a significant international public health and biodefense threat. In 1995, the first multidrug resistant (MDR) isolate of Y. pestis (strain IP275) was identified, and shown to contain a self-transmissible plasmid (pIP1202) that con...

  17. Update on Emergency Department Visits Involving Energy Drinks: A Continuing Public Health Concern

    MedlinePlus

    Update on Emergency Department Visits Involving Energy Drinks: A Continuing Public Health Concern Energy drinks are flavored beverages containing high amounts of caffeine and typically other additives, such as ...

  18. 77 FR 43373 - Emergency Clearance; Public Information Collection Requirements Submitted to the Office of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-24

    ... From the Federal Register Online via the Government Publishing Office NATIONAL SCIENCE FOUNDATION... Budget; Notice AGENCY: National Science Foundation. ACTION: Emergency Clearance: Public Information... Foundation (NSF) is announcing plans to request approval of this collection. In accordance with...

  19. Funding mechanisms for gender-specific research: proceedings from a panel discussion at the 2014 Academic Emergency Medicine consensus conference.

    PubMed

    Safdar, Basmah; Greenberg, Marna R; Anise, Ayodola; Brown, Jeremy; Conwit, Robin; Filart, Rosemarie; Scott, Jane; Choo, Esther K

    2014-12-01

    As part of the 2014 Academic Emergency Medicine (AEM) consensus conference "Gender-Specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes," we assembled a diverse panel of representatives from federal and nonfederal funding agencies to discuss future opportunities for sex- and gender-specific research. The discussion revolved around the mission and priorities of each organization, as well as its interest in promoting sex- and gender-specific research. The panelists were asked to provide specific examples of funding lines generated or planned for as pertinent to emergency care. Training opportunities for future researchers in this area were also discussed. PMID:25413301

  20. Medicines

    MedlinePlus

    ... better. In the United States, the Food and Drug Administration is in charge of assuring the safety ... prescription and over-the-counter medicines. Even safe drugs can cause unwanted side effects or interactions with ...

  1. Medicines

    MedlinePlus

    ... you get better. In the United States, the Food and Drug Administration is in charge of assuring ... can cause unwanted side effects or interactions with food or other medicines you may be taking. They ...

  2. Age-related geriatric medicine: relevance of special skills of geriatric medicine to elderly people admitted to hospital as medical emergencies.

    PubMed Central

    Kafetz, K; O'Farrell, J; Parry, A; Wijesuriya, V; McElligott, G; Rossiter, B; Lugon, M

    1995-01-01

    This study was carried out to find out how many patients aged 75 and over admitted to hospital as medical emergencies had features appropriate to care by physicians in geriatric medicine and to examine the extent of use of specialist facilities by these patients. The purpose was to examine criticisms of age-related admission policies which have focused on misplacement of patients with single diagnoses and lack of access to specialist care. An analysis was made of admission, process and discharge characteristics relevant to the special skills of geriatric medicine, multiple pathology and use of specialist services by 554 patients aged 75 and over. These were collected prospectively, consecutively admitted as medical emergencies via the accident and emergency department of a large district general hospital with an age-related (75 and over) medical admissions policy. 84 patients (15%) had single pathology and no characteristics suggesting the need for specialist geriatric care. 177 (32%) had single pathology and one or more specialized characteristics. 66 (12%) had multiple pathology alone. 227 (41%) had multiple pathology and specialized characteristics. There were 142 specialist referrals in 121 patients (22% of the whole sample). We concluded that the special skills of general physicians specializing in the medical and associated community problems of elderly people are highly relevant to patients aged 75 and over presenting as medical emergencies. There was no evidence of lack of involvement of specialists in their care. PMID:8544147

  3. How, why, and for whom do emergency medicine providers use Prescription Drug Monitoring Programs?

    PubMed Central

    Smith, Robert J.; Kilaru, Austin S.; Perrone, Jeanmarie; Paciotti, Breah; Barg, Frances K.; Gadsden, Sarah M.; Meisel, Zachary F.

    2015-01-01

    Objective The prescription opioid epidemic is currently responsible for the greatest number of unintentional deaths in the United States. One potential strategy for decreasing this epidemic is implementation of state-based Prescription Drug Monitoring Programs (PDMPs), which are designed for providers to identify patients who “doctor shop” for prescriptions. Emergency medicine physicians are some of the most frequent PDMP users and opioid prescribers, but little is known about how they actually use PDMPs, for which patients, and for what reasons. Methods We conducted and transcribed semi-structured qualitative interviews with 61 physicians at a national academic conference in October 2012. Deidentified transcripts were entered into QSR NVivo 10.0, coded, and analyzed for themes using modified grounded theory. Results There is variation in pattern and frequency of PDMP access by emergency physicians. Providers rely on both structural characteristics of the PDMP, such as usability, and also their own clinical gestalt impression when deciding to use PDMPs for a given patient encounter. Providers use the information in PDMPs to alter clinical decisions and guide opioid prescribing patterns. Physicians describe alternative uses for the databases, such as improving their ability to facilitate discussions on addiction and provide patient education. Conclusion PDMPs are used for multiple purposes, including identifying opioid misuse and enhancing provider-patient communication. Given variation in practice, standards may help direct indication and manner of physician use. Steps to minimize administrative barriers to PDMP access are warranted. Finally, alternative PDMP uses should be further studied to determine their appropriateness and potentially expand their role in clinical practice. PMID:25688454

  4. Emergency medicine providers’ opioid prescribing practices stratified by gender, age, and years in practice

    PubMed Central

    Varney, Shawn M.; Bebarta, Vikhyat S.; Mannina, Lisa M.; Ramos, Rosemarie G.; Ganem, Victoria J.; Carey, Katherine R.

    2016-01-01

    BACKGROUND: Emergency medicine providers (EMPs) prescribe about 25% of opioids, but the effect of EMP risk perception on decisions to prescribe opioids is unknown. This study was undertaken to identify factors that influence EMP risk and opioid prescribing practices. METHODS: We distributed an anonymous questionnaire to EMPs at a military trauma and referral center. Response frequencies and distributions were assessed for independence using the Chi-square test. RESULTS: Eighty-nine EMPs completed the questionnaire (100% response). Respondents were primarily younger male physicians (80%) in practice under five years (55%). Male EMPs were more likely to prescribe more opioid tablets than female ones both when and when not concerned for opioid misuse (P<0.001, P<0.007, respectively). Of the providers, 70% stated that patient age would influence their prescribing decisions. Hydrocodone and oxycodone were the opioids prescribed most frequently. About 60% of the providers reported changing their prescribing behavior would not prevent opioid misuse. Additionally, 40% of the providers believed at least 10% of patients seen at this military ED misused opioids. CONCLUSION: Female EM providers reported prescribing fewer opioid tablets. Patient age influenced prescribing behavior, but the effect is unknown. Finally, EM providers reported that altering their prescribing behavior would not prevent prescription opioid misuse. PMID:27313804

  5. Improving knowledge and process for international emergency medicine fellowship applicants: a call for a uniform application.

    PubMed

    Jacquet, Gabrielle A; Bayram, Jamil D; Ewen, William B; Hansoti, Bhakti; Andescavage, Steven; Price, David; Suter, Robert E; Vu, Alexander

    2013-01-01

    Background. There are currently 34 International Emergency Medicine (IEM) fellowship programs. Applicants and programs are increasing in number and diversity. Without a standardized application, applicants have a difficulty approaching programs in an informed and an organized method; a streamlined application system is necessary. Objectives. To measure fellows' knowledge of their programs' curricula prior to starting fellowship and to determine what percent of fellows and program directors would support a universal application system. Methods. A focus group of program directors, recent, and current fellows convened to determine the most important features of an IEM fellowship application process. A survey was administered electronically to a convenience sample of 78 participants from 34 programs. Respondents included fellowship directors, fellows, and recent graduates. Results. Most fellows (70%) did not know their program's curriculum prior to starting fellowship. The majority of program directors and fellows support a uniform application service (81% and 67%, resp.) and deadline (85% for both). A minority of program directors (35%) and fellows (30%) support a formal match. Conclusions. Program directors and fellows support a uniform application service and deadline, but not a formalized match. Forums for disseminating IEM fellowship information and for administering a uniform application service and deadline are currently in development to improve the process. PMID:23533764

  6. The knowledge of emergency contraception and dispensing practices of Patent Medicine Vendors in South West Nigeria.

    PubMed

    Fayemi, Mojisola M; Oduola, Olufemi L; Ogbuji, Queen C; Osinowo, Kehinde A; Oyewo, Adejoke E; Osiberu, Olabimpe M

    2010-09-01

    Patent Medicine Vendors (PMVs) can play a critical role in increasing access to emergency contraceptive pills (ECPs) in developing countries, but few studies have examined their knowledge and dispensing practices. Using cluster sampling, the authors selected and interviewed 97 PMVs (60.8 per cent female) in Oyo and Ogun States of Nigeria to assess their knowledge, dispensing practices, and referral for ECPs. About one-third (27.8 per cent) of respondents were not aware of ECPs, and only half knew that ECPs could prevent pregnancy. Forty per cent had ever dispensed ECPs. Reasons proffered by those who do not dispense ECPs included barriers from the State Ministry of Health, police, other regulatory agencies, and religious beliefs. Only 50.5 per cent have referral arrangements for clients. Strategies to increase access to ECPs through PMVs include training on counseling techniques and referral, effective government regulation, and community involvement. Where unsafe abortion is a major cause of maternal mortality, these strategies offer protection for many women in the future. PMID:20805800

  7. Competency Assessment in Senior Emergency Medicine Residents for Core Ultrasound Skills

    PubMed Central

    Schmidt, Jessica N.; Kendall, John; Smalley, Courtney

    2015-01-01

    Introduction Quality resident education in point-of-care ultrasound (POC US) is becoming increasingly important in emergency medicine (EM); however, the best methods to evaluate competency in graduating residents has not been established. We sought to design and implement a rigorous assessment of image acquisition and interpretation in POC US in a cohort of graduating residents at our institution. Methods We evaluated nine senior residents in both image acquisition and image interpretation for five core US skills (focused assessment with sonography for trauma (FAST), aorta, echocardiogram (ECHO), pelvic, central line placement). Image acquisition, using an observed clinical skills exam (OSCE) directed assessment with a standardized patient model. Image interpretation was measured with a multiple-choice exam including normal and pathologic images. Results Residents performed well on image acquisition for core skills with an average score of 85.7% for core skills and 74% including advanced skills (ovaries, advanced ECHO, advanced aorta). Residents scored well but slightly lower on image interpretation with an average score of 76%. Conclusion Senior residents performed well on core POC US skills as evaluated with a rigorous assessment tool. This tool may be developed further for other EM programs to use for graduating resident evaluation. PMID:26594291

  8. Realism of procedural task trainers in a pediatric emergency medicine procedures course

    PubMed Central

    Shefrin, Allan; Khazei, Afshin; Cheng, Adam

    2015-01-01

    Background Pediatric emergency medicine (PEM) physicians have minimal experience in life saving procedures and have turned to task trainers to learn these skills. Realism of these models is an important consideration that has received little study. Method PEM physicians and trainees participated in a day long procedural training course that utilized commercially available and homemade task trainers to teach pericardiocentesis, chest tube insertion, cricothyroidotomy and central line insertion. Participants rated the realism of the task trainers as part of a post-course survey. Results The homemade task trainers received variable realism ratings, with 91% of participants rating the pork rib chest tube model as realistic, 82% rating the gelatin pericardiocentesis mold as realistic and 36% rating the ventilator tubing cricothyroidotomy model as realistic. Commercial trainers also received variable ratings, with 45% rating the chest drain and pericardiocentesis simulator as realistic, 74% rating the crichotracheotomy trainer as realistic and 80% rating the central line insertion trainer as realistic. Conclusions Task training models utilized in our course received variable realism ratings. When deciding what type of task trainer to use future courses should carefully consider the desired aspect of realism, and how it aligns with the procedural skill, balanced with cost considerations. PMID:26451232

  9. Use and toxicity of complementary and alternative medicines among patients visiting emergency department: Systematic review

    PubMed Central

    Jatau, Abubakar Ibrahim; Aung, Myat Moe Thwe; Kamauzaman, Tuan Hairulnizam Tuan; Chedi, Basheer A. Z.; Sha’aban, Abubakar; Rahman, Ab Fatah Ab

    2016-01-01

    Many studies have been conducted in health-care settings with regards to complementary and alternative medicine (CAM) use among patients. However, information regarding CAM use among patients in the emergency department (ED) is scarce. The aim of this article was to conduct a systematic review of published studies with regards to CAM use among the ED patients. A literature search of published studies from inception to September 2015 was conducted using PubMed, Scopus, and manual search of the reference list. 18 studies that met the inclusion criteria were reviewed. The prevalence rate of CAM use among ED patients across the studies ranged of 1.4-68.1%. Herbal therapy was the sub-modality of CAM most commonly used and frequently implicated in CAM-related ED visits. Higher education, age, female gender, religious affiliation, and chronic diseases were the most frequent factors associated with CAM use among the ED patients. Over 80% of the ED physicians did not ask the patients about the CAM therapy. Similarly, 80% of the ED patients were ready to disclose CAM therapy to the ED physician. The prevalence rate of CAM use among patients at ED is high and is growing with the current increasing popularity, and it has been a reason for some of the ED visits. There is a need for the health-care professionals to receive training and always ask patients about CAM therapy to enable them provide appropriate medical care and prevent CAM-related adverse events. PMID:27104042

  10. Emergency medicine resident crisis resource management ability: a simulation-based longitudinal study

    PubMed Central

    Clarke, Samuel; Horeczko, Timothy; Carlisle, Matthew; Barton, Joseph D.; Ng, Vivienne; Al-Somali, Sameerah; Bair, Aaron E.

    2014-01-01

    Background Simulation has been identified as a means of assessing resident physicians’ mastery of technical skills, but there is a lack of evidence for its utility in longitudinal assessments of residents’ non-technical clinical abilities. We evaluated the growth of crisis resource management (CRM) skills in the simulation setting using a validated tool, the Ottawa Crisis Resource Management Global Rating Scale (Ottawa GRS). We hypothesized that the Ottawa GRS would reflect progressive growth of CRM ability throughout residency. Methods Forty-five emergency medicine residents were tracked with annual simulation assessments between 2006 and 2011. We used mixed-methods repeated-measures regression analyses to evaluate elements of the Ottawa GRS by level of training to predict performance growth throughout a 3-year residency. Results Ottawa GRS scores increased over time, and the domains of leadership, problem solving, and resource utilization, in particular, were predictive of overall performance. There was a significant gain in all Ottawa GRS components between postgraduate years 1 and 2, but no significant difference in GRS performance between years 2 and 3. Conclusions In summary, CRM skills are progressive abilities, and simulation is a useful modality for tracking their development. Modification of this tool may be needed to assess advanced learners’ gains in performance. PMID:25499769

  11. Simulation in graduate medical education 2008: a review for emergency medicine.

    PubMed

    McLaughlin, Steve; Fitch, Michael T; Goyal, Deepi G; Hayden, Emily; Kauh, Christine Yang; Laack, Torrey A; Nowicki, Thomas; Okuda, Yasuharu; Palm, Ken; Pozner, Charles N; Vozenilek, John; Wang, Ernest; Gordon, James A

    2008-11-01

    Health care simulation includes a variety of educational techniques used to complement actual patient experiences with realistic yet artificial exercises. This field is rapidly growing and is widely used in emergency medicine (EM) graduate medical education (GME) programs. We describe the state of simulation in EM resident education, including its role in learning and assessment. The use of medical simulation in GME is increasing for a number of reasons, including the limitations of the 80-hour resident work week, patient dissatisfaction with being "practiced on," a greater emphasis on patient safety, and the importance of early acquisition of complex clinical skills. Simulation-based assessment (SBA) is advancing to the point where it can revolutionize the way clinical competence is assessed in residency training programs. This article also discusses the design of simulation centers and the resources available for developing simulation programs in graduate EM education. The level of interest in these resources is evident by the numerous national EM organizations with internal working groups focusing on simulation. In the future, the health care system will likely follow the example of the airline industry, nuclear power plants, and the military, making rigorous simulation-based training and evaluation a routine part of education and practice. PMID:18638028

  12. Use and toxicity of complementary and alternative medicines among patients visiting emergency department: Systematic review.

    PubMed

    Jatau, Abubakar Ibrahim; Aung, Myat Moe Thwe; Kamauzaman, Tuan Hairulnizam Tuan; Chedi, Basheer A Z; Sha'aban, Abubakar; Rahman, Ab Fatah Ab

    2016-01-01

    Many studies have been conducted in health-care settings with regards to complementary and alternative medicine (CAM) use among patients. However, information regarding CAM use among patients in the emergency department (ED) is scarce. The aim of this article was to conduct a systematic review of published studies with regards to CAM use among the ED patients. A literature search of published studies from inception to September 2015 was conducted using PubMed, Scopus, and manual search of the reference list. 18 studies that met the inclusion criteria were reviewed. The prevalence rate of CAM use among ED patients across the studies ranged of 1.4-68.1%. Herbal therapy was the sub-modality of CAM most commonly used and frequently implicated in CAM-related ED visits. Higher education, age, female gender, religious affiliation, and chronic diseases were the most frequent factors associated with CAM use among the ED patients. Over 80% of the ED physicians did not ask the patients about the CAM therapy. Similarly, 80% of the ED patients were ready to disclose CAM therapy to the ED physician. The prevalence rate of CAM use among patients at ED is high and is growing with the current increasing popularity, and it has been a reason for some of the ED visits. There is a need for the health-care professionals to receive training and always ask patients about CAM therapy to enable them provide appropriate medical care and prevent CAM-related adverse events. PMID:27104042

  13. Emerging diseases and ecosystem instability: new threats to public health.

    PubMed Central

    Epstein, P R

    1995-01-01

    Ecologists have begun to describe an environmental distress syndrome, whereby widespread loss of top predators and harsh environmental conditions are encouraging the selection of opportunistic pests and pathogens across a wide taxonomic range of plants and animals. Environmental change and pollutants stress individuals and populations, and this may be reflected in the global resurgence of infectious disease as these stresses cascade through the community assemblages of species. In 1993, the sudden appearance of a virulent, rodent-borne hantavirus in the arid US Southwest accompanied anomalous weather patterns, and a novel Vibrio cholerae variant (O139 Bengal) emerged in Asia where marine ecosystems are experiencing a pandemic of coastal algal blooms, apparently harboring and amplifying the agent. This paper suggests a framework for integrating the surveillance of health outcomes and key reservoir and vector species, with ecological and climatic monitoring. PMID:7856775

  14. Zika virus disease: a public health emergency of international concern.

    PubMed

    Lupton, Kelly

    The emergence of Zika virus disease (ZIKV) in the Americas, mainly Brazil, has required the World Health Organization to take action to halt the spread of the virus by implementing preventive measures. This has resulted in increased surveillance of the virus and its potential complications. In the UK, cases of ZIKV have been reported in returning travellers. With the importance of this disease increasing, it is vital that nurses and other health professionals take the time to learn about ZIKV in order to pass on this knowledge to patients, enabling them to make informed choices about travel to affected areas. This article will discuss the ZIKV, its complications and what to advise travellers, including pregnant women, to prevent transmission and spread. PMID:26911164

  15. SARS: mobilizing and maintaining a public health emergency response.

    PubMed

    Posid, Joseph M; Bruce, Sherrie M; Guarnizo, Julie T; Taylor, Melissa L; Garza, Brenda W

    2005-01-01

    During the spring and summer of 2003, the Centers for Disease Control and Prevention (CDC) mobilized the resources of the entire agency in a concerted effort to meet the challenges posed by the outbreak of Severe Acute Respiratory Syndrome (SARS). Over the 133 days that comprised the emergency response phase of the SARS outbreak, CDC utilized the skills of more than 850 people. These staff were deployed from every Center, Institute, and Office within CDC and the Agency for Toxic Substances and Disease Registry. They provided technical assistance to countries reporting large numbers of cases and requesting assistance, met passengers and crew from these locations upon arrival in the United States, and assured that the syndrome was reported and thoroughly investigated within the United States. This paper describes the operational requirements that were established and the resources that were used to conduct this investigation. PMID:15829833

  16. [Organizational forms of emergency medicine from the perspective of DGCH and BDC. Discipline-specific or interdisciplinary?].

    PubMed

    Bauer, H; Bruch, H P

    2011-04-01

    Due to logistic, organizational and economic advantages, interdisciplinary emergency centers are gaining more and more acceptance compared to established, discipline-specific and independent emergency rooms. Organizational concepts for interdisciplinary emergency centers need to consider the mandate for comprehensive patient care and the consequential performance spectrum. Thus, the implementation of generally accepted guidelines and specifications is demanding.Currently developed concepts of the accordant interdisciplinary working groups try to fulfill these premises. Further fundamental criteria to be met are the quality and education of medical and nursing staff, which are predominantly doing their jobs within the interdisciplinary emergency centers. The concept of the German surgical societies and connected organizations is not the implementation of a new definition of the role of emergency specialized physicians but rather a substantial advancement of the existing and established regulations for further education. Therefore, a further advanced-training program for clinical emergency medicine has to be implemented in addition to the existing emergency education within the common trunk, which every physician has to pass through during discipline-specific education. Furthermore, this program should complement the existing pre-clinical emergency education, which can be acquired after specialization.The accordant criteria to be developed and the coordination with the German Medical Association (Bundesärztekammer) are currently prioritized on the agenda of the interdisciplinary working group. Due to reasons of compatibility with the regulations for further education, specific management skills for future heads and directors of such interdisciplinary emergency centers should not be stipulated within the advanced-training program for clinical emergency medicine but should be gained through specific course concepts beyond this program. PMID:21424296

  17. Modeling and public health emergency responses: lessons from SARS.

    PubMed

    Glasser, John W; Hupert, Nathaniel; McCauley, Mary M; Hatchett, Richard

    2011-03-01

    Modelers published thoughtful articles after the 2003 SARS crisis, but had limited if any real-time impact on the global response and may even have inadvertently contributed to a lingering misunderstanding of the means by which the epidemic was controlled. The impact of any intervention depends on its efficiency as well as efficacy, and efficient isolation of infected individuals before they become symptomatic is difficult to imagine. Nonetheless, in exploring the possible impact of quarantine, the product of efficiency and efficacy was varied over the entire unit interval. Another mistake was repeatedly fitting otherwise appropriate gamma distributions to times to event regardless of whether they were stationary or not, particularly onset-isolation intervals whose progressive reduction evidently contributed to SARS control. By virtue of their unknown biology, newly-emerging diseases are more challenging than familiar human scourges. Influenza, for example, recurs annually and has been modeled more thoroughly than any other infectious disease. Moreover, models were integrated into preparedness exercises, during which working relationships were established that bore fruit during the 2009 A/H1N1 pandemic. To provide the most accurate and timely advice possible, especially about the possible impact of measures designed to control diseases caused by novel human pathogens, we must appreciate the value and difficulty of policy-oriented modeling. Effective communication of insights gleaned from modeling SARS will help to ensure that policymakers involve modelers in future outbreaks of newly-emerging infectious diseases. Accordingly, we illustrate the increasingly timely care-seeking by which, together with increasingly accurate diagnoses and effective isolation, SARS was controlled via heuristic arguments and descriptive analyses of familiar observations. PMID:21420657

  18. Chemical mutagenesis: an emerging issue for public health.

    PubMed Central

    Claxton, L D; Barry, P Z

    1977-01-01

    Chemical mutagens are recognized as prevalent in the environment and a potential threat to the health of future generations. This paper presents an overview of chemical mutagenesis as an issue for public health. Several problems in the determination of risk to human populations are discussed, including difficulties of extrapolating scientific data to humans, the latency period between exposure and recognizable genetic damage, and the large number of chemicals which must be tested. Test systems are described. Possibilities of control through federal regulation are discussed. PMID:911015

  19. Childhood constipation as an emerging public health problem.

    PubMed

    Rajindrajith, Shaman; Devanarayana, Niranga Manjuri; Crispus Perera, Bonaventure Jayasiri; Benninga, Marc Alexander

    2016-08-14

    Functional constipation (FC) is a significant health problem in children and contrary to common belief, has serious ramifications on the lives of children and their families. It is defined by the Rome criteria which encourage the use of multiple clinical features for diagnosis. FC in children has a high prevalence (0.7%-29%) worldwide, both in developed and developing countries. Biopsychosocial risk factors such as psychological stress, poor dietary habits, obesity and child maltreatment are commonly identified predisposing factors for FC. FC poses a significant healthcare burden on the already overstretched health budgets of many countries in terms of out-patient care, in-patient care, expenditure for investigations and prescriptions. Complications are common and range from minor psychological disturbances, to lower health-related quality of life. FC in children also has a significant impact on families. Many paediatric clinical trials have poor methodological quality, and drugs proved to be useful in adults, are not effective in relieving symptoms in children. A significant proportion of inadequately treated children have similar symptoms as adults. These factors show that constipation is an increasing public health problem across the world with a significant medical, social and economic impact. This article highlights the potential public health impact of FC and the possibility of overcoming this problem by concentrating on modifiable risk factors rather than expending resources on high cost investigations and therapeutic modalities. PMID:27570423

  20. Childhood constipation as an emerging public health problem

    PubMed Central

    Rajindrajith, Shaman; Devanarayana, Niranga Manjuri; Crispus Perera, Bonaventure Jayasiri; Benninga, Marc Alexander

    2016-01-01

    Functional constipation (FC) is a significant health problem in children and contrary to common belief, has serious ramifications on the lives of children and their families. It is defined by the Rome criteria which encourage the use of multiple clinical features for diagnosis. FC in children has a high prevalence (0.7%-29%) worldwide, both in developed and developing countries. Biopsychosocial risk factors such as psychological stress, poor dietary habits, obesity and child maltreatment are commonly identified predisposing factors for FC. FC poses a significant healthcare burden on the already overstretched health budgets of many countries in terms of out-patient care, in-patient care, expenditure for investigations and prescriptions. Complications are common and range from minor psychological disturbances, to lower health-related quality of life. FC in children also has a significant impact on families. Many paediatric clinical trials have poor methodological quality, and drugs proved to be useful in adults, are not effective in relieving symptoms in children. A significant proportion of inadequately treated children have similar symptoms as adults. These factors show that constipation is an increasing public health problem across the world with a significant medical, social and economic impact. This article highlights the potential public health impact of FC and the possibility of overcoming this problem by concentrating on modifiable risk factors rather than expending resources on high cost investigations and therapeutic modalities. PMID:27570423

  1. A nationwide survey on the expectation of public healthcare providers on family medicine specialists in Malaysia—a qualitative analysis of 623 written comments

    PubMed Central

    Chew, Boon-How; Cheong, Ai-Theng; Ismail, Mastura; Hamzah, Zuhra; A-Rashid, Mohd-Radzniwan; Md-Yasin, Mazapuspavina; Ali, Norsiah

    2014-01-01

    Objective To examine the expectation of public healthcare providers/professionals (PHCPs) who are working closely with family medicine specialists (FMSs) at public health clinics. Design Cross-sectional study. Setting This study is part of a larger national study on the perception of the Malaysian public healthcare professionals on FMSs. Participants PHCPs from three categories of health facilities, namely hospitals, health clinics and health offices. Main outcome measures Qualitative analysis of written comments of respondents’ expectation of FMSs. Results The participants’ response rate was 58% (780/1345) with an almost equal proportion from each public healthcare facility. We identified 21 subthemes for the 623 expectation comments. The six emerging themes are (1) need for more FMSs, (2) clinical roles and functions of FMSs, (3) administrative roles of FMSs, (4) contribution to community and public health, (5) attributes improvement and (6) research and audits. FMSs were expected to give attention to clinical duty. Delivering this responsibility with competence included having the latest medical knowledge in their own and others’ medical disciplines, practising evidence-based medicine in prehospital and posthospital care, better supervision of staff and doctors under their care, fostering effective teamwork, communicating more often with hospital specialists and making appropriate referral. Expectations ranged from definite and strong for more FMSs at the health clinics to low expectation for FMSs’ involvement in research; to mal-expectation on FMSs’ involvement in community and public health programmes. Conclusions There were some remarkable differences in expectations on FMSs from the three different PHCPs. These ranged from being clinically competent and administratively available for patients and staff at the health clinics, to mal-expectations on FMSs to engage in public health affairs. Relevant parties, including FMSs themselves, could take

  2. Changes in the trade in native medicinal plants in Brazilian public markets.

    PubMed

    Brandão, Maria das Graças Lins; Cosenza, Gustavo Pereira; Pereira, Flávia Liparini; Vasconcelos, Ariela Silva; Fagg, Christopher William

    2013-08-01

    Plants continue to be an important source of new bioactive substances. Brazil is one of the world's mega-diverse countries, with 20 % of the world's flora. However, the accelerated destruction of botanically rich ecosystems has contributed to a gradual loss of native medicinal species. In previous study, we have observed a fast and intensive change in trade of medicinal plants in an area of Amazon, where human occupation took place. In this study, we surveyed 15 public markets in different parts of Brazil in search of samples of 40 plants used in traditional medicine and present in first edition of Brazilian Official Pharmacopoeia (FBRAS), published in 1926. Samples of plants commercialized as the same vernacular name as in Pharmacopoeia were acquired and submitted to analysis for authentication. A total of 252 plant samples were purchased, but the laboratory analyses showed that only one-half of the samples (126, 50.2 %) were confirmed as the same plant species so named in FBRAS. The high number of unauthenticated samples demonstrates a loss of knowledge of the original native species. The proximity of the market from areas in which the plant occurs does not guarantee that trade of false samples occurs. The impact of the commerce of the substitute species on their conservation and in public health is worrying. Strategies are necessary to promote the better use and conservation of this rich heritage offered by Brazilian biodiversity. PMID:23322507

  3. Master's and doctoral theses in family medicine and their publication output, Suez Canal University, Egypt

    PubMed Central

    Nour-Eldein, Hebatallah; Mansour, Nadia M.; Abdulmajeed, Abdulmajeed A.

    2015-01-01

    Background: The completion of a thesis is a significant requirement for both a Master's and a doctorate degree in general practice/family medicine (GP/FM). A postgraduate thesis is a well-planned, time-intensive activity carried out over several years. The quality of the theses can be judged by the proportion of published papers. Objective: This study aimed to describe Master's and doctoral theses in family medicine and their publications between 1982 and 2014. Materials and Methods: GP/FM degree theses were reviewed at the Faculty of Medicine and central Suez Canal libraries. Several characteristics were extracted from each thesis relating to the main researcher, supervisors, themes, and study methods according to predefined criteria. Publications from the theses were described. Results: Over 33 years, 208 theses were completed by 173 GP/FM researchers. The majority of the theses were for Master's degrees (84.1%). Regarding the study design, most of the degree theses were cross-sectional studies (76.9%). The adult population was targeted in 33.7% of research theses. Nonprobability sampling was used in 51%. Rural communities were the setting of research in 43.8%, and primary health center (PHC)-based studies in 59.1%. The “Patient” category exceeded the other categories (28.4%). Publication from theses started in the second decade of research production. Of the degree theses, 21.6% original articles were published. Only 13.3% of articles from theses were published in PubMed-indexed journals. The researcher was first author in 62.2% of published articles. Conclusion: The production of GP/FM theses and their publications are going to increase. Continuous assessment and planning for GP/FM studies are recommended. PMID:25949959

  4. Review on pharmacological pain management in trauma patients in (pre-hospital) emergency medicine in the Netherlands.

    PubMed

    Dijkstra, B M; Berben, S A A; van Dongen, R T M; Schoonhoven, L

    2014-01-01

    Pain is one of the main complaints of trauma patients in (pre-hospital) emergency medicine. Significant deficiencies in pain management in emergency medicine have been identified. No evidence-based protocols or guidelines have been developed so far, addressing effectiveness and safety issues, taking the specific circumstances of pain management of trauma patients in the chain of emergency care into account. The aim of this systematic review was to identify effective and safe initial pharmacological pain interventions, available in the Netherlands, for trauma patients with acute pain in the chain of emergency care. Up to December 2011, a systematic search strategy was performed with MeSH terms and free text words, using the bibliographic databases CINAHL, PubMed and Embase. Methodological quality of the articles was assessed using standardized evaluation forms. Of a total of 2328 studies, 25 relevant studies were identified. Paracetamol (both orally and intravenously) and intravenous opioids (morphine and fentanyl) proved to be effective. Non-steroidal anti-inflammatory drugs (NSAIDs) showed mixed results and are not recommended for use in pre-hospital ambulance or (helicopter) emergency medical services [(H)EMS]. These results could be used for the development of recommendations on evidence-based pharmacological pain management and an algorithm to support the provision of adequate (pre-hospital) pain management. Future studies should address analgesic effectiveness and safety of various drugs in (pre-hospital) emergency care. Furthermore, potential innovative routes of administration (e.g., intranasal opioids in adults) need further exploration. PMID:23737462

  5. An Assessment of State Board of Pharmacy Legal Documents for Public Health Emergency Preparedness.

    PubMed

    Ford, Heath; Trent, Shane; Wickizer, Stephen

    2016-03-25

    Objective. To estimate pharmaceutical emergency preparedness of US states and commonwealth territories. Methods. A quantitative content analysis was performed to evaluate board of pharmacy legal documents (ie, statutes, rules, and regulations) for the presence of the 2006 Rules for Public Health Emergencies (RPHE) from the National Association of Boards of Pharmacy's (NABP) Model Pharmacy Practice Act. Results. The median number of state-adopted RPHE was one, which was significantly less than the hypothesized value of four. Rule Two, which recommended policies and procedures for reporting disasters, was adopted significantly more than other RPHE. Ten states incorporated language specific to public health emergency refill dispensing, and among these, only six allowed 30-day refill quantities. Conclusion. Based on the 2006 NABP model rules, it does not appear that states are prepared to expedite an effective pharmaceutical response during a public health emergency. Boards of pharmacy should consider adding the eight RPHE to their state pharmacy practice acts. PMID:27073273

  6. An Assessment of State Board of Pharmacy Legal Documents for Public Health Emergency Preparedness

    PubMed Central

    Trent, Shane; Wickizer, Stephen

    2016-01-01

    Objective. To estimate pharmaceutical emergency preparedness of US states and commonwealth territories. Methods. A quantitative content analysis was performed to evaluate board of pharmacy legal documents (ie, statutes, rules, and regulations) for the presence of the 2006 Rules for Public Health Emergencies (RPHE) from the National Association of Boards of Pharmacy’s (NABP) Model Pharmacy Practice Act. Results. The median number of state-adopted RPHE was one, which was significantly less than the hypothesized value of four. Rule Two, which recommended policies and procedures for reporting disasters, was adopted significantly more than other RPHE. Ten states incorporated language specific to public health emergency refill dispensing, and among these, only six allowed 30-day refill quantities. Conclusion. Based on the 2006 NABP model rules, it does not appear that states are prepared to expedite an effective pharmaceutical response during a public health emergency. Boards of pharmacy should consider adding the eight RPHE to their state pharmacy practice acts. PMID:27073273

  7. A review of published literature on emergency medicine training programs in low- and middle-income countries

    PubMed Central

    2013-01-01

    Background The objective of this review is to identify and critically evaluate the published literature on emergency medicine (EM) training programs in resource-limited health-care settings in order to provide insight for developing EM training programs in such health systems. Methods A literature search was conducted up to the end of April 2011 using MEDLINE, EMBASE, The Cochrane Library, EBM Reviews, Healthstar and Web of Science databases, using the following search terms: Emergency Medicine, Emergency Medicine Services, Education Training Residency Programs, Emergency Medical Systems and Medical Education, without limitation to income countries as outlined in the World Bank World Trade Indicators classification 2009-2010 (World Trade Indicators Country Classification by Region and Income, July 2009-July 2010). As the intent of the review was to identify and critically evaluate the literature readily available (published) to LMICs developing EM programs, the gray literature was not searched. Results The search yielded 16 articles that met the final inclusion criteria. As the majority of articles provide a narrative description of the processes and building blocks used in developing the residency programs reported, we present our results in narrative format. By providing a summary of the lessons learned to date, we hope to provide a useful starting point for other resource-limited settings interested in establishing emergency medicine specialty training programs and hope to encourage further information exchange on this matter. Conclusions The results of the review indicate that EM training is in its infancy in resource-constrained health-care systems. There are few detailed reports of these programs successes and limitations, including efforts to optimize graduate retention. Despite the paucity of currently published data on the development of EM residency training programs in these settings, this review demonstrates the need for encouraging further information

  8. [Excessive Internet use and Internet addiction: emerging public health issues.].

    PubMed

    Coniglio, Maria Anna; Muni, Viviana; Giammanco, Giuseppe; Pignato, Sarina

    2007-01-01

    A survey was performed among students of various faculties at the University of Catania (Italy) to examine the health effects of excessive Internet use and behaviour patterns of Internet dependency. Three hundred students were recruited through a non probabilistic quota sampling method and were asked to complete a questionnaire aimed at identifying attitudes and behaviours regarding Internet use, and the psychological and physical consequences of excessive use of the Internet. The most relevant findings that emerged from student responses regard: emotional dependency on the Internet (5% of students believe that Internet facilitates social relationships, 4% experiences euphoric feelings or excitement while on-line, 1% consider the Internet as a way of escaping from real life), the excessive amount of time spent on-line (8%) and the inability to end an on-line session(8%), lying to family members to conceal the nature of involvement with the Internet (3%), giving up sports (2%) or meals (1%), the negative impact on school grades (3%), lack of sleep (4%), and physical health problems such as backache (2%), arm or wrist pain (2%), vision disturbances (6%). PMID:18216888

  9. Emerging foodborne diseases: an evolving public health challenge.

    PubMed Central

    Tauxe, R. V.

    1997-01-01

    The epidemiology of foodborne disease is changing. New pathogens have emerged, and some have spread worldwide. Many, including Salmonella, Escherichia coli O157:H7, Campylobacter, and Yersinia enterocolitica, have reservoirs in healthy food animals, from which they spread to an increasing variety of foods. These pathogens cause millions of cases of sporadic illness and chronic complications, as well as large and challenging outbreaks over many states and nations. Improved surveillance that combines rapid subtyping methods, cluster identification, and collaborative epidemiologic investigation can identify and halt large, dispersed outbreaks. Outbreak investigations and case-control studies of sporadic cases can identify sources of infection and guide the development of specific prevention strategies. Better understanding of how pathogens persist in animal reservoirs is also critical to successful long-term prevention. In the past, the central challenge of foodborne disease lay in preventing the contamination of human food with sewage or animal manure. In the future, prevention of foodborne disease will increasingly depend on controlling contamination of feed and water consumed by the animals themselves. PMID:9366593

  10. [Treatment of childhood injuries and violence in public emergency services].

    PubMed

    Malta, Deborah Carvalho; Mascarenhas, Márcio Denis Medeiros; Neves, Alice Cristina Medeiros das; Silva, Marta Alves da

    2015-05-01

    This study aimed to analyze the profile of treatment for accidents and violence involving children under 10 years of age in Brazil in the year 2011. This was a cross-sectional descriptive study in 71 emergency services in the Brazilian Unified National Health System (SUS), located in the national capital and 24 state capitals. Data were obtained from the Ministry of Health's system of sentinel surveillance services for Violence and Accidents (VIVA Survey). The highest proportion of injuries (67.4%) occurred inside the child's home. Among unintentional injuries, falls were the most frequent (52.4%), followed by running into objects or persons (21.8%) and traffic injuries (10.9%), especially as passengers (bicycles were an important means of transportation involved in the injuries). The vast majority of unintentional injuries are avoidable, and educational measures should be adopted, especially with parents, teachers, the community, and health workers, calling attention to the risks and the adoption of safe behaviors in the home, at school, and in leisure-time activities. Cases of violence are subject to mandatory reporting, and prompt measures should be taken to protect victims. PMID:26083183

  11. Public confidence in local management officials: organizational credibility and emergency behavior

    SciTech Connect

    Sorensen, J.H.

    1984-01-01

    Confidence issues create potential risks for the public in any emergency situation. They do so because credibility and associated perceptions of legitimacy and competency of organizations are determinants of human behavior in disasters. Credibility, however, is only one of numerous factors that shape response of people or organizations to a threatening event. The purposes of this paper are to review what is known about the way in which credibility and related constructs influence emergency response, discuss how this knowledge applies to radiological emergency planning, and suggest how credibility-induced risk can be minimized in emergency planning and response.

  12. The emergence of tropical medicine in Portugal: the School of Tropical Medicine and the Colonial Hospital of Lisbon (1902-1935).

    PubMed

    Amara, Isabel

    2008-01-01

    The School of Tropical Medicine was founded in 1902 along with the Colonial Hospital of Lisbon. The Portuguese government recognized the importance of colonising the tropics and therefore supported the creation of a specific locus of medical training that would prove to be crucial to the clinical and experimental study of tropical diseases. This paper examines the importance of such institutions for the emergence of a new scientific area of research while also functioning as a consolidation factor for the Third Portuguese Colonial Empire. The creation of a new concept of medical practice with respect to tropical diseases characterizes a specific aspect of colonization: it underlies and drives the discourse of colonization itself. Consultation of data collected by the Portuguese Tropical School and the Colonial Hospital during the period between 1902 and 1935, the starting point of the present study, seeks to shed light on the ongoing debate concerning the history of tropical medicine within European colonial discourse. PMID:19230343

  13. Overview of the Publications From the Anthroposophic Medicine Outcomes Study (AMOS): A Whole System Evaluation Study

    PubMed Central

    Kiene, Helmut; Ziegler, Renatus; Tröger, Wilfried; Meinecke, Christoph; Schnürer, Christof; Vögler, Hendrik; Glockmann, Anja; Kienle, Gunver Sophia

    2014-01-01

    Anthroposophic medicine is a physician-provided complementary therapy system that was founded by Rudolf Steiner and Ita Wegman. Anthroposophic therapy includes special medicinal products, artistic therapies, eurythmy movement exercises, and special physical therapies. The Anthroposophic Medicine Outcomes Study (AMOS) was a prospective observational multicenter study of 1631 outpatients starting anthroposophic therapy for anxiety disorders, asthma, attention deficit hyperactivity disorder, depression, low back pain, migraine, and other chronic indications under routine conditions in Germany. AMOS incorporated two features proposed for the evaluation of integrative therapy systems: (1) a sequential approach, starting with the whole therapy system (use, safety, outcomes, perceived benefit), addressing comparative effectiveness and proceeding to the major system components (physician counseling, anthroposophic medicinal products, art therapy, eurythmy therapy, rhythmical massage therapy) and (2) a mix of different research methods to build an information synthesis, including pre-post analyses, prospective comparative analyses, economic analyses, and safety analyses of individual patient data. AMOS fostered two methodological innovations for the analysis of single-arm therapy studies (combined bias suppression, systematic outcome comparison with corresponding cohorts in other studies) and the first depression cost analysis worldwide comparing primary care patients treated for depression vs depressed patients treated for another disorder vs nondepressed patients. A total of 21 peer-reviewed publications from AMOS have resulted. This article provides an overview of the main research questions, methods, and findings from these publications: anthroposophic treatment was safe and was associated with clinically relevant improvements in symptoms and quality of life without cost increase; improvements were found in all age, diagnosis, and therapy modality groups and were

  14. Overview of the Publications From the Anthroposophic Medicine Outcomes Study (AMOS): A Whole System Evaluation Study.

    PubMed

    Hamre, Harald Johan; Kiene, Helmut; Ziegler, Renatus; Tröger, Wilfried; Meinecke, Christoph; Schnürer, Christof; Vögler, Hendrik; Glockmann, Anja; Kienle, Gunver Sophia

    2014-01-01

    Anthroposophic medicine is a physician-provided complementary therapy system that was founded by Rudolf Steiner and Ita Wegman. Anthroposophic therapy includes special medicinal products, artistic therapies, eurythmy movement exercises, and special physical therapies. The Anthroposophic Medicine Outcomes Study (AMOS) was a prospective observational multicenter study of 1631 outpatients starting anthroposophic therapy for anxiety disorders, asthma, attention deficit hyperactivity disorder, depression, low back pain, migraine, and other chronic indications under routine conditions in Germany. AMOS INCORPORATED TWO FEATURES PROPOSED FOR THE EVALUATION OF INTEGRATIVE THERAPY SYSTEMS: (1) a sequential approach, starting with the whole therapy system (use, safety, outcomes, perceived benefit), addressing comparative effectiveness and proceeding to the major system components (physician counseling, anthroposophic medicinal products, art therapy, eurythmy therapy, rhythmical massage therapy) and (2) a mix of different research methods to build an information synthesis, including pre-post analyses, prospective comparative analyses, economic analyses, and safety analyses of individual patient data. AMOS fostered two methodological innovations for the analysis of single-arm therapy studies (combined bias suppression, systematic outcome comparison with corresponding cohorts in other studies) and the first depression cost analysis worldwide comparing primary care patients treated for depression vs depressed patients treated for another disorder vs nondepressed patients. A total of 21 peer-reviewed publications from AMOS have resulted. This article provides an overview of the main research questions, methods, and findings from these publications: anthroposophic treatment was safe and was associated with clinically relevant improvements in symptoms and quality of life without cost increase; improvements were found in all age, diagnosis, and therapy modality groups and were

  15. Responding to Public Health Emergencies on Tribal Lands: Jurisdictional Challenges and Practical Solutions.

    PubMed

    Barnard, Justin B

    2015-01-01

    Response to public health emergencies on tribal lands poses a unique challenge for state and tribal public health officials. The complexity and intensely situation-specific nature of federal Indian jurisprudence leaves considerable question as to which government entity, state or tribal, has jurisdiction on tribal lands to undertake basic emergency measures such as closure of public spaces, quarantine, compulsory medical examination, and investigation. That jurisdictional uncertainty, coupled with cultural differences and an often troubled history of tribal-state relations, threatens to significantly impede response to infectious disease outbreaks or other public health emergencies on tribal lands. Given that tribal communities may be disproportionately impacted by public health emergencies, it is critical that tribal, state, and local governments engage with each other in coordinated planning for public health threats. This Article is offered as a catalyst for such planning efforts. The Article identifies some of the most pressing jurisdictional issues that may confront governments responding to a public health emergency on tribal lands, with the aim of highlighting the nature of the problem and the need for action. The Article goes on to examine the most promising means of addressing jurisdictional uncertainty: intergovernmental agreements. Already utilized in many areas of shared interest between tribe and state, intergovernmental agreements offer neighboring state, local, and tribal governments a vehicle for delineating roles and authorities in an emergency, and may lay the groundwork for sharing resources. The Article surveys various representative tribal public health intergovernmental agreements, and concludes with suggestions for tribes and state or local governments looking to craft their own agreements. PMID:26333235

  16. Food aid in emergencies and public health nutrition.

    PubMed

    Bhatia, Rita; Thorne-Lyman, Andrew

    2003-01-01

    HUNGER LEAVES SCARS: The visible kind may be born by the survivors of famine. Less visible, but all the more damaging, are the long-term effects of hunger that run through families through generations. Hunger passed from mother to child represents a ruinous inheritance. It marks a cycle of hunger that transcends generations, unless the cycle is broken. Food aid provided at crucial times in the lives of women and infants represents an investment for future. Thus, in contrast to former conceptions of food aid as an exclusively life-saving vehicle, modern aims of food aid also include preventing increases in the prevalence of malnutrition and asset depletion. Mass migration and food shortages have been responsible for most deaths following civil conflicts around the world. The most visible form of migration occurs when people cross international borders. The reasons for the flight of refugees and internally displaced persons are generally same; war, civil strife, and persecution. "NUTRITIONAL GATEWAYS": Finally, the importance of timely and sustained delivery of adequate food aid adequate in quality and quantity to people in dire need during the emergency is paramount. Food aid is the most direct means for conveying nutritional benefits: the time frame is often limited, sustainability is not an issue. However, in the case of drought victims, refugees or displaced people, the nutritional situation and the actions needed are more complex. In many situations people arrive are often in very bad state. While high prevalence of malnutrition is associated with inadequate food rations, in some situation malnutrition developed primarily because of the high incidence of diarrhoeal diseases. The synergism between high malnutrition and increased incidence of communicable diseases explains much of excess mortality seen in refugee and displaced persons. PMID:15806950

  17. Developing a Research Agenda to Optimize Diagnostic Imaging in the Emergency Department: An Executive Summary of the 2015 Academic Emergency Medicine Consensus Conference.

    PubMed

    Marin, Jennifer R; Mills, Angela M

    2015-12-01

    The 2015 Academic Emergency Medicine (AEM) consensus conference, "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization," was held on May 12, 2015, with the goal of developing a high-priority research agenda on which to base future research. The specific aims of the conference were to: 1) understand the current state of evidence regarding emergency department (ED) diagnostic imaging utilization and identify key opportunities, limitations, and gaps in knowledge; 2) develop a consensus-driven research agenda emphasizing priorities and opportunities for research in ED diagnostic imaging; and 3) explore specific funding mechanisms available to facilitate research in ED diagnostic imaging. Over a 2-year period, the executive committee and other experts in the field convened regularly to identify specific areas in need of future research. Six content areas within emergency diagnostic imaging were identified prior to the conference and served as the breakout groups on which consensus was achieved: clinical decision rules; use of administrative data; patient-centered outcomes research; training, education, and competency; knowledge translation and barriers to imaging optimization; and comparative effectiveness research in alternatives to traditional computed tomography use. The executive committee invited key stakeholders to assist with planning and to participate in the consensus conference to generate a multidisciplinary agenda. There were 164 individuals involved in the conference spanning various specialties, including emergency medicine (EM), radiology, surgery, medical physics, and the decision sciences. This issue of AEM is dedicated to the proceedings of the 16th annual AEM consensus conference as well as original research related to emergency diagnostic imaging. PMID:26581181

  18. Biomarker-guided personalised emergency medicine for all - hope for another hype?

    PubMed

    Schuetz, Philipp; Aujesky, Drahomir; Müller, Christian; Müller, Beat

    2015-01-01

    , and procalcitonin for antibiotic stewardship in infections of the respiratory tract and sepsis. For these markers we provide an overview on physiopathology, historical evolution of evidence, strengths and limitations for a rational implementation into clinical algorithms. We critically discuss results from key intervention trials that led to their use in clinical routine and potential future indications. The rational for the use of all these biomarkers, first, tackle diagnostic ambiguity and consecutive defensive medicine, second, delayed and sub-optimal therapeutic decisions, and third, prognostic uncertainty with misguided triage and site-of-care decisions all contributing to the waste of our limited health care resources. A multifaceted approach for a more targeted management of medical patients from emergency admission to discharge including biomarkers, will translate into better resource use, shorter length of hospital stay, reduced overall costs, improved patients satisfaction and outcomes in terms of mortality and re-hospitalisation. Hopefully, the concepts outlined in this review will help the reader to improve their diagnostic skills and become more parsimonious laboratory test requesters. PMID:25695147

  19. The Opportunities of Crises and Emergency Risk Communication in Activities of Serbian Public Health Workforce in Emergencies

    PubMed Central

    Radović, V; Ćurčić, L

    2012-01-01

    Background: The aim of the study was a recommendation and establishment the concept of the appropriate communication between public health, other competent services and population in emergency as the corner stone which guarantee that all goals which are important for community life will be achieved. Methods: We used methodology appropriate for social science: analyses of documents, historical approach and comparative analysis. Results: The finding shows the urgent need for accepting of crises and emergency risk communication principles, or some similar concepts, in Serbia, and implementing effective two way communication especially in multiethnic region. The pragmatic value of the paper lays in information about the recent improvement of health workforce and emergency services in emergencies using new concept of communication and as source of numerous useful documents published in USA and few recent Serbian examples. Conclusion: Health workforce has significant role in the process of protection of population in emergencies. Policy makers should work on finding a way to improve their coordination and communication, creating new academic programs, providing of adequate training, and financial means in order to give them different role in society and provide visibility. From other side health workforce should build back to the citizen trust in what they are doing for society welfare using all their skills and abilities. PMID:23308348

  20. Scribe Impacts on Provider Experience, Operations, and Teaching in an Academic Emergency Medicine Practice

    PubMed Central

    Hess, Jeremy J.; Wallenstein, Joshua; Ackerman, Jeremy D.; Akhter, Murtaza; Ander, Douglas; Keadey, Matthew T.; Capes, James P.

    2015-01-01

    Introduction Physicians dedicate substantial time to documentation. Scribes are sometimes used to improve efficiency by performing documentation tasks, although their impacts have not been prospectively evaluated. Our objective was to assess a scribe program’s impact on emergency department (ED) throughput, physician time utilization, and job satisfaction in a large academic emergency medicine practice. Methods We evaluated the intervention using pre- and post-intervention surveys and administrative data. All site physicians were included. Pre- and post-intervention data were collected in four-month periods one year apart. Primary outcomes included changes in monthly average ED length of stay (LOS), provider-specific average relative value units (RVUs) per hour (raw and normalized to volume), self-reported estimates of time spent teaching, self-reported estimates of time spent documenting, and job satisfaction. We analyzed data using descriptive statistics and appropriate tests for paired pre-post differences in continuous, categorical, and ranked variables. Results Pre- and post-survey response rates were 76.1% and 69.0%, respectively. Most responded positively to the intervention, although 9.5% reported negative impressions. There was a 36% reduction (25%–50%; p<0.01) in time spent documenting and a 30% increase (11%–46%, p<0.01) in time spent in direct patient contact. No statistically significant changes were seen in job satisfaction or perception of time spent teaching. ED volume increased by 88 patients per day (32–146, p=0.04) pre- to post- and LOS was unchanged; rates of patients leaving against medical advice dropped, and rates of patients leaving without being seen increased. RVUs per hour increased 5.5% and per patient 5.3%; both were statistically significant. No statistically significant changes were seen in patients seen per hour. There was moderate correlation between changes in ED volume and changes in productivity metrics. Conclusion

  1. German critical incident reporting system database of prehospital emergency medicine: Analysis of reported communication and medication errors between 2005–2015

    PubMed Central

    Hohenstein, Christian; Fleischmann, Thomas; Rupp, Peter; Hempel, Dorothea; Wilk, Sophia; Winning, Johannes

    2016-01-01

    BACKGROUND: Communication failure in prehospital emergency medicine can affect patient safety as it does in other areas of medicine as well. We analyzed the database of the critical incident reporting system for prehospital emergency medicine in Germany retrospectively regarding communication errors. METHODS: Experts of prehospital emergency medicine and risk management screened the database for verbal communication failure, non-verbal communication failure and missing communication at all. RESULTS: Between 2005 and 2015, 845 reports were analyzed, of which 247 reports were considered to be related to communication failure. An arbitrary classification resulted in six different kinds: 1) no acknowledgement of a suggestion; 2) medication error; 3) miscommunication with dispatcher; 4) utterance heard/understood improperly; 5) missing information transfer between two persons; and 6) other communication failure. CONCLUSION: Communication deficits can lead to critical incidents in prehospital emergency medicine and are a very important aspect in patient safety. PMID:27313802

  2. Cancer among circumpolar populations: an emerging public health concern

    PubMed Central

    Young, T. Kue; Kelly, Janet J.; Friborg, Jeppe; Soininen, Leena; Wong, Kai O.

    2016-01-01

    Objectives To determine and compare the incidence of cancer among the 8 Arctic States and their northern regions, with special focus on 3 cross-national indigenous groups – Inuit, Athabaskan Indians and Sami. Methods Data were extracted from national and regional statistical agencies and cancer registries, with direct age-standardization of rates to the world standard population. For comparison, the “world average” rates as reported in the GLOBOCAN database were used. Findings Age-standardized incidence rates by cancer sites were computed for the 8 Arctic States and 20 of their northern regions, averaged over the decade 2000–2009. Cancer of the lung and colon/rectum in both sexes are the commonest in most populations. We combined the Inuit from Alaska, Northwest Territories, Nunavut and Greenland into a “Circumpolar Inuit” group and tracked cancer trends over four 5-year periods from 1989 to 2008. There has been marked increase in lung, colorectal and female breast cancers, while cervical cancer has declined. Compared to the GLOBOCAN world average, Inuit are at extreme high risk for lung and colorectal cancer, and also certain rare cancers such as nasopharyngeal cancer. Athabaskans (from Alaska and Northwest Territories) share some similarities with the Inuit but they are at higher risk for prostate and breast cancer relative to the world average. Among the Sami, published data from 3 cohorts in Norway, Sweden and Finland show generally lower risk of cancer than non-Sami. Conclusions Cancer among certain indigenous people in the Arctic is an increasing public health concern, especially lung and colorectal cancer. PMID:26765259

  3. Eyes wide open: an essay on developing an engaged awareness in global medicine and public health

    PubMed Central

    2014-01-01

    Background There is a growing understanding of the role social determinants such as poverty, gender discrimination, racial prejudice, and economic inequality play on health and illness. While these determinants and effects may be challenging to identify in parts of high-income countries, they are patently obvious in many other areas of the world. How we react to these determinants and effects depends on what historical, cultural, ideological, and psychological characteristics we bring to our encounters with inequity, as well as how our feelings and thoughts inform our values and actions. Discussion To address these issues, we share a series of questions we have asked ourselves¿United States¿ citizens with experience living and working in Central America¿in relation to our encounters with inequity. We offer a conceptual framework for contemplating responses in hopes of promoting among educators and practitioners in medicine and public health an engaged awareness of how our every day work either perpetuates or breaks down barriers of social difference. We review key moments in our own experiences as global health practitioners to provide context for these questions. Summary Introspective reflection can help professionals in global medicine and public health recognize the dynamic roles that they play in the world. Such reflection can bring us closer to appreciating the forces that have worked both for and in opposition to global health, human rights, and well-being. It can help us recognize how place, time, environment, and context form the social determination of health. It is from this holistic perspective of social relations that we can work to effect fair, equitable, and protective environments as they relate to global medicine and public health. PMID:25346040

  4. Turkey’s contribution to medicine: Main institutions, fields and publications

    PubMed Central

    Onat, Altan

    2013-01-01

    Objective: To identify and disclose publications from Turkey with the greatest “genuine” contributons to medicine in the past 50 years. Material and Methods: Based on the data of Web of Science, publications originating from Turkey’s institutions that were received by May, 2013, ≥72 citations were identified, after excluding papers having more than a minor share by international authors. Results: Primary authors numbering 223 generated 271 medical papers, each receiving ≥72 (95% CI 72; 263) citations. The articles cited herein were of a level of top global 8–10% papers. Half of the articles were published in 1997–2004. Compared with about 25–28 papers annually 10 years previously, it is estimated that currently only 20 papers are generated in Turkey annually, representing a global share of only 1.5 per thousand. The rate of rise registered in the period 1995–2004 may be anticipated to attenuate. Internal medicine, led by rheumatology, cardiology and hematology, and neurosciences were represented at 1.8-fold odds higher than the overall average. Led by Behçet’s disease, health issues encountered more widely than in other populations, formed frequent topics of contribution. Led by the Medical Faculties of Istanbul, Hacettepe, Ankara Universities and the Military Medical Academy, only 33 medical faculties and 14 public and private hospitals constituted sources. Conclusion: Since the elicited results are unsatisfactory, compared with Turkey’s potential, much more concerted efforts should be directed to rebuild a milieu favorable to promote research likely to contribute to medicine. PMID:25931859

  5. Traditional Arabic and Islamic Medicine, a Re-emerging Health Aid

    PubMed Central

    Cooper, Edwin; Said, Omar

    2010-01-01

    Complementary medicine is a formal method of health care in most countries of the ancient world. It is expected to become more widely integrated into the modern medical system, including the medical curriculum. Despite the perception of modern medicine as more efficacious, traditional medicine continues to be practiced. More than 70% of the developing world's population still depends primarily on the complementary and alternative systems of medicine (CAM). In rural areas, cultural beliefs and practices often lead to self-care, home remedies or consultation with traditional healers. Herbal medicine can be broadly classified into four basic systems as follows: Traditional Chinese Herbalism, Ayurvedic Herbalism, Western Herbalism—which originally came from Greece and Rome to Europe and then spread to North and South America and Traditional Arabic and Islamic Medicine (TAIM). There is no doubt that today the concept of Arabic traditional herbal medicine is a part of modern life in the Middle East, and it is acquiring worldwide respect, with growing interest among traditional herbalists and the scientific community. TAIM therapies have shown remarkable success in healing acute as well as chronic diseases and have been utilized by people in most countries of the Mediterranean who have faith in spiritual healers. TAIM is the first choice for many in dealing with ailments such as infertility, epilepsy, psychosomatic troubles and depression. In parallel, issues of efficacy and safety of complementary medicine have become increasingly important and supervision of the techniques and procedures used is required for commercial as well as traditional uses. More research is therefore needed to understand this type of medicine and ensure its safe usage. The present review will discuss the status of traditional Arab medicine (particularly herbal medicine), including the efficacy and toxicity of specific medicinal preparations, with an emphasis on the modern in vitro and in vivo

  6. Correlates of work-related stress among consultants and senior registrars in accident and emergency medicine.

    PubMed

    Heyworth, J; Whitley, T W; Allison, E J; Revicki, D A

    1993-12-01

    A mail survey was conducted of consultants and senior registrars practising accident and emergency (A&E) medicine in the United Kingdom. The 201 respondents (72%) comprised 154 consultants (70.6%) and 47 senior registrars (77%), who provided demographic information and completed inventories measuring stress, depression, task and role clarity, work group functioning and overall satisfaction with work. The respondents did not report particularly high levels of stress or depression and generally evaluated aspects of their work environments favourably. Higher levels of stress were reported by consultants and respondents from district general hospitals. Levels of stress were similar to those reported by other groups of health care providers. Respondents generally considered tasks and roles to be clearly defined, work groups to be supportive, efficient units and work satisfying. There was no statistically significant correlation on the affective scales for the number of patient attendances, on call commitment or staffing numbers. Senior staff with more than 10 years experience in the specialty reported more satisfaction with work and work group functioning, and perceived their tasks and roles to be significantly clearer. Consultants over 45 evaluated their work groups favourably and were more likely to view them as cohesive, smoothly functioning units than senior registrars. The results probably reflect the ad hoc coping strategies adopted by a group of doctors, who have already demonstrated appropriate personality characteristics by completing a long training programme, with no realistic alternative late career opportunities. To prevent mid or late career attrition, however, A&E doctors should receive formal training in stress recognition and avoidance. Accessible counselling without stigma should be easily available. Senior A&E doctors have a role in detecting and managing stress amongst other staff in the department. PMID:8110315

  7. The Social Media Index: Measuring the Impact of Emergency Medicine and Critical Care Websites

    PubMed Central

    Thoma, Brent; Sanders, Jason L.; Lin, Michelle; Paterson, Quinten S.; Steeg, Jordon; Chan, Teresa M.

    2015-01-01

    Introduction The number of educational resources created for emergency medicine and critical care (EMCC) that incorporate social media has increased dramatically. With no way to assess their impact or quality, it is challenging for educators to receive scholarly credit and for learners to identify respected resources. The Social Media index (SMi) was developed to help address this. Methods We used data from social media platforms (Google PageRanks, Alexa Ranks, Facebook Likes, Twitter Followers, and Google+ Followers) for EMCC blogs and podcasts to derive three normalized (ordinal, logarithmic, and raw) formulas. The most statistically robust formula was assessed for 1) temporal stability using repeated measures and website age, and 2) correlation with impact by applying it to EMCC journals and measuring the correlation with known journal impact metrics. Results The logarithmic version of the SMi containing four metrics was the most statistically robust. It correlated significantly with website age (Spearman r=0.372; p<0.001) and repeated measures through seven months (r=0.929; p<0.001). When applied to EMCC journals, it correlated significantly with all impact metrics except number of articles published. The strongest correlations were seen with the Immediacy Index (r=0.609; p<0.001) and Article Influence Score (r=0.608; p<0.001). Conclusion The SMi’s temporal stability and correlation with journal impact factors suggests that it may be a stable indicator of impact for medical education websites. Further study is needed to determine whether impact correlates with quality and how learners and educators can best utilize this tool. PMID:25834664

  8. What is the Prevalence and Success of Remediation of Emergency Medicine Residents?

    PubMed Central

    Silverberg, Mark; Weizberg, Moshe; Murano, Tiffany; Smith, Jessica L.; Burkhardt, John C.; Santen, Sally A.

    2015-01-01

    Introduction The primary objective of this study was to determine the prevalence of remediation, competency domains for remediation, the length, and success rates of remediation in emergency medicine (EM). Methods We developed the survey in Surveymonkey™ with attention to content and response process validity. EM program directors responded how many residents had been placed on remediation in the last three years. Details regarding the remediation were collected including indication, length and success. We reported descriptive data and estimated a multinomial logistic regression model. Results We obtained 126/158 responses (79.7%). Ninety percent of programs had at least one resident on remediation in the last three years. The prevalence of remediation was 4.4%. Indications for remediation ranged from difficulties with one core competency to all six competencies (mean 1.9). The most common were medical knowledge (MK) (63.1% of residents), patient care (46.6%) and professionalism (31.5%). Mean length of remediation was eight months (range 1–36 months). Successful remediation was 59.9% of remediated residents; 31.3% reported ongoing remediation. In 8.7%, remediation was deemed “unsuccessful.” Training year at time of identification for remediation (post-graduate year [PGY] 1), longer time spent in remediation, and concerns with practice-based learning (PBLI) and professionalism were found to have statistically significant association with unsuccessful remediation. Conclusion Remediation in EM residencies is common, with the most common areas being MK and patient care. The majority of residents are successfully remediated. PGY level, length of time spent in remediation, and the remediation of the competencies of PBLI and professionalism were associated with unsuccessful remediation. PMID:26594275

  9. Complementary and alternative medicines versus prescription drugs: perceptions of emergency department patients

    PubMed Central

    Taylor, D McD; Walsham, N; Taylor, S E; Wong, L F

    2006-01-01

    Background The perceptions of emergency department (ED) patients towards complementary and alternative medicines (CAM) are poorly understood. We assessed these perceptions and compared CAM users with non‐users, particularly regarding CAM safety and efficacy. Methods This was an analytical, cross sectional survey of ED patients undertaken in a tertiary referral ED. A five point Likert scale evaluated patients' level of agreement with statements relating to CAM and prescription drugs. Results Of 404 patients who were enrolled (participation rate 97.1%), 275 (68.1%; 95% confidence interval (CI) 63.2 to 72.5) were CAM users (had taken a CAM within the previous 12 months). There were 178 patients (44.1%, 95% CI 39.2 to 49.1) who agreed or strongly agreed that CAM are drug free, and there was no significant difference between CAM users and non‐users (p = 0.77). There were 115 patients (28.5%, 95% CI 24.2 to 33.2) who agreed or strongly agreed that CAM are always safe to take with prescription drugs, and there were no significant difference between CAM users and non‐users (p = 0.39). Significantly more CAM users agreed or strongly agreed that CAM are safe to take, can prevent people from becoming ill, allow people to be in charge of their own health, can treat the mind, body, and spirit, and are more effective than prescription drugs (p<0.01). Significantly fewer CAM users agreed or strongly agreed that prescription drugs are safe to take (p<0.001). Conclusion Considerable proportions of ED patients are CAM users yet are ignorant of the nature and potential toxicities of CAM. In addition, CAM users have significantly different perceptions of CAM and prescription drugs from non‐users. The impact of these perceptions on clinical practice needs evaluation. PMID:16549570

  10. Use of Social Media During Public Emergencies by People with Disabilities

    PubMed Central

    Morris, John T.; Mueller, James L.; Jones, Michael L.

    2014-01-01

    Introduction: People with disabilities are generally more vulnerable during disasters and public emergencies than the general population. Physical, sensory and cognitive impairments may result in greater difficulty in receiving and understanding emergency alert information, and greater difficulty in taking appropriate action. The use of social media in the United States has grown considerably in recent years. This has generated increasing interest on the part of national, state and local jurisdictions in leveraging these channels to communicate public health and safety information. How and to what extent people with disabilities use social and other communications media during public emergencies can help public safety organizations understand the communication needs of the citizens in their jurisdictions, and plan their social media and other communications strategies accordingly. Methods: This article presents data from a survey on the use of social media and other communications media during public emergencies by people with disabilities conducted from November 1, 2012 through March 30, 2013. Results: The data presented here show four key results. First, levels of use of social media in general are high for people with disabilities, as well as for the general population. Second, use of social media during emergencies is still low for both groups. Third, levels of use of social media are not associated with income levels, but are significantly and strongly associated with age: younger people use social media at higher rates than older people in both groups (p<0.001). Fourth, differences in the use of social media during emergencies across disability types are slight, with the exception of deaf and hard-of-hearing respondents, the former more likely to have used social media to receive (p=0.002), verify (p=0.092) and share (p=0.007) emergency information. Conclusion: These last two results suggest that effective emergency communications strategies need to rely on

  11. A nationwide survey of public healthcare providers’ impressions of family medicine specialists in Malaysia: a qualitative analysis of written comments

    PubMed Central

    Cheong, Ai-Theng; Ismail, Mastura; Hamzah, Zuhra; A-Rashid, Mohd-Radzniwan; Md-Yasin, Mazapuspavina; Ali, Norsiah; Mohd-Salleh, Noridah; Bashah, Baizury

    2016-01-01

    Objective To examine impressions of public healthcare providers/professionals (PHCPs) who are working closely with family medicine specialists (FMSs) at public health clinics. Design Cross-sectional study. Setting This study is part of a larger national study on the perception of Malaysian public healthcare professionals on FMSs (PERMFAMS). Participants PHCPs from three categories of health facility: hospitals, health clinics and health offices. Main outcome measures Qualitative analyses of written comments of respondents’ general impression of FMSs. Results The participants’ response rate was 58.0% (780/1345), with almost equal proportions from each public healthcare facility. A total of 23 categories for each of the 648 impression comments were identified. The six emerging themes were: (1) importance of FMSs; (2) roles of FMSs; (3) clinical performance of FMSs; (4) attributes of FMSs; (5) FMS practice challenges; (6) misconception of FMS roles. Overall, FMS practice was perceived to be safe and able to provide effective treatments in a challenging medical discipline that was in line with the current standards of medical care and ethical and professional values. The areas of concern were in clinical performance expressed by PHCPs from some hospitals and the lack of personal attributes and professionalism among FMSs mentioned by PHCPs from health clinics and offices. Conclusions FMSs were perceived to be capable of providing effective treatment and were considered to be important primary care physicians. There were a few negative impressions in some areas of FMS practice, which demanded attention by the FMSs themselves and the relevant authorities in order to improve efficiency and safeguard the fraternity's reputation. PMID:26743703

  12. Major emerging vector-borne zoonotic diseases of public health importance in Canada

    PubMed Central

    Kulkarni, Manisha A; Berrang-Ford, Lea; Buck, Peter A; Drebot, Michael A; Lindsay, L Robbin; Ogden, Nicholas H

    2015-01-01

    In Canada, the emergence of vector-borne diseases may occur via international movement and subsequent establishment of vectors and pathogens, or via northward spread from endemic areas in the USA. Re-emergence of endemic vector-borne diseases may occur due to climate-driven changes to their geographic range and ecology. Lyme disease, West Nile virus (WNV), and other vector-borne diseases were identified as priority emerging non-enteric zoonoses in Canada in a prioritization exercise conducted by public health stakeholders in 2013. We review and present the state of knowledge on the public health importance of these high priority emerging vector-borne diseases in Canada. Lyme disease is emerging in Canada due to range expansion of the tick vector, which also signals concern for the emergence of human granulocytic anaplasmosis, babesiosis, and Powassan virus. WNV has been established in Canada since 2001, with epidemics of varying intensity in following years linked to climatic drivers. Eastern equine encephalitis virus, Jamestown Canyon virus, snowshoe hare virus, and Cache Valley virus are other mosquito-borne viruses endemic to Canada with the potential for human health impact. Increased surveillance for emerging pathogens and vectors and coordinated efforts among sectors and jurisdictions will aid in early detection and timely public health response. PMID:26954882

  13. Addressing gaps in health care sector legal preparedness for public health emergencies.

    PubMed

    Ransom, Montrece McNeill; Goodman, Richard A; Moulton, Anthony D

    2008-03-01

    Health care providers and their legal counsel play pivotal roles in preparing for and responding to public health emergencies. Lawyers representing hospitals, health systems, and other health care provider components are being called upon to answer complex legal questions regarding public health preparedness issues that most providers have not previously faced. Many of these issues are legal issues with which public health officials should be familiar, and that can serve as a starting point for cross-sector legal preparedness planning involving both the public health and health care communities. This article examines legal issues that health care providers face in preparing for public health emergencies, and steps that providers, their legal counsel, and others can take to address those issues and to strengthen community preparedness. PMID:18388658

  14. Free Open Access Meducation (FOAM): the rise of emergency medicine and critical care blogs and podcasts (2002-2013).

    PubMed

    Cadogan, Mike; Thoma, Brent; Chan, Teresa M; Lin, Michelle

    2014-10-01

    Disruptive technologies are revolutionising continuing professional development in emergency medicine and critical care (EMCC). Data on EMCC blogs and podcasts were gathered prospectively from 2002 through November 2013. During this time there was a rapid expansion of EMCC websites, from two blogs and one podcast in 2002 to 141 blogs and 42 podcasts in 2013. This paper illustrates the explosive growth of EMCC websites and provides a foundation that will anchor future research in this burgeoning field. PMID:24554447

  15. Effects of a Web-based Educational Module on Pediatric Emergency Medicine Physicians' Knowledge, Attitudes, and Behaviors Regarding Youth Violence

    PubMed Central

    Madsen, Tracy E.; Riese, Alison; Choo, Ester K.; Ranney, Megan L.

    2014-01-01

    Introduction: Youth seen in the emergency department (ED) with injuries from youth violence (YV) have increased risk for future violent injury and death. Pediatric emergency medicine (PEM) physicians rarely receive training in, or perform, YV screening and intervention. Our objective was to examine effects of a web-based educational module on PEM physicians' knowledge, attitudes, and behaviors regarding YV screening and interventions in the ED. Methods: We invited all PEM fellows and attendings at an urban Level I pediatric trauma center to complete an interactive web-based education module (and 1-month booster) with information on YV's public health impact and how to screen, counsel and refer YV-involved patients. Consenting subjects completed electronic assessments of YV prevention knowledge and attitudes (using validated measures when possible) before and after the initial module and after the booster. To measure behavior change, chart review identified use of YV-specific discharge instructions in visits by YV-injured PEM patients (age 12–17; identified by E codes) 6 months before and after the intervention. We analyzed survey data were analyzed with Fisher's exact for binary outcomes and Kruskal-Wallis for Likert responses. Proportion of patients given YV discharge instructions before and after the intervention was compared using chi-square. Results: Eighteen (67%) of 27 PEM physicians participated; 1 was lost at post-module assessment and 5 at 1 month. Module completion time ranged from 15–30 minutes. At baseline, 50% of subjects could identify victims' re-injury rate; 28% were aware of ED YV discharge instructions. After the initial module and at 1 month, there were significant increases in knowledge (p<0.001) and level of confidence speaking with patients about avoiding YV (p=0.01, df=2). Almost all (94%) said the module would change future management. In pre-intervention visits, 1.6% of patients with YV injuries were discharged with YV instructions

  16. Mobile satellite services for public safety, disaster mitigation and disaster medicine

    NASA Astrophysics Data System (ADS)

    Freibaum, Jerry

    Between 1967 and 1987 nearly three million lives were lost and property damage of $25 to $100 billion resulted form natural disasters that adversely affected more than 829 million people. The social and economic impacts have been staggering and are expected to grow more serious as a result of changing demographic factors. The role that the Mobile Satellite Service can play in the International Decade is discussed. MSS was not available for disaster relief operations during the recent Loma Prieta/San Francisco earthquake. However, the results of a review of the performance of seven other communication services with respect to public sector operations during and shortly after the earthquake are described. The services surveyed were: public and private telephone, mobile radio telephone, noncellular mobile radio, broadcast media, CB radio, ham radio, and government and nongovernment satellite systems. The application of MSS to disaster medicine, particularly with respect to the Armenian earthquake is also discussed.

  17. Mobile satellite services for public safety, disaster mitigation and disaster medicine

    NASA Technical Reports Server (NTRS)

    Freibaum, Jerry

    1990-01-01

    Between 1967 and 1987 nearly three million lives were lost and property damage of $25 to $100 billion resulted form natural disasters that adversely affected more than 829 million people. The social and economic impacts have been staggering and are expected to grow more serious as a result of changing demographic factors. The role that the Mobile Satellite Service can play in the International Decade is discussed. MSS was not available for disaster relief operations during the recent Loma Prieta/San Francisco earthquake. However, the results of a review of the performance of seven other communication services with respect to public sector operations during and shortly after the earthquake are described. The services surveyed were: public and private telephone, mobile radio telephone, noncellular mobile radio, broadcast media, CB radio, ham radio, and government and nongovernment satellite systems. The application of MSS to disaster medicine, particularly with respect to the Armenian earthquake is also discussed.

  18. Legal issues affecting children with preexisting conditions during public health emergencies.

    PubMed

    Rutkow, Lainie; Vernick, Jon S; Wissow, Lawrence S; Tung, Gregory J; Marum, Felicity; Barnett, Daniel J

    2013-06-01

    Among the millions of children in the United States exposed to public health emergencies in recent years, those with preexisting health conditions face particular challenges. A public health emergency may, for example, disrupt treatment regimens or cause children to be separated from caregivers. Ongoing shortages of pediatricians and pediatric subspecialists may further exacerbate the risks that children with preexisting conditions face in disaster circumstances. The US Department of Homeland Security recently called for better integration of children's needs into all preparedness activities. To aid in this process, multiple legal concerns relevant to pediatricians and pediatric policymakers must be identified and addressed. Obtaining informed consent from children and parents may be particularly challenging during certain public health emergencies. States may need to invoke legal protections for children who are separated from caregivers during emergencies. Maintaining access to prescription medications may also require pediatricians to use specific legal mechanisms. In addition to practitioners, recommendations are given for policymakers to promote effective pediatric response to public health emergencies. PMID:23641730

  19. Treatment of uncomplicated malaria at public health facilities and medicine retailers in south-eastern Nigeria

    PubMed Central

    2011-01-01

    Background At primary care facilities in Nigeria, national treatment guidelines state that malaria should be symptomatically diagnosed and treated with artemisinin-based combination therapy (ACT). Evidence from households and health care providers indicates that many patients do not receive the recommended treatment. This study sought to determine the extent of the problem by collecting data as patients and caregivers leave health facilities, and determine what influences the treatment received. Methods A cross-sectional cluster survey of 2,039 respondents exiting public health centres, pharmacies and patent medicine dealers was undertaken in urban and rural settings in Enugu State, south-eastern Nigeria. Results Although 79% of febrile patients received an anti-malarial, only 23% received an ACT. Many patients (38%) received sulphadoxine-pyrimethamine (SP). A further 13% of patients received an artemisinin-derivative as a monotherapy. An estimated 66% of ACT dispensed was in the correct dose. The odds of a patient receiving an ACT was highly associated with consumer demand (OR: 55.5, p < 0.001). Conclusion Few febrile patients attending public health facilities, pharmacies and patent medicine dealers received an ACT, and the use of artemisinin-monotherapy and less effective anti-malarials is concerning. The results emphasize the importance of addressing both demand and supply-side influences on malaria treatment and the need for interventions that target consumer preferences as well as seek to improve health service provision. PMID:21651787

  20. Competency-based simulation assessment of resuscitation skills in emergency medicine postgraduate trainees – a Canadian multi-centred study

    PubMed Central

    Dagnone, J. Damon; Hall, Andrew K.; Sebok-Syer, Stefanie; Klinger, Don; Woolfrey, Karen; Davison, Colleen; Ross, John; McNeil, Gordon; Moore, Sean

    2016-01-01

    Background The use of high-fidelity simulation is emerging as a desirable method for competency-based assessment in postgraduate medical education. We aimed to demonstrate the feasibility and validity of a multi-centre simulation-based Objective Structured Clinical Examination (OSCE) of resuscitation competence with Canadian Emergency Medicine (EM) trainees. Method EM postgraduate trainees (n=98) from five Canadian academic centres participated in a high fidelity, 3-station simulation-based OSCE. Expert panels of three emergency physicians evaluated trainee performances at each centre using the Queen’s Simulation Assessment Tool (QSAT). Intraclass correlation coefficients were used to measure the inter-rater reliability, and analysis of variance was used to measure the discriminatory validity of each scenario. A fully crossed generalizability study was also conducted for each examination centre. Results Inter-rater reliability in four of the five centres was strong with a median absolute intraclass correlation coefficient (ICC) across centres and scenarios of 0.89 [0.65–0.97]. Discriminatory validity was also strong (p < 0.001 for scenarios 1 and 3; p < 0.05 for scenario 2). Generalizability studies found significant variations at two of the study centres. Conclusions This study demonstrates the successful pilot administration of a multi-centre, 3-station simulation-based OSCE for the assessment of resuscitation competence in post-graduate Emergency Medicine trainees. PMID:27103954

  1. [Development of an instrument for the surveillance of quality indicators in specialized training in Preventive Medicine and Public Health].

    PubMed

    Gil-Borrelli, Christian Carlo; Latasa, Pello; Reques, Laura; Alemán, Guadalupe

    2015-01-01

    This study describes the process of developing an instrument intended for use in assessing satisfaction with the quality of training in preventive medicine and public health for resident physicians. To develop this instrument, the National Survey of Satisfaction with Medical Residency was adapted by an expert panel consisting of 23 resident physicians in preventive medicine and public health belonging to 9 autonomous communities in Spain. The adaptation of the survey to the specialty rotations included new dimensions and items and was evaluated with a 5-point Likert scale. The most important dimensions were planning and the achievement of specific objectives, supervision, delegation of responsibilities, resources and work environment, personal assessment, encouragement, support, and whether the rotation resulted in a publication or research project, etc. The development and utilization of this tool will enable future trainees in preventive medicine and public health to make an informed choice about their training itineraries. PMID:26112655

  2. Antagonism and accommodation: interpreting the relationship between public health and medicine in the United States during the 20th century.

    PubMed Central

    Brandt, A M; Gardner, M

    2000-01-01

    Throughout the course of the 20th century, many observers have noted important tensions and antipathies between public health and medicine. At the same time, reformers have often called for better engagement and collaboration between the 2 fields. This article examines the history of the relationship between medicine and public health to examine how they developed as separate and often conflicting professions. The historical character of this relationship can be understood only in the context of institutional developments in professional education, the rise of the biomedical model of disease, and the epidemiologic transition from infectious disease to the predominance of systemic chronic diseases. Many problems in the contemporary burden of disease pose opportunities for effective collaborations between population-based and clinical interventions. A stronger alliance between public health and medicine through accommodation to a reductionist biomedicine, however, threatens to subvert public health's historical commitment to understanding and addressing the social roots of disease. PMID:10800418

  3. Public Careers and Private Sexuality: Some Gay and Lesbian Lives in the History of Medicine and Public Health

    PubMed Central

    Hansen, Bert

    2002-01-01

    This study explores the careers of 5 physicians active in public health and medicine during the first half of the 20th century to illustrate interactions between private and professional life. An examination of these individuals, who might today be variously designated as gay, lesbian, bisexual, transgender, or queer, suggests how historical understanding can be enriched by a greater willingness to investigate intimacy and sexual life as potentially relevant to career and achievements. Further, the narratives support a plea for all historians to provide readers with a more frank acknowledgment of the possible relevance of personal life to intellectual work, even in the sciences. Additionally, this historical exploration of ways that careers and achievements may have been affected by a person's homosexuality (even when the person did not publicly embrace a gay identity) opens up a new area of research through biographical sketches based on historical sources combined with generalizations that are intentionally provisional. Included are the stories of Sara Josephine Baker, Harry Stack Sullivan, Ethel Collins Dunham, Martha May Eliot, and Alan L. Hart. PMID:11772756

  4. Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 3: Paediatric deaths associated with over the counter cough and cold medicines.

    PubMed

    Deschler, Deanna; Judge, Bryan

    2014-02-01

    A short cut review was carried out to establish whether over the counter cough and cold medicines were associated with unexpected deaths in childhood. 115 papers were found using the reported searches, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of those best papers are tabulated. It is concluded that while over the counter cough and cold medications may be associated with unexpected paediatric deaths, the degree of risk is not clear. PMID:24429253

  5. Differences in the availability of medicines for chronic and acute conditions in the public and private sectors of developing countries

    PubMed Central

    Roubos, Ilse; Ewen, Margaret; Mantel-Teeuwisse, Aukje K; Leufkens, Hubertus GM; Laing, Richard O

    2011-01-01

    Abstract Objective To investigate potential differences in the availability of medicines for chronic and acute conditions in low- and middle-income countries. Methods Data on the availability of 30 commonly-surveyed medicines – 15 for acute and 15 for chronic conditions – were obtained from facility-based surveys conducted in 40 developing countries. Results were aggregated by World Bank country income group and World Health Organization region. Findings The availability of medicines for both acute and chronic conditions was suboptimal across countries, particularly in the public sector. Generic medicines for chronic conditions were significantly less available than generic medicines for acute conditions in both the public sector (36.0% availability versus 53.5%; P = 0.001) and the private sector (54.7% versus 66.2%; P = 0.007). Antiasthmatics, antiepileptics and antidepressants, followed by antihypertensives, were the drivers of the observed differences. An inverse association was found between country income level and the availability gap between groups of medicines, particularly in the public sector. In low- and lower-middle income countries, drugs for acute conditions were 33.9% and 12.9% more available, respectively, in the public sector than medicines for chronic conditions. Differences in availability were smaller in the private sector than in the public sector in all country income groups. Conclusion Current disease patterns do not explain the significant gaps observed in the availability of medicines for chronic and acute conditions. Measures are needed to better respond to the epidemiological transition towards chronic conditions in developing countries alongside current efforts to scale up treatment for communicable diseases. PMID:21673857

  6. A quantitative tool for measuring the quality of medical training in emergency medicine.

    PubMed

    Smith, Simon M; Davis, Peyton; Davies, Llion

    2015-12-01

    The most common method of assessing the quality of medical education is through a selection of qualitative assessments, usually as part of a programme evaluation. Common qualitative assessments include measurements of students' and teachers' participation, outcome measures such as assessment results, and qualitative assessments such as interviews and questionnaires of students and teachers. Programme evaluation can therefore be a process that is both laborious and subject to accusations of a lack of objectivity. As a result, the development of a quantitative tool that could be used alongside a programme evaluation may be both useful and desirable. A pragmatic scoring system, utilizing routinely collected quantitative data, termed as the Quality Assessment Tool, was developed during the 2013 academic year within the setting of an Emergency Medicine training programme in the UK. This tool was tested against the standard assessment currently used for this programme to establish whether the quantitative tool correlated with the programme evaluation. Second, the individual items within the tool were investigated to identify any correlations with the current assessment of quality established by the programme evaluation. The Quality Assessment Tool appears to be correlated to the quality of training delivered at individual training sites in a single specialty. It certainly identifies those centres delivering the highest quality of training and also identifies those centres whose training is consistently of a lower standard. The assessment tool is less accurate at ranking those training centres whose training is merely 'satisfactory'; whether this is a result of the imprecision of the tool itself or a reflection of the subjective nature of the current assessment (i.e. whether the current evaluation system lacks validity) cannot be stated. In summary, it appears to be possible to use a single quantitative tool to reliably, and with validity, measure the quality of training

  7. Correlation of the National Emergency Medicine M4 Clerkship Examination with USMLE Examination Performance

    PubMed Central

    Lawson, Luan E.; Musick, Davis; Brewer, Kori

    2015-01-01

    Introduction Assessment of medical students’ knowledge in clinical settings is complex yet essential to the learning process. Clinical clerkships use various types of written examinations to objectively test medical knowledge within a given discipline. Within emergency medicine (EM), a new national standardized exam was developed to test medical knowledge in this specialty. Evaluation of the psychometric properties of a new examination is an important issue to address during test development and use. Studies have shown that student performance on selected standardized exams will reveal students’ strengths and/or weaknesses, so that effective remedial efforts can be implemented. Our study sought to address these issues by examining the association of scores on the new EM national exam with other standardized exam scores. Methods From August 2011 to April 2013, average National EM M4 examination scores of fourth-year medical students taken at the end of a required EM clerkship were compiled. We examined the correlation of the National EM M4 examination with the scores of initial attempts of the United States Medical Licensing Exam (USMLE) Step 1 and Step 2 Clinical Knowledge (CK) examinations. Correlation coefficients and 95% confidence intervals of correlation coefficients are reported. We also examined the association between the national EM M4 examination score, final grades for the EM rotation, and USMLE Step 1 and Step 2 CK scores. Results 133 students were included in the study and achieved a mean score of 79.5 SD 8.0 on the National EM M4 exam compared to a national mean of 79.7 SD 3.89. The mean USMLE Step 1 score was 226.8 SD 19.3. The mean USMLE Step 2 CK score was 238.5 SD 18.9. National EM M4 examination scores showed moderate correlation with both USMLE Step 1 (mean score=226.8; correlation coefficient=0.50; 95% CI [0.28–0.67]) and USMLE Step 2 CK (mean score=238.5; correlation coefficient=0.47; 95% CI [0.25–0.65]). Students scoring below the

  8. Can Simulation Measure Differences in Task-Switching Ability Between Junior and Senior Emergency Medicine Residents?

    PubMed Central

    Smith, Dustin; Miller, Daniel G.; Cukor, Jeffrey

    2016-01-01

    Introduction Work interruptions during patient care have been correlated with error. Task-switching is identified by the Accreditation Council for Graduate Medical Education (ACGME) as a core competency for emergency medicine (EM). Simulation has been suggested as a means of assessing EM core competencies. We assumed that senior EM residents had better task-switching abilities than junior EM residents. We hypothesized that this difference could be measured by observing the execution of patient care tasks in the simulation environment when a patient with a ST-elevation myocardial infarction (STEMI) interrupted the ongoing management of a septic shock case. Methods This was a multi-site, prospective, observational, cohort study. The study population consisted of a convenience sample of EM residents in their first three years of training. Each subject performed a standardized simulated encounter by evaluating and treating a patient in septic shock. At a predetermined point in every sepsis case, the subject was given a STEMI electrocardiogram (ECG) for a separate chest pain patient in triage and required to verbalize an interpretation and action. We scored learner performance using a dichotomous checklist of critical actions covering sepsis care, ECG interpretation and triaging of the STEMI patient. Results Ninety-one subjects participated (30 postgraduate year [PGY]1s, 32 PGY2s, and 29 PGY3s). Of those, 87 properly managed the patient with septic shock (90.0% PGY1s, 100% PGY2, 96.6% PGY 3s; p=0.22). Of the 87 who successfully managed the septic shock, 80 correctly identified STEMI on the simulated STEMI patient (86.7% PGY1s, 96.9% PGY2s, 93.1% PGY3s; p=0.35). Of the 80 who successfully managed the septic shock patient and correctly identified the STEMI, 79 provided appropriate interventions for the STEMI patient (73.3% PGY1s, 93.8% PGY2s, 93.8% PGY3s; p=0.07). Conclusion When management of a septic shock patient was interrupted with a STEMI ECG in a simulated

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

    PubMed Central

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

    2015-01-01

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

  10. Teaching Emotional Intelligence: A Control Group Study of a Brief Educational Intervention for Emergency Medicine Residents

    PubMed Central

    Gorgas, Diane L.; Greenberger, Sarah; Bahner, David P.; Way, David P.

    2015-01-01

    Introduction Emotional Intelligence (EI) is defined as an ability to perceive another’s emotional state combined with an ability to modify one’s own. Physicians with this ability are at a distinct advantage, both in fostering teams and in making sound decisions. Studies have shown that higher physician EI’s are associated with lower incidence of burn-out, longer careers, more positive patient-physician interactions, increased empathy, and improved communication skills. We explored the potential for EI to be learned as a skill (as opposed to being an innate ability) through a brief educational intervention with emergency medicine (EM) residents. Methods This study was conducted at a large urban EM residency program. Residents were randomized to either EI intervention or control groups. The intervention was a two-hour session focused on improving the skill of social perspective taking (SPT), a skill related to social awareness. Due to time limitations, we used a 10-item sample of the Hay 360 Emotional Competence Inventory to measure EI at three time points for the training group: before (pre) and after (post) training, and at six-months post training (follow up); and at two time points for the control group: pre- and follow up. The preliminary analysis was a four-way analysis of variance with one repeated measure: Group x Gender x Program Year over Time. We also completed post-hoc tests. Results Thirty-three EM residents participated in the study (33 of 36, 92%), 19 in the EI intervention group and 14 in the control group. We found a significant interaction effect between Group and Time (p≤0.05). Post-hoc tests revealed a significant increase in EI scores from Time 1 to 3 for the EI intervention group (62.6% to 74.2%), but no statistical change was observed for the controls (66.8% to 66.1%, p=0.77). We observed no main effects involving gender or level of training. Conclusion Our brief EI training showed a delayed but statistically significant positive impact

  11. Communications in Public Health Emergency Preparedness: A Systematic Review of the Literature

    PubMed Central

    Savoia, Elena; Viswanath, Kasisomayajula

    2013-01-01

    During a public health crisis, public health agencies engage in a variety of public communication efforts to inform the population, encourage the adoption of preventive behaviors, and limit the impact of adverse events. Given the importance of communication to the public in public health emergency preparedness, it is critical to examine the extent to which this field of study has received attention from the scientific community. We conducted a systematic literature review to describe current research in the area of communication to the public in public health emergency preparedness, focusing on the association between sociodemographic and behavioral factors and communication as well as preparedness outcomes. Articles were searched in PubMed and Embase and reviewed by 2 independent reviewers. A total of 131 articles were included for final review. Fifty-three percent of the articles were empirical, of which 74% were population-based studies, and 26% used information environment analysis techniques. None had an experimental study design. Population-based studies were rarely supported by theoretical models and mostly relied on a cross-sectional study design. Consistent results were reported on the association between population socioeconomic factors and public health emergency preparedness communication and preparedness outcomes. Our findings show the need for empirical research to determine what type of communication messages can be effective in achieving preparedness outcomes across various population groups. They suggest that a real-time analysis of the information environment is valuable in knowing what is being communicated to the public and could be used for course correction of public health messages during a crisis. PMID:24041193

  12. Understanding the nature of health: New perspectives for medicine and public health. Improved wellbeing at lower costs

    PubMed Central

    Bircher, Johannes; Hahn, Eckhart G.

    2016-01-01

    Background: Current dilemmas of health care systems call for a new look at the nature of health. This is offered by the Meikirch model. We explore its hypothetical benefit for the future of medicine and public health. Meikirch model: It states: “Health is a dynamic state of wellbeing emergent from conducive interactions between individuals’ potentials, life’s demands, and social and environmental determinants.” “Throughout the life course health results when an individuals’ biologically given potential (BGP) and his or her personally acquired potential (PAP), interacting with social and environmental determinants, satisfactorily respond to the demands of life.” Methods: We explored the Meikirch model’s possible applications for personal and public health care. Results: The PAP of each individual is the most modifiable component of the model. It responds to constructive social interactions and to personal growth. If an individual’s PAP is nurtured to develop further, it likely will contribute much more to health than without fostering. It may also compensate for losses of the BGP. An ensuing new culture of health may markedly improve health in the society. The rising costs of health care presumably are due in part to the tragedy of the commons and to moral hazard. Health as a complex adaptive system offers new possibilities for patient care, particularly for general practitioners. Discussion: Analysis of health systems by the Meikirch model reveals that in many areas more can be done to improve people’s health and to reduce health care costs than is done today. The Meikirch model appears promising for individual and public health in low and high income countries. Emphasizing health instead of disease the Meikirch model reinforces article 12 of the International Covenant on Economic, Social and Cultural Rights of the United Nations – that abandons the WHO definition - and thereby may contribute to its reinterpretation. PMID:27134730

  13. A PUBLIC HEALTH PERSPECTIVE ON THE U.S. RESPONSE TO THE FUKUSHIMA RADIOLOGICAL EMERGENCY

    PubMed Central

    Whitcomb, Robert C.; Ansari, Armin J.; Buzzell, Jennifer J.; McCurley, M. Carol; Miller, Charles W.; Smith, James M.; Evans, D. Lynn

    2015-01-01

    On 11 March 2011, northern Japan was struck by first a magnitude 9.0 earthquake off the eastern coast and then by an ensuing tsunami. At the Fukushima Dai-ichi Nuclear Power Plant (NPP), these twin disasters initiated a cascade of events that led to radionuclide releases. Radioactive material from Japan was subsequently transported to locations around the globe, including the U.S. The levels of radioactive material that arrived in the U.S. were never large enough to cause health effects, but the presence of this material in the environment was enough to require a response from the public health community. Events during the response illustrated some U.S. preparedness challenges that previously had been anticipated and others that were newly identified. Some of these challenges include the following: (1) Capacity, including radiation health experts, for monitoring potentially exposed people for radioactive contamination are limited and may not be adequate at the time of a large-scale radiological incident; (2) there is no public health authority to detain people contaminated with radioactive materials; (3) public health and medical capacities for response to radiation emergencies are limited; (4) public health communications regarding radiation emergencies can be improved to enhance public health response; (5) national and international exposure standards for radiation measurements (and units) and protective action guides lack uniformity; (6) access to radiation emergency monitoring data can be limited; and (7) the Strategic National Stockpile may not be currently prepared to meet the public health need for KI in the case of a surge in demand from a large-scale radiation emergency. Members of the public health community can draw on this experience to improve public health preparedness. PMID:25627948

  14. A public health perspective on the U.S. response to the Fukushima radiological emergency.

    PubMed

    Whitcomb, Robert C; Ansari, Armin J; Buzzell, Jennifer J; McCurley, M Carol; Miller, Charles W; Smith, James M; Evans, D Lynn

    2015-03-01

    On 11 March 2011, northern Japan was struck by first a magnitude 9.0 earthquake off the eastern coast and then by an ensuing tsunami. At the Fukushima Dai-ichi Nuclear Power Plant (NPP), these twin disasters initiated a cascade of events that led to radionuclide releases. Radioactive material from Japan was subsequently transported to locations around the globe, including the U.S. The levels of radioactive material that arrived in the U.S. were never large enough to cause health effects, but the presence of this material in the environment was enough to require a response from the public health community. Events during the response illustrated some U.S. preparedness challenges that previously had been anticipated and others that were newly identified. Some of these challenges include the following: (1) Capacity, including radiation health experts, for monitoring potentially exposed people for radioactive contamination are limited and may not be adequate at the time of a large-scale radiological incident; (2) there is no public health authority to detain people contaminated with radioactive materials; (3) public health and medical capacities for response to radiation emergencies are limited; (4) public health communications regarding radiation emergencies can be improved to enhance public health response; (5) national and international exposure standards for radiation measurements (and units) and protective action guides lack uniformity; (6) access to radiation emergency monitoring data can be limited; and (7) the Strategic National Stockpile may not be currently prepared to meet the public health need for KI in the case of a surge in demand from a large-scale radiation emergency. Members of the public health community can draw on this experience to improve public health preparedness. PMID:25627948

  15. Museum Monsters and Victorious Viruses: Improving Public Understanding of Emerging Biomedical Research

    PubMed Central

    Diamond, Judy; Jee, Benjamin; Matuk, Camilla; McQuillan, Julia; Spiegel, Amy N.; Uttal, David

    2015-01-01

    Although microbes directly impact everyone's health, most people have limited knowledge about them. In this article, we describe a museum and media public education campaign aimed at helping diverse audiences better understand emerging knowledge about microbes and infectious disease. Funded primarily by the Science Education Partnership (SEPA) program of the National Institutes of Health, this campaign involved crosscutting programs designed to extend impacts throughout a broad public audience. PMID:26392634

  16. Ultrasound in sports medicine: relevance of emerging techniques to clinical care of athletes.

    PubMed

    Yim, Eugene Sun; Corrado, Gianmichael

    2012-08-01

    The applications of ultrasound in managing the clinical care of athletes have been expanding over the past decade. This review provides an analysis of the research that has been published regarding the use of ultrasound in athletes and focuses on how these emerging techniques can impact the clinical management of athletes by sports medicine physicians. Electronic database literature searches were performed using the subject terms 'ultrasound' and 'athletes' from the years 2003 to 2012. The following databases were searched: PubMed, Web of Science, Cochrane Library, CINAHL, and SPORTDiscus™. The search produced 617 articles in total, with a predominance of articles focused on cardiac and musculoskeletal ultrasound. 266 of the studies involved application of ultrasound in evaluating the cardiovascular properties of athletes, and 151 studies involved musculoskeletal ultrasound. Other applications of ultrasound included abdominal, vascular, bone density and volume status. New techniques in echocardiography have made significant contributions to the understanding of the physiological changes that occur in the athlete's heart in response to the haemodynamic stress associated with different types of activity. The likely application of these techniques will be in managing athletes with hypertrophic cardiomyopathy, and the techniques are near ready for application into clinical practice. These techniques are highly specialized, however, and will require referral to dedicated laboratories to influence the clinical management of athletes. Investigation of aortic root pathology and pulmonary vascular haemodynamics are also emerging, but will require additional studies with larger numbers and outcomes analysis to validate their clinical utility. Some of these techniques are relatively simple, and thus hold the potential to enter clinical management in a point-of-care fashion. Musculoskeletal ultrasound has demonstrated a number of diagnostic and therapeutic techniques

  17. Organization, execution and evaluation of the 2014 Academic Emergency Medicine consensus conference on Gender-Specific Research in Emergency Care - an executive summary.

    PubMed

    Safdar, Basmah; Greenberg, Marna R

    2014-12-01

    With the goal of reducing inequalities in patient care, the 2014 Academic Emergency Medicine (AEM) consensus conference, "Gender-Specific Research in Emergency Care: Investigate, Understand, and Translate How Gender Affects Patient Outcomes," convened a diverse group of researchers, clinicians, health care providers, patients, and representatives of federal agencies and policy-makers in Dallas, Texas, in May 2014. The executive and steering committees identified seven clinical domains as key to gender-specific emergency care: cardiovascular, neurological, trauma/injury, substance abuse, pain, mental health, and diagnostic imaging. The main aims of the conference were to: 1) summarize and consolidate current data related to sex- and gender-specific research for acute care and identify critical gender-related gaps in knowledge to inform an EM research agenda; 2) create a consensus-driven research agenda that advances sex- and gender-specific research in the prevention, diagnosis, and management of acute diseases and identify strategies to investigate them; and 3) build a multinational interdisciplinary consortium to disseminate and study the sex and gender medicine of acute conditions. Over a 2-year period, this collaborative network of stakeholders identified key areas where sex- and gender-specific research is most likely to improve clinical care and ultimately patient outcomes. The iterative consensus process culminated in a daylong conference on May 13, 2014, with a total of 133 registrants, with the majority being between ages 31 and 50 years (57%), females (71%), and whites (79%). Content experts led the consensus-building workshops at the conference and used the nominal group technique to consolidate consensus recommendations for priority research. In addition, panel sessions addressed funding mechanisms for gender-specific research as well as gender-specific regulatory challenges to product development and approval. This special issue of AEM reports the

  18. High Yield Research Opportunities in Geriatric Emergency Medicine: Prehospital Care, Delirium, Adverse Drug Events, and Falls

    PubMed Central

    Carpenter, Christopher R.; Shah, Manish N.; Hustey, Fredric M.; Heard, Kennon; Gerson, Lowell W.

    2011-01-01

    Emergency services constitute crucial and frequently used safety nets for older persons, an emergency visit by a senior very often indicates high vulnerability for functional decline and death, and interventions via the emergency system have significant opportunities to change the clinical course of older patients who require its services. However, the evidence base for widespread employment of emergency system-based interventions is lacking. In this article, we review the evidence and offer crucial research questions to capitalize on the opportunity to optimize health trajectories of older persons seeking emergency care in four areas: prehospital care, delirium, adverse drug events, and falls. PMID:21498881

  19. Thorax, Trachea, and Lung Ultrasonography in Emergency and Critical Care Medicine: Assessment of an Objective Structured Training Concept

    PubMed Central

    Breitkreutz, Raoul; Dutiné, Martina; Scheiermann, Patrick; Kujumdshiev, Sandy; Ackermann, Hanns; Seeger, Florian Hartmut; Walcher, Felix; Hirche, Tim Oliver

    2013-01-01

    Background and Study objective. Focused lung ultrasound (LUS) examinations are important tools in critical care medicine. There is evidence that LUS can be used for the detection of acute thoracic lesions. However, no validated training method is available. The goal of this study was to develop and assess an objective structured clinical examination (OSCE) curriculum for focused thorax, trachea, and lung ultrasound in emergency and critical care medicine (THOLUUSE). Methods. 39 trainees underwent a one-day training course in a prospective educational study, including lectures in sonoanatomy and -pathology of the thorax, case presentations, and hands-on training. Trainees' pre- and posttest performances were assessed by multiple choice questionnaires, visual perception tests by interpretation video clips, practical performance of LUS, and identification of specific ultrasound findings. Results. Trainees postcourse scores of correct MCQ answers increased from 56 ± 4% to 82 ± 2% (mean± SD; P < 0.001); visual perception skills increased from 54 ± 5% to 78 ± 3% (P < 0.001); practical ultrasound skills improved, and correct LUS was performed in 94%. Subgroup analysis revealed that learning success was independent from the trainees' previous ultrasound experience. Conclusions. THOLUUSE significantly improves theoretical and practical skills for the diagnosis of acute thoracic lesions. We propose to implement THOLUUSE in emergency medicine training. PMID:24369503

  20. Public Health and Preventive Medicine Meet Integrative Health: Applications of Competency Mapping to Curriculum Education at the University of Michigan.

    PubMed

    Wells, Eden V; Benn, Rita K; Warber, Sara L

    2015-11-01

    The University of Michigan School of Public Health Preventive Medicine Residency (UMSPH PMR) Integrative Medicine Program (IMP) was developed to incorporate integrative medicine (IM), public health, and preventive medicine principles into a comprehensive curriculum for preventive medicine residents and faculty. The objectives of this project were to (1) increase the preventive medicine workforce skill sets based in complementary and alternative medicine and IM that would address individual and population health issues; (2) address the increasing demand for evidence-based IM by training physicians to implement cost-effective primary and secondary prevention services and programs; and (3) share lessons learned, curriculum evaluations, and best practices with the larger cohort of funded IM PMR programs. The UMSPH PMR collaborated with University of Michigan IM faculty to incorporate existing IM competencies with those already established for preventive medicine and public health residency training as the first critical step for IMP curriculum integration. Essential teaching strategies incorporated didactic and practicum methods, and made use of seasoned IM faculty, along with newly minted preventive medicine integrative teaching faculty, and PMR resident learners as IM teachers. The major components of the IMP curriculum included resident participation in IMP Orientation Sessions, resident leadership in epidemiology graduate IM seminars, resident rotations in IM month-long clinical practicums, resident participation in interprofessional health system-wide IM clinical case conferences, and PMR faculty enrollment in the renowned Faculty Scholars Program in Integrative Healthcare. This paper describes the novel interdisciplinary collaborations and key curriculum components that resulted in the IMP, as well as evaluation of strengths, weaknesses, and lessons learned. PMID:26477903

  1. 77 FR 24510 - Notice of Proposed Information Collection for Public Comment Emergency Comment Request; Office of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-24

    ... URBAN DEVELOPMENT Notice of Proposed Information Collection for Public Comment Emergency Comment Request; Office of Housing Assistance Contract Administration Oversight, Multifamily Housing Programs AGENCY... Development, 451 7th Street SW., Washington, DC 20410, telephone (202) 402-3885 (this is not a toll...

  2. 75 FR 51825 - Quality and Compliance in Merging and Emerging Cultures; Public Conference

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-23

    ...The Food and Drug Administration (FDA) is announcing a public conference entitled ``The New Paradigm: Quality and Compliance in Merging and Emerging Cultures.'' The conference, cosponsored with the Parenteral Drug Association (PDA), will focus on challenges facing the medical products industry in navigating regulatory compliance, achieving worldwide quality improvement, and enhancing quality......

  3. 75 FR 65340 - Agency Emergency Information Collection Clearance Request for Public Comment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-22

    ... From the Federal Register Online via the Government Publishing Office ] DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency Emergency Information Collection Clearance Request for Public Comment AGENCY: Office of the Secretary, HHS. In compliance with the requirement of section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, the Office of...

  4. 76 FR 1166 - Office of Consumer Information and Insurance Oversight; Emergency Clearance; Public Information...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-07

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of Consumer Information and Insurance Oversight; Emergency Clearance; Public Information Collection Requirements Submitted to the Office of Management and Budget (OMB) AGENCY: Office of Consumer Information and Insurance...

  5. 76 FR 16793 - Emergency Clearance: Public Information Collection Requirements Submitted to the Office of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-25

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare and Medicaid Services Emergency Clearance: Public Information Collection Requirements Submitted to the Office of Management and Budget (OMB) AGENCY: Center for Medicare and Medicaid Services, HHS. In compliance...

  6. Exploring the Influence of Emerging Media Technologies on Public High School Teachers

    ERIC Educational Resources Information Center

    Eldridge, John A.

    2010-01-01

    The purpose of this research is to better understand the influence emerging media technologies such as MP3 players, cell phones, and social networking sites are having on teachers in public high schools. Through the experiences teachers and staff members shared with us, the reader will gain a better understanding of how teachers and staff members…

  7. Emergency preparedness of families of children with developmental disabilities: What public health and safety emergency planners need to know

    PubMed Central

    Wolf-Fordham, Susan; Curtin, Carol; Maslin, Melissa; Bandini, Linda; Hamad, Charles D.

    2015-01-01

    Objective To assess the emergency preparedness knowledge, behaviors, and training needs of families of children with developmental disabilities (DD). Design An online survey. Participants A sample of 314 self-selecting US parents/guardians of children with DD, aged birth-21 years. Main outcome measures 1) Preparedness self-assessment; 2) self-report regarding the extent to which families followed 11 specific preparedness action steps derived from publicly available preparedness guides; and 3) parent training and support needs. Results Although most participants assessed themselves to be somewhat to moderately well prepared, even those who reported being “very well prepared” had taken fewer than half of 11 recommended action steps. Most participants expressed a need for preparedness support; virtually all the respondents felt that training was either important or very important. Conclusions Children with disabilities are known to be particularly vulnerable to negative disaster impacts. Overall, parents in this study appeared under-prepared to meet family disaster needs, although they recognized its importance. The results suggest opportunities and methods for public health and safety planning, education and outreach to parents of children with DD who would benefit from targeted training such as information and skill building to develop effective family preparedness plans and connections to local emergency management and responders. PMID:25779895

  8. The emergence of pioneering public health education programs in the United States.

    PubMed Central

    Viseltear, A. J.

    1988-01-01

    This paper considers the social forces leading to the establishment of pioneering public health education programs in the United States. Schools of Public Health emerged in the United States as the result of a confluence of factors, including the changing nature of higher education, the development of commerce and industry, the rise to prominence of the science of bacteriology, and the urbanization of the nation, all coupled with a pervasive spirit of utility and a desire to be, in a word, useful. Each line leading to the establishment of five public health institutions at the Massachusetts Institute of Technology, Harvard-M.I.T., Yale, Michigan, and Pennsylvania is explored. PMID:3071923

  9. A Conceptual Framework for Allocation of Federally Stockpiled Ventilators During Large-Scale Public Health Emergencies.

    PubMed

    Zaza, Stephanie; Koonin, Lisa M; Ajao, Adebola; Nystrom, Scott V; Branson, Richard; Patel, Anita; Bray, Bruce; Iademarco, Michael F

    2016-01-01

    Some types of public health emergencies could result in large numbers of patients with respiratory failure who need mechanical ventilation. Federal public health planning has included needs assessment and stockpiling of ventilators. However, additional federal guidance is needed to assist states in further allocating federally supplied ventilators to individual hospitals to ensure that ventilators are shipped to facilities where they can best be used during an emergency. A major consideration in planning is a hospital's ability to absorb additional ventilators, based on available space and staff expertise. A simple pro rata plan that does not take these factors into account might result in suboptimal use or unused scarce resources. This article proposes a conceptual framework that identifies the steps in planning and an important gap in federal guidance regarding the distribution of stockpiled mechanical ventilators during an emergency. PMID:26828799

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

    PubMed

    Safdar, Basmah; Nagurney, John T; Anise, Ayodola; DeVon, Holli A; D'Onofrio, Gail; Hess, Erik P; Hollander, Judd E; Legato, Mariane J; McGregor, Alyson J; Scott, Jane; Tewelde, Semhar; Diercks, Deborah B

    2014-12-01

    Coronary artery disease (CAD) is the most common cause of death for both men and women. However, over the years, emergency physicians, cardiologists, and other health care practitioners have observed varying outcomes in men and women with symptomatic CAD. Women in general are 10 to 15 years older than men when they develop CAD, but suffer worse postinfarction outcomes compared to age-matched men. This article was developed by the cardiovascular workgroup at the 2014 Academic Emergency Medicine (AEM) consensus conference to identify sex- and gender-specific gaps in the key themes and research questions related to emergency cardiac ischemia care. The workgroup had diverse stakeholder representation from emergency medicine, cardiology, critical care, nursing, emergency medical services, patients, and major policy-makers in government, academia, and patient care. We implemented the nominal group technique to identify and prioritize themes and research questions using electronic mail, monthly conference calls, in-person meetings, and Web-based surveys between June 2013 and May 2014. Through three rounds of nomination and refinement, followed by an in-person meeting on May 13, 2014, we achieved consensus on five priority themes and 30 research questions. The overarching themes were as follows: 1) the full spectrum of sex-specific risk as well as presentation of cardiac ischemia may not be captured by our standard definition of CAD and needs to incorporate other forms of ischemic heart disease (IHD); 2) diagnosis is further challenged by sex/gender differences in presentation and variable sensitivity of cardiac biomarkers, imaging, and risk scores; 3) sex-specific pathophysiology of cardiac ischemia extends beyond conventional obstructive CAD to include other causes such as microvascular dysfunction, takotsubo, and coronary artery dissection, better recognized as IHD; 4) treatment and prognosis are influenced by sex-specific variations in biology, as well as patient

  11. Overview of research on women in medicine--issues for public policymakers.

    PubMed Central

    Bowman, M; Gross, M L

    1986-01-01

    The recent expansion of the nation's supply of physicians has brought with it dramatic increases in the number of women entering medical school and practice. This paper provides an overview of the literature on women in medicine and synthesizes major findings on the differences between male and female physicians in terms of specialty choice, productivity, income, geographic location of practice, practice settings and types of patients, leadership within the profession, and other characteristics. Between 1981 and the year 2000, the total supply of physicians in practice is expected to increase by 27 percent; the number of women in practice is expected to increase by 153 percent. By the year 2000, one physician in five will be a woman. The fairly limited research on gender-related differences indicate that women tend to cluster in a few specialties (pediatrics, psychiatry, pathology, preventive medicine, physical medicine and rehabilitation, and anesthesiology), many of which are specialties expected to have fewer physicians than needed nationally by 1990. Women have also been shown to have lower productivity and lower income than male physicians, to choose urban locations more frequently, to prefer salaried and institutional settings more often, to serve different types of patients, and to belong to medical organizations less frequently. From the standpoint of public policy, the differences between the characteristics of male and female physicians have mixed implications. For example, the choice of specialty and lower productivity of women could lessen the negative impact of future physician surpluses. On the other hand, a preference for urban practice could exacerbate geographic maldistribution problems.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3094083

  12. Investigation of public exposure resulted from the radioiodine delay tank facility of nuclear medicine department

    NASA Astrophysics Data System (ADS)

    Yusof, Mohd Fahmi Mohd; Ali, Abdul Muhaimin Mat; Abdullah, Reduan; Idris, Abdullah Waidi

    2016-01-01

    The study is carried out to assess the exposure rate that could contribute to public exposure in a radioiodine ward delay tank facility of Radiotherapy, Oncology and Nuclear Medicine, Department, Hospital Universiti Sains Malaysia (HUSM). The exposure rate at several locations including the delay tank room, doorway and at the public walking route was measured using Victoreen 415P-RYR survey meter. The radioactive level of the 131I waste was measured using Captus 3000 well counting system. The results showed that exposure rate and total count of the delay tank sample increased when the radioiodine ward was fully occupied with patient and reduced when the ward was vacant. Occupancy of radioiodine ward for two consecutive weeks had dramatically increased the exposure rate around the delay tank and radioactive level of 131I waste. The highest exposure rate and radioactive level was recorded when the ward was occupied for two consecutive weeks with 177.00 µR/h and 58.36 kcpm respectively. The exposure rate decreased 15.76 % when the door of the delay tank room was closed. The exposure rate at public walking route decreased between 15.58 % and 36.92 % as the distance increased between 1 and 3 m.

  13. A microcomputer teaching and decision-support system for emergency medicine: use of hypermedia and artificial intelligence in combination.

    PubMed

    Thoreux, P H; Cléret, M; Jouannic, I; Denier, P; Bouget, J; Le Beux, P

    1996-01-01

    Hospital emergency units are submitted to a continuous intensive and polyvalent practice of medicine. In addition to the few experienced physicians, the medical staff is often made up of young and unskilled students and residents. The ability to reach at any time a wide and flexible knowledge is of the utmost importance to improve the quality of care given to patients and to perfect bedside teaching. The purpose of this work was to present a computerized system, a kind of shell, using, in combination, artificial intelligence and hypertext/hypermedia tools. A modular architecture is presented integrating two entities: an illustrated encyclopedic hypertext network and several expert modules based on production rules concerning well-limited fields of medicine (basic clinical problem-solving, metabolic and acid-base disorders). An interface using the World Wide Web (WWW) will soon be proposed. PMID:8871896

  14. Role of public transport in accessibility to emergency dental care in Melbourne, Australia.

    PubMed

    Rocha, Carla M; Kruger, Estie; McGuire, Shane; Tennant, Marc

    2015-01-01

    The aim of this study was to develop a method for the analysis of the influence of public transport supply in a large city (Melbourne) on the access to emergency dental treatment. Geographic Information Systems (GIS) tools were used to associate the geographical distribution of patients (and their socioeconomic status) with accessibility (through public transport supply, i.e. bus, tram and/or train) to emergency dental care. The methodology used allowed analysis of the socioeconomic status of patient residential areas and both spatial location and supply frequency of public transport by using existing data from patient records, census and transport departments. In metropolitan Melbourne, a total of 13 784 patients met the inclusion criteria for the study sample, of which 95% (n = 13 077) were living within a 50 km radius of the Royal Dental Hospital of Melbourne. Low socioeconomic areas had a higher demand for dental emergency care in the Royal Dental Hospital of Melbourne. Public transport supply was similar across the various socioeconomic strata in the population, with 80% of patients having good access to public transport. However, when considering only high-frequency bus stops, the percentage of patients living within 400 m from a bus stop dropped to 65%. Despite this, the number of patients (adjusted to the population) coming from areas not supplied by public transport, and from areas with good or poor public transport supply, was similar. The methodology applied in the present study highlights the importance of evaluating not only the spatial distribution but also the frequency of public transport supply when studying access to services. This methodology can be extrapolated to other settings to identity transport/access patterns for a variety of services. PMID:26509207

  15. A simplified training method for soft tissue foreign body detection using ultrasound in emergency medicine residency program

    PubMed Central

    Farahmand, Shervin; Mehran, Sadjad; Arbab, Mona; Khazaeipour, Zahra; Basir-Ghafouri, Hamed; Saeedi, Morteza

    2014-01-01

    Using ultrasound for detecting soft tissue foreign bodies seems to be the preferred choice with minimum invasion and easy availability at the bedside in emergency departments. In this study, a workshop (1 hour of lecture presentation and 3 hours of interactive hands-on) was designed to evaluate the efficacy of a short course of simple interactive training to improve the ability of emergency medicine residents to detect foreign bodies with ultrasound. Eight pieces of fresh full thickness (10 × 10 × 10 cm) lamb leg muscle were used in this study. Five different types of foreign bodies, including: a piece of glass (5 × 5 × 4 mm), wood (5 × 5 × 4 mm), gravel (5 mm diameter), plastic (5 × 5 × 2 mm) and a nail (25 mm in length) were placed deep inside each lamb leg. An ultrasound machine with a 7.5 MHz linear probe was used in this study. 35 emergency medicine residents (12 PGY1, 11 PGY2 and 12 PGY3) were enrolled in this study. Pretest and post-test results were compared and analyzed. Among all 35 participants in the training session, foreign body detection was significantly improved after the workshop (p < 0.001). Overall sensitivity and specificity for differentiating the presence and absence of a foreign body with 95% confidence were 60% (75% for PGY3) and 85.7% (91.7% for PGY3), respectively. The overall accuracy increased from 20.2% to 72.8% due to this session. This study supported the possibility of using ultrasound to detect foreign bodies by emergency physicians with a very short training course. This is highly beneficial for overcrowded emergency departments.

  16. A Transdisciplinary Approach to Public Health Law: The Emerging Practice of Legal Epidemiology.

    PubMed

    Burris, Scott; Ashe, Marice; Levin, Donna; Penn, Matthew; Larkin, Michelle

    2016-03-18

    Public health law has roots in both law and science. For more than a century, lawyers have helped develop and implement health laws; over the past 50 years, scientific evaluation of the health effects of laws and legal practices has achieved high levels of rigor and influence. We describe an emerging model of public health law that unites these two traditions. This transdisciplinary model adds scientific practices to the lawyerly functions of normative and doctrinal research, counseling, and representation. These practices include policy surveillance and empirical public health law research on the efficacy of legal interventions and the impact of laws and legal practices on health and health system operation. A transdisciplinary model of public health law, melding its legal and scientific facets, can help break down enduring cultural, disciplinary, and resource barriers that have prevented the full recognition and optimal role of law in public health. PMID:26667606

  17. Public Health Emergency Operations Center - A critical component of mass gatherings management infrastructure.

    PubMed

    Elachola, Habidah; Al-Tawfiq, Jaffar A; Turkestani, Abdulhafiz; Memish, Ziad A

    2016-01-01

    Mass gatherings (MG) are characterized by the influx of large numbers of people with the need to have infrastructural changes to support these gatherings. Thus, Public Health Emergency Operations Center (PHEOC) is critical management infrastructure for both the delivery of public health functions and for mounting adequate response during emergencies. The recognition of the importance of PHEOC at the leadership and political level is foundational for the success of any public health intervention during MG. The ability of the PHEOC to effectively function depends on appropriate design and infrastructure, staffing and command structure, and plans and procedures developed prior to the event. Multi-ministerial or jurisdictional coordination will be required and PHEOC should be positioned with such authorities. This paper outlines the essential concepts, elements, design, and operational aspects of PHEOC during MG. PMID:27580322

  18. Invasive Mechanical Ventilation in California Over 2000–2009: Implications for Emergency Medicine

    PubMed Central

    Mudumbai, Seshadri C.; Barr, Juli; Scott, Jennifer; Mariano, Edward R.; Bertaccini, Edward; Nguyen, Hieu; Memtsoudis, Stavros G.; Cason, Brian; Phibbs, Ciaran S.; Wagner, Todd

    2015-01-01

    Introduction Patients who require invasive mechanical ventilation (IMV) often represent a sequence of care between the emergency department (ED) and intensive care unit (ICU). Despite being the most populous state, little information exists to define patterns of IMV use within the state of California. Methods We examined data from the masked Patient Discharge Database of California’s Office of Statewide Health Planning and Development from 2000–2009. Adult patients who received IMV during their stay were identified using the International Classification of Diseases 9th Revision and Clinical Modification procedure codes (96.70, 96.71, 96.72). Patients were divided into age strata (18–34yr, 35–64yr, and >65yr). Using descriptive statistics and regression analyses, for IMV discharges during the study period, we quantified the number of ED vs. non-ED based admissions; changes in patient characteristics and clinical outcome; evaluated the marginal costs for IMV; determined predictors for prolonged acute mechanical ventilation (PAMV, i.e. IMV>96hr); and projected the number of IMV discharges and ED-based admissions by year 2020. Results There were 696,634 IMV discharges available for analysis. From 2000–2009, IMV discharges increased by 2.8%/year: n=60,933 (293/100,000 persons) in 2000 to n=79,868 (328/100,000 persons) in 2009. While ED-based admissions grew by 3.8%/year, non-ED-based admissions remained stable (0%). During 2000–2009, fastest growth was noted for 1) the 35–64 year age strata; 2) Hispanics; 3) patients with non-Medicare public insurance; and 4) patients requiring PAMV. Average total patient cost-adjusted charges per hospital discharge increased by 29% from 2000 (from $42,528 to $60,215 in 2014 dollars) along with increases in the number of patients discharged to home and skilled nursing facilities. Higher marginal costs were noted for younger patients (ages 18–34yr), non-whites, and publicly insured patients. Some of the strongest

  19. Personality and Longevity: Knowns, Unknowns, and Implications for Public Health and Personalized Medicine

    PubMed Central

    Chapman, Benjamin P.; Roberts, Brent; Duberstein, Paul

    2011-01-01

    We review evidence for links between personality traits and longevity. We provide an overview of personality for health scientists, using the primary organizing framework used in the study of personality and longevity. We then review data on various aspects of personality linked to longevity. In general, there is good evidence that higher level of conscientiousness and lower levels of hostility and Type D or “distressed” personality are associated with greater longevity. Limited evidence suggests that extraversion, openness, perceived control, and low levels of emotional suppression may be associated with longer lifespan. Findings regarding neuroticism are mixed, supporting the notion that many component(s) of neuroticism detract from life expectancy, but some components at some levels may be healthy or protective. Overall, evidence suggests various personality traits are significant predictors of longevity and points to several promising directions for further study. We conclude by discussing the implications of these links for epidemiologic research and personalized medicine and lay out a translational research agenda for integrating the psychology of individual differences into public health and medicine. PMID:21766032

  20. [Alice Hamilton (1869-1970): a pioneer of occupational medicine and public health].

    PubMed

    Kowalska, M; Steplewski, Z

    1999-01-01

    Dr. Alice Hamilton (1869-1970) was the mother of occupational health a pioneer in public health in the United States. She worked as a doctor in Hull House, the first settlement house, and she was an advocate of the birth-control movement. She led pioneering studies of occupational head, mercury, carbon monoxide poisoning and many other chemical intoxications of workers. She was an assistant professor of industrial medicine at the Harvard Medical School (1919-1935). During the years 1924-1930 she worked for the Health Organization of the League of Nations. From 1943 she acted as a vice-president of the American Health Association. Alice Hamilton was an expert in the field of occupational lead poisoning. PMID:10438256

  1. Evaluating and improving multiple choice papers: true-false questions in public health medicine.

    PubMed

    Dixon, R A

    1994-09-01

    The quality of a multiple true-false (MTF) examination paper in public health medicine for 149 clinical medical students was evaluated using predefined performance criteria to offer guidelines for improvement of such a paper. There were 35 questions, each with five true-false branches, and the performance of the overall best 25% of candidates was compared for individual items with that of the overall worst 25%. To improve discrimination between best and worst candidates, 60% of items needed changes, and several indicators were used to identify how, usually because the branch was too easy (26%), unpopular (16%) or too hard (10%). A number of guidelines for writing good MTF questions and for improving them are suggested. The inequity is illustrated of marking systems which do not allocate a negative mark for incorrect answers equal in size to the positive mark for correct ones, with zero for unanswered questions or 'don't know' answers. PMID:7845259

  2. Increasing access to nonprescription medicines: a global public health challenge and opportunity.

    PubMed

    Hemwall, E L

    2010-03-01

    As escalating health-care costs continue to be a focus of public discourse, the populace has become increasingly attentive to its own health and lifestyle choices. Nonprescription (over-the-counter, OTC) medicines represent an important option in this evolving environment and, through novel "Rx-to-OTC" switch efforts, could expand beyond their traditional role in symptomatic relief of common conditions such as minor pain, coughs, colds, heartburn, and allergy. This is certainly not a new concept. In fact, the self-care movement has roots reaching into the past century. Pharmaceutical companies and their consumer-product subsidiaries or partners have long considered and, when feasible, invested in difficult OTC switch development programs. PMID:20160746

  3. Biomedicalization and the public sphere: newspaper coverage of health and medicine, 1960s-2000s.

    PubMed

    Hallin, Daniel C; Brandt, Marisa; Briggs, Charles L

    2013-11-01

    This article examines historical trends in the reporting of health and medicine in The New York Times and Chicago Tribune from the 1960s to the 2000s. It focuses on the extent to which health reporting can be said to have become increasingly politicized, or to have shifted from treating the production of medical knowledge as something belonging to a restricted, specialized sphere, to treating it as a part of the general arena of public debate. We coded a sample of 400 stories from the two newspapers for four different Implied Audiences which health stories can address: Scientific/Professional, Patient/Consumer, Investor and Citizen/Policymaker. Stories were also coded for the origin of the story, the sources cited, the presence of controversy, and the positive or negative representation of biomedical institutions and actors. The data show that through all five decades, news reporting on health and medicine addressed readers as Citizen/Policymakers most often, though Patient/Consumer and Investor-oriented stories increased over time. Biomedical researchers eclipsed individual physicians and public health officials as sources of news, and the sources diversified to include more business sources, civil society organizations and patients and other lay people. The reporting of controversy increased, and portrayals of biomedicine shifted from lopsidedly positive to more mixed. We use these data in pinpointing how media play a constitutive role in the process of "biomedicalization," through which biomedicine has both extended its reach into and become entangled with other spheres of society and of knowledge production. PMID:24034959

  4. Importance of Public-Private Partnerships: Strengthening Laboratory Medicine Systems and Clinical Practice in Africa

    PubMed Central

    Shrivastava, Ritu; Gadde, Renuka; Nkengasong, John N.

    2016-01-01

    After the launch of the US President’s Emergency Plan for AIDS Relief in 2003, it became evident that inadequate laboratory systems and services would severely limit the scale-up of human immunodeficiency virus infection prevention, care, and treatment programs. Thus, the Office of Global AIDS Coordinator, Centers for Disease Control and Prevention, and Becton, Dickinson, and Company developed a public-private partnership (PPP). Between October 2007 and July 2012, the PPP combined the competencies of the public and private sector to boost sustainable laboratory systems and develop workforce skills in 4 African countries. Key accomplishments of the initiative include measurable and scalable outcomes to strengthen national capacities to build technical skills, develop sample referral networks, map disease prevalence, support evidence-based health programming, and drive continuous quality improvement in laboratories. This report details lessons learned from our experience and a series of recommendations on how to achieve successful PPPs. PMID:27025696

  5. Importance of Public-Private Partnerships: Strengthening Laboratory Medicine Systems and Clinical Practice in Africa.

    PubMed

    Shrivastava, Ritu; Gadde, Renuka; Nkengasong, John N

    2016-04-15

    After the launch of the US President's Emergency Plan for AIDS Relief in 2003, it became evident that inadequate laboratory systems and services would severely limit the scale-up of human immunodeficiency virus infection prevention, care, and treatment programs. Thus, the Office of the US Global AIDS Coordinator, Centers for Disease Control and Prevention, and Becton, Dickinson and Company developed a public-private partnership (PPP). Between October 2007 and July 2012, the PPP combined the competencies of the public and private sectors to boost sustainable laboratory systems and develop workforce skills in 4 African countries. Key accomplishments of the initiative include measurable and scalable outcomes to strengthen national capacities to build technical skills, develop sample referral networks, map disease prevalence, support evidence-based health programming, and drive continuous quality improvement in laboratories. This report details lessons learned from our experience and a series of recommendations on how to achieve successful PPPs. PMID:27025696

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

    PubMed

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

    2015-07-01

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

  7. The Maurice Ellis lecture for 1986. The responsibility of emergency medicine towards the prevention of road accidents.

    PubMed Central

    Rutherford, W H

    1986-01-01

    It is argued that doctors who work in accident and emergency departments should play their part in road accident prevention. It is suggested that this might be done in the field of research, by direct action, through education of the public and by influencing legislation. Examples are given of both small and simple, and major national research projects based in accident and emergency departments. The type of direct action envisaged is modelled on the work of Dr Hayle Hadeson in preventing accidents to children. Examples of the education of the public are drawn from publicity work in the seat-belt campaign, and experiences of lobbying members of parliament in relation to seat-belt legislation are described. The relative under-funding of trauma research compared with cancer of heart disease research is seen as a measure of society's lack of interest in accident prevention, and colleagues unchallenged to do more to alter this situation. PMID:3768120

  8. Communication of emergency public warnings: A social science perspective and state-of-the-art assessment

    SciTech Connect

    Mileti, D.S. ); Sorensen, J.H. )

    1990-08-01

    More than 200 studies of warning systems and warning response were reviewed for this social science perspective and state-of-the-art assessment of communication of emergency public warnings. The major findings are as follows. First, variations in the nature and content of warnings have a large impact on whether or not the public heeds the warning. Relevant factors include the warning source; warning channel; the consistency, credibility, accuracy, and understandability of the message; and the warning frequency. Second, characteristics of the population receiving the warning affect warning response. These include social characteristics such as gender, ethnicity and age, social setting characteristics such as stage of life or family context, psychological characteristics such as fatalism or risk perception, and knowledge characteristics such as experience or training. Third, many current myths about public response to emergency warning are at odds with knowledge derived from field investigations. Some of these myths include the keep it simple'' notion, the cry wolf'' syndrome, public panic and hysteria, and those concerning public willingness to respond to warnings. Finally, different methods of warning the public are not equally effective at providing an alert and notification in different physical and social settings. Most systems can provide a warning given three or more hours of available warning time. Special systems such as tone-alert radios are needed to provide rapid warning. 235 refs., 8 figs., 2 tabs.

  9. DELIBERATE SELF-HARM PATIENTS VISITING PUBLIC AND PRIVATE EMERGENCY DEPARTMENTS OF KARACHI

    PubMed Central

    SHAHID, MUHAMMAD; KHAN, MUHAMMAD ZAMAN; AFZAL, BADAR; KHAN, SUMAIYA TAUSEEQ; NAKEER, ROOHAM

    2015-01-01

    OBJECTIVE To study the mode of attempted deliberate self-harm (DSH) in patients presenting to the Emergency Departments (ED) of public and private hospitals of Karachi, Pakistan. DESIGN A cross sectional study. PLACE AND DURATION OF STUDY Aga Khan University Hospital Karachi, Jinnah Post Graduate Medical Centre Karachi and Civil Hospital Karachi; March 2011 to February 2012. SUBJECTS AND METHODS One hundred DSH cases from ED of a private sector hospital were compared with 101 patients from two public sector hospitals. RESULTS DSH patients in the private hospital were mostly females (70%), had higher level of education (32%), did not share their problems (67%) with someone and had more mental disorders (28%). Patients from public hospitals were treated more for physical illnesses compared to private facility. Organophosphorus poisoning (90%) was a common mode of DSH in patients presenting to public hospitals; however significant number of organophosphorus poisoning (40%) was also seen in private hospital besides the benzodiazepine overdose (32%). CONCLUSION Emergency Physicians working in the EDs, both public and private sector hospitals of Karachi, should have adequate knowledge of managing organophosphorus poisoning. As more and more cases are presenting to the EDs, there should be a public health initiative to control the illegal sale and availability of such compounds in Pakistan. PMID:26985203

  10. Longitudinal Community Assessment for Public Health Emergency Response to Wildfire, Bastrop County, Texas.

    PubMed

    Kirsch, Katie R; Feldt, Bonnie A; Zane, David F; Haywood, Tracy; Jones, Russell W; Horney, Jennifer A

    2016-01-01

    On September 4, 2011, a wildfire ignited in Bastrop County, Texas, resulting in losses of 34,068 acres of land and 1,645 homes and 2 deaths. At the request of the Texas Department of State Health Services Health Service Region 7 and the Bastrop County Office of Emergency Management, Community Assessments for Public Health Emergency Response (CASPER) were conducted in the weeks following the wildfire and again 3.5 years later to assess both the immediate and long-term public health and preparedness impacts of the wildfire. The objective of these assessments was to learn more about the trajectory of disaster recovery, including rebuilding, evacuation, household emergency planning, and mental and physical health outcomes among both adults and children. In 2015, households exposed to the 2011 wildfires were significantly more likely to have established a family meeting place and evacuation route, to have confidence in the local government's ability to respond to disaster, and to report symptoms of depression and higher stress. Longitudinal assessments using the CASPER method can provide actionable information for improved planning, preparedness, and recovery to public health and emergency management agencies and community residents. PMID:27081889

  11. 78 FR 60283 - Guidance for Temporary Reassignment of State and Local Personnel During a Public Health Emergency

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-01

    ... HUMAN SERVICES Guidance for Temporary Reassignment of State and Local Personnel During a Public Health... (PAHPRA), Public Law 113-5, amends section 319 of the Public Health Service (PHS) Act to provide the... personnel during a declared Federal public health emergency upon request by a state or tribal...

  12. Ten Years of Medicinal Chemistry (2005-2014) in the Journal of Medicinal Chemistry: Country of Contributors, Topics, and Public-Private Partnerships.

    PubMed

    Costantino, Luca; Barlocco, Daniela

    2016-08-25

    This review analyzes the articles that have appeared during the past 10 years in the Journal of Medicinal Chemistry, the leading journal in the field of medicinal chemistry, to provide a picture of the changing trends in this research area. Our analysis involved the country of the corresponding author, assuming that he/she was the leader of the research group, the interaction between private and public sectors, and the research topics. This analysis provides information on the contributions to the journal of authors from each country and highlights the differences between the public and private sectors regarding the research topics pursued. Moreover, changes in the number of articles that describe work on hits, leads, or clinical candidates during these years have been correlated with the affiliation of the contributors (public or private). An analysis of top-cited articles that have appeared in the journal has also been included. The data will provide the basis for understanding the evolution that is taking place in medicinal chemistry. PMID:27007729

  13. Wilderness Medicine Newsletter, 2000: For the Recognition, Treatment, and Prevention of Wilderness Emergencies.

    ERIC Educational Resources Information Center

    Weber, Holly A., Ed.

    2000-01-01

    The six issues of Wilderness Medicine Newsletter published in 2000 provide medical and rescue information for the nonphysician in remote wilderness areas. Feature articles include: "Lions & Tigers & Bears, Oh My!" (wildlife precautions) (Jeanne Twehous); "Calamity in the Unroofed Temple" (collapse of a famous snow arch) (Nicholas Howe);…

  14. The Prevalence and Characteristics of Emergency Medicine Patient Use of New Media

    PubMed Central

    2015-01-01

    Background Little is known about “new media” use, defined as media content created or consumed on demand on an electronic device, by patients in emergency department (ED) settings. The application of this technology has the potential to enhance health care beyond the index visit. Objective The objectives are to determine the prevalence and characteristics of ED patients’ use of new media and to then define and identify the potential of new media to transcend health care barriers and improve the public’s health. Methods Face-to-face, cross-sectional surveys in Spanish and English were given to 5,994 patients who were sequentially enrolled from July 12 to August 30, 2012. Data were collected from across a Southern Connecticut health care system’s 3 high-volume EDs for 24 hours a day, 7 days a week for 6 weeks. The EDs were part of an urban academic teaching hospital, an urban community hospital, and an academic affiliate hospital. Results A total of 5,994 (89% response rate) ED patients reported identical ownership of cell phones (85%, P<.001) and smartphones (51%, P<.001) that were used for calling (99%, P<.001). The older the patient, however, the less likely it was that the patient used the phone for texting (96% vs 16%, P<.001). Income was positively associated with smartphone ownership (P<.001) and the use of health apps (P>.05) and personal health records (P<.001). Ownership of iPhones compared to Android phones were similar (44% vs 45%, P<.05). Race and ethnicity played a significant role in texting and smartphone ownership, with Hispanics reporting the highest rates of 79% and 56%, respectively, followed by black non-Hispanics at 77% and 54%, respectively, and white non-Hispanics at 65% and 42%, respectively (P<.05). Conclusions There is a critical mass of ED patients who use new media. Older persons are less comfortable texting and using smartphone apps. Income status has a positive relationship with smartphone ownership and use of smartphone apps

  15. How do we want to grow old? Anti-ageing-medicine and the scope of public healthcare in liberal democracies.

    PubMed

    Schweda, Mark; Marckmann, Georg

    2013-09-01

    Healthcare counts as a morally relevant good whose distribution should neither be left to the free market nor be simply imposed by governmental decisions without further justification. This problem is particularly prevalent in the current boom of anti-ageing medicine. While the public demand for medical interventions which promise a longer, healthier and more active and attractive life has been increasing, public healthcare systems usually do not cover these products and services, thus leaving their allocation to the mechanisms of supply and demand on the free market. This situation raises the question on which basis the underlying preferences for and claims to a longer, healthier life should be evaluated. What makes anti-ageing medicine eligible for public funding? In this article, we discuss the role of anti-ageing medicine with regard to the scope and limits of public healthcare. We will first briefly sketch the basic problem of justifying a particular healthcare scheme within the framework of a modern liberal democracy, focusing on the challenge anti-ageing interventions pose in this regard. In the next section, we will present and discuss three possible solutions to the problem, essentialistic, transcendental, and procedural strategies of defining the scope of public healthcare. We will suggest a procedural solution adopting essentialistic and transcendental elements and discuss its theoretical and practical implications with regard to anti-ageing medicine. PMID:22500556

  16. Applying behavioral science to workforce challenges in the public health emergency preparedness system.

    PubMed

    McCabe, O Lee; DiClemente, Carlo C; Links, Jonathan M

    2012-01-01

    When disasters and other broad-scale public health emergencies occur in the United States, they often reveal flaws in the pre-event preparedness of those individuals and agencies charged with responsibility for emergency response and recovery activities. A significant contributor to this problem is the unwillingness of some public health workers to participate in the requisite planning, training, and response activities to ensure quality preparedness. The thesis of this article is that there are numerous, empirically supported models of behavior change that hold potential for motivating role-appropriate behavior in public health professionals. The models that are highlighted here for consideration and prospective adaptation to the public health emergency preparedness system (PHEPS) are the Transtheoretical Model of Intentional Behavior Change (TTM) and Motivational Interviewing (MI). Core concepts in TTM and MI are described, and specific examples are offered to illustrate the relevance of the frameworks for understanding and ameliorating PHEPS-based workforce problems. Finally, the requisite steps are described to ensure the readiness of organizations to support the implementation of the ideas proposed. PMID:22916453

  17. Primary Care in the Emergency Department – An Untapped Resource for Public Health Research and Innovation

    PubMed Central

    Brody, AM; Murphy, E; Flack, JM; Levy, PD

    2014-01-01

    With rising patient volumes and increasingly complex cases, the specialty of emergency medicine faces a growing array of challenges. Efforts have been made to improve patient throughput, yet little attention has been directed to the increasing amount of primary care delivered in emergency departments (EDs) for chronic disease states such as hypertension and diabetes. Management of chronic medical conditions is traditionally seen as beyond the purview of the ED, and emergency physicians tend to defer critical aspects of related patient care to other components of the healthcare continuum. As a result, vulnerable patients are often forced to navigate exceedingly complex and fragmented systems of care with little guidance, which often leads to inadequate treatment and exposure to increased risk for development of potentially avoidable complications. As evidenced by our experience with hypertension in an under resourced community, there is a crucial need for emergency physicians to espouse their role as providers of healthcare across the acuity spectrum and lead the way in defining regionally relevant solutions to better manage patients with chronic medical problems. PMID:25314280

  18. CDC Grand Rounds: Addressing Preparedness Challenges for Children in Public Health Emergencies.

    PubMed

    Hinton, Cynthia F; Griese, Stephanie E; Anderson, Michael R; Chernak, Esther; Peacock, Georgina; Thorpe, Phoebe G; Lurie, Nicole

    2015-01-01

    Recent public health emergencies including Hurricane Katrina (2005), the influenza H1N1 pandemic (2009), and the Ebola virus disease outbreak in West Africa (2014–2015) have demonstrated the importance of multiple-level emergency planning and response. An effective response requires integrating coordinated contributions from community-based health care providers, regional health care coalitions, state and local health departments, and federal agency initiatives. This is especially important when planning for the needs of children, who make up 23% of the U.S. population (1) and have unique needs that require unique planning strategies. PMID:26356838

  19. Public Health Emergency Planning for Children in Chemical, Biological, Radiological, and Nuclear (CBRN) Disasters

    PubMed Central

    Bartenfeld, Michael T.; Peacock, Georgina; Griese, Stephanie E.

    2015-01-01

    Children represent nearly a quarter of the US population, but their unique needs in chemical, biological, radiological, and nuclear (CBRN) emergencies may not be well understood by public health and emergency management personnel or even clinicians. Children are different from adults physically, developmentally, and socially. These characteristics have implications for providing care in CBRN disasters, making resulting illness in children challenging to prevent, identify, and treat. This article discusses these distinct physical, developmental, and social traits and characteristics of children in the context of the science behind exposure to, health effects from, and treatment for the threat agents potentially present in CBRN incidents. PMID:25014894

  20. The First View Concept: introduction of industrial flow techniques into emergency medicine organization.

    PubMed

    Hogan, Barbara; Rasche, Christoph; von Reinersdorff, Andrea Braun

    2012-06-01

    The number of patients seeking treatment in emergency departments is rising, although many governments are seeking to reduce expenditure on health. Emergency departments must achieve more with the same resources or perform the same functions with fewer resources. Patients demand higher emergency clinical care quality, with low waiting times viewed as a key quality criterion by many patients. The objective of this study was to create an improved working system in emergency departments that cuts patient waiting times for first specialty physician contact. Techniques from industrial flow management were applied to the working process of an emergency department and the concept was named 'First View.' A total of 3269 patient contacts using the First View Concept during a treatment month showed statistical significance. Before introduction, a total 3230 patients in a comparative treatment month had a median waiting time before the first doctor contact of 47.6 min, a first quartile waiting time of 36.1 min, and a third quartile waiting time of 62.7 min. After introduction, 3269 patients had a median waiting time before first specialty physician contact of 11.2 min, a first quartile waiting time of 9.1 min, and a third quartile waiting time of 15.2 min. Industrial flow concepts can achieve significant improvements in emergency department workflows in countries in which sufficient numbers of specialty physicians are available. More attention to the organization of emergency department working processes is needed, especially involving lean management. PMID:22186149

  1. Public Health Emergency Preparedness and Response Communications with Health Care Providers: A Literature Review

    PubMed Central

    2011-01-01

    Background Health care providers (HCPs) play an important role in public health emergency preparedness and response (PHEPR) so need to be aware of public health threats and emergencies. To inform HCPs, public health issues PHEPR messages that provide guidelines and updates, and facilitate surveillance so HCPs will recognize and control communicable diseases, prevent excess deaths and mitigate suffering. Public health agencies need to know that the PHEPR messages sent to HCPs reach their target audience and are effective and informative. Public health agencies need to know that the PHEPR messages sent to HCPs reach their target audience and are effective and informative. We conducted a literature review to investigate the systems and tools used by public health to generate PHEPR communications to HCPs, and to identify specific characteristics of message delivery mechanisms and formats that may be associated with effective PHEPR communications. Methods A systematic review of peer- and non-peer-reviewed literature focused on the following questions: 1) What public health systems exist for communicating PHEPR messages from public health agencies to HCPs? 2) Have these systems been evaluated and, if yes, what criteria were used to evaluate these systems? 3) What have these evaluations discovered about characterizations of the most effective ways for public health agencies to communicate PHEPR messages to HCPs? Results We identified 25 systems or tools for communicating PHEPR messages from public health agencies to HCPs. Few articles assessed PHEPR communication systems or messaging methods or outcomes. Only one study compared the effectiveness of the delivery format, device or message itself. We also discovered that the potential is high for HCPs to experience "message overload" given redundancy of PHEPR messaging in multiple formats and/or through different delivery systems. Conclusions We found that detailed descriptions of PHEPR messaging from public health to HCPs

  2. Good publication practices in clinical pharmacology: transparency, evidence-based medicine and the 7-D assessment*

    PubMed Central

    Woodcock, Barry G.; Luger, Veronika

    2015-01-01

    Transparency and evidence-based medicine are cornerstones of good publication practices (GPP), and concern publishers, editors, research investigators, and reviewers alike. Methods for implementing these principles within the framework of GPP are described. The main aspects include obtaining a Manuscript Agreement Contract, a Statement on Transparency of Authorship and a Declaration of Conflicts of Interest from the authors. Assessing whether a manuscript meets the requirements of EBM is demonstrated using the “7-D assessment”. The main purpose of this tool is to established that the (1) right Design, (2) right Diagnosis, (3) right Drug molecule, (4) right Dosage, (5) right Data, (6) right Deductions, and (7) right Documentation have been implemented in order to meet the objectives of the investigation. If the findings from any one of these assessments is questionable, the compliance of the research with EBM principles will be weakened and the reviewers and editors will make recommendations to the publisher accordingly. The guidelines described will help to provide a fair and transparent process of scientific publication and foster the freedom of clinical pharmacological research. PMID:26329349

  3. The Common Ground Preparedness Framework: A Comprehensive Description of Public Health Emergency Preparedness

    PubMed Central

    Theadore, Fred; Jellison, James B.

    2012-01-01

    Currently, public health emergency preparedness (PHEP) is not well defined. Discussions about public health preparedness often make little progress, for lack of a shared understanding of the topic. We present a concise yet comprehensive framework describing PHEP activities. The framework, which was refined for 3 years by state and local health departments, uses terms easily recognized by the public health workforce within an information flow consistent with the National Incident Management System. To assess the framework's completeness, strengths, and weaknesses, we compare it to 4 other frameworks: the RAND Corporation's PREPARE Pandemic Influenza Quality Improvement Toolkit, the National Response Framework's Public Health and Medical Services Functional Areas, the National Health Security Strategy Capabilities List, and the Centers for Disease Control and Prevention's PHEP Capabilities. PMID:22397343

  4. The common ground preparedness framework: a comprehensive description of public health emergency preparedness.

    PubMed

    Gibson, P Joseph; Theadore, Fred; Jellison, James B

    2012-04-01

    Currently, public health emergency preparedness (PHEP) is not well defined. Discussions about public health preparedness often make little progress, for lack of a shared understanding of the topic. We present a concise yet comprehensive framework describing PHEP activities. The framework, which was refined for 3 years by state and local health departments, uses terms easily recognized by the public health workforce within an information flow consistent with the National Incident Management System. To assess the framework's completeness, strengths, and weaknesses, we compare it to 4 other frameworks: the RAND Corporation's PREPARE Pandemic Influenza Quality Improvement Toolkit, the National Response Framework's Public Health and Medical Services Functional Areas, the National Health Security Strategy Capabilities List, and the Centers for Disease Control and Prevention's PHEP Capabilities. PMID:22397343

  5. 76 FR 52731 - Notice of Public Meeting of the President's Emergency Plan for AIDS Relief (PEPFAR) Scientific...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-23

    ... of Public Meeting of the President's Emergency Plan for AIDS Relief (PEPFAR) Scientific Advisory... open to the public. The meeting will be hosted by the Office of the U.S. Global AIDS Coordinator, Ambassador Eric Goosby, who leads implementation of the President's Emergency Plan for AIDS Relief...

  6. 77 FR 55891 - Notice of Public Meeting of the President's Emergency Plan for AIDS Relief (PEPFAR) Scientific...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-11

    ... of Public Meeting of the President's Emergency Plan for AIDS Relief (PEPFAR) Scientific Advisory... public. The meeting will be hosted by the Office of the U.S. Global AIDS Coordinator, and led by Ambassador Eric Goosby, who leads implementation of the President's Emergency Plan for AIDS Relief...

  7. 78 FR 55326 - Notice of Public Meeting of the President's Emergency Plan for AIDS Relief (PEPFAR) Scientific...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-10

    ... of Public Meeting of the President's Emergency Plan for AIDS Relief (PEPFAR) Scientific Advisory... is open to the public. The meeting will be hosted by the Office of the U.S. Global AIDS Coordinator, and led by Ambassador Eric Goosby, who leads implementation of the President's Emergency Plan for...

  8. Tissue plasminogen activator for acute ischemic stroke: a New York city emergency medicine perspective.

    PubMed

    Chan, Yu-Feng; Kwiatkowski, Thomas G; Rella, Joseph G; Rennie, William P; Kwon, Robert K; Silverman, Robert A

    2005-11-01

    Nationally, only 2-3% of patients with acute ischemic stroke (AIS) currently receive tissue plasminogen activator (TPA). To better understand the reasons, we investigated the practice patterns, level of familiarity and acceptance of TPA for AIS among emergency physicians in New York City (NYC). Fifty-seven 911-receiving hospital emergency department directors were surveyed regarding TPA use. Of those responding, 37% had never used TPA to treat AIS. Lack of neurological support was reported by 33%. Departments with formal protocols were more likely to use TPA for AIS. In conclusion, there is considerable variation in the practice, knowledge, and attitudes regarding the use of TPA for AIS in NYC emergency departments. Improved educational efforts and institutional support may be necessary to ensure the appropriate use of TPA by emergency physicians. PMID:16243196

  9. Cognitive Aids in Medicine Assessment Tool (CMAT): preliminary validation of a novel tool for the assessment of emergency cognitive aids.

    PubMed

    Evans, D; McCahon, R; Barley, M; Norris, A; Khajuria, A; Moppett, I

    2015-08-01

    Applying human factors principles to the design of clinical emergency guidelines is important. The UK Civil Aviation Authority uses a Checklist Assessment Tool for evaluating the content and usability of emergency drills before introduction into service on aircraft. We hypothesised that this model could be used to develop a generic medical tool. A three-stage modified Delphi process was used to adapt the above tool for use in designing medical emergency guidelines. The resulting Cognitive aids in Medicine Assessment Tool was then used to score and rank seven published difficult airway guidelines; the scores were used to assess its validity and reliability. Pearson's rank coefficient between these scores and scores from independent assessors was 0.89 (p = 0.007). Internal consistency, as assessed by Cronbach's alpha, was 0.74, 0.96 and 0.72 for the tool's three constituent domains of physical characteristics, content and layout/format, respectively. Inter-rater reliability, as assessed by Cohen's kappa, ranged from 0.33 to 0.72. The adoption of our tool has the potential to improve the usability of medical emergency guidelines. PMID:25758401

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

    PubMed Central

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

    2015-01-01

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

  11. Identifying the Science and Technology Dimensions of Emerging Public Policy Issues through Horizon Scanning

    PubMed Central

    Parker, Miles; Acland, Andrew; Armstrong, Harry J.; Bellingham, Jim R.; Bland, Jessica; Bodmer, Helen C.; Burall, Simon; Castell, Sarah; Chilvers, Jason; Cleevely, David D.; Cope, David; Costanzo, Lucia; Dolan, James A.; Doubleday, Robert; Feng, Wai Yi; Godfray, H. Charles J.; Good, David A.; Grant, Jonathan; Green, Nick; Groen, Arnoud J.; Guilliams, Tim T.; Gupta, Sunjai; Hall, Amanda C.; Heathfield, Adam; Hotopp, Ulrike; Kass, Gary; Leeder, Tim; Lickorish, Fiona A.; Lueshi, Leila M.; Magee, Chris; Mata, Tiago; McBride, Tony; McCarthy, Natasha; Mercer, Alan; Neilson, Ross; Ouchikh, Jackie; Oughton, Edward J.; Oxenham, David; Pallett, Helen; Palmer, James; Patmore, Jeff; Petts, Judith; Pinkerton, Jan; Ploszek, Richard; Pratt, Alan; Rocks, Sophie A.; Stansfield, Neil; Surkovic, Elizabeth; Tyler, Christopher P.; Watkinson, Andrew R.; Wentworth, Jonny; Willis, Rebecca; Wollner, Patrick K. A.; Worts, Kim; Sutherland, William J.

    2014-01-01

    Public policy requires public support, which in turn implies a need to enable the public not just to understand policy but also to be engaged in its development. Where complex science and technology issues are involved in policy making, this takes time, so it is important to identify emerging issues of this type and prepare engagement plans. In our horizon scanning exercise, we used a modified Delphi technique [1]. A wide group of people with interests in the science and policy interface (drawn from policy makers, policy adviser, practitioners, the private sector and academics) elicited a long list of emergent policy issues in which science and technology would feature strongly and which would also necessitate public engagement as policies are developed. This was then refined to a short list of top priorities for policy makers. Thirty issues were identified within broad areas of business and technology; energy and environment; government, politics and education; health, healthcare, population and aging; information, communication, infrastructure and transport; and public safety and national security. PMID:24879444

  12. Identifying the science and technology dimensions of emerging public policy issues through horizon scanning.

    PubMed

    Parker, Miles; Acland, Andrew; Armstrong, Harry J; Bellingham, Jim R; Bland, Jessica; Bodmer, Helen C; Burall, Simon; Castell, Sarah; Chilvers, Jason; Cleevely, David D; Cope, David; Costanzo, Lucia; Dolan, James A; Doubleday, Robert; Feng, Wai Yi; Godfray, H Charles J; Good, David A; Grant, Jonathan; Green, Nick; Groen, Arnoud J; Guilliams, Tim T; Gupta, Sunjai; Hall, Amanda C; Heathfield, Adam; Hotopp, Ulrike; Kass, Gary; Leeder, Tim; Lickorish, Fiona A; Lueshi, Leila M; Magee, Chris; Mata, Tiago; McBride, Tony; McCarthy, Natasha; Mercer, Alan; Neilson, Ross; Ouchikh, Jackie; Oughton, Edward J; Oxenham, David; Pallett, Helen; Palmer, James; Patmore, Jeff; Petts, Judith; Pinkerton, Jan; Ploszek, Richard; Pratt, Alan; Rocks, Sophie A; Stansfield, Neil; Surkovic, Elizabeth; Tyler, Christopher P; Watkinson, Andrew R; Wentworth, Jonny; Willis, Rebecca; Wollner, Patrick K A; Worts, Kim; Sutherland, William J

    2014-01-01

    Public policy requires public support, which in turn implies a need to enable the public not just to understand policy but also to be engaged in its development. Where complex science and technology issues are involved in policy making, this takes time, so it is important to identify emerging issues of this type and prepare engagement plans. In our horizon scanning exercise, we used a modified Delphi technique. A wide group of people with interests in the science and policy interface (drawn from policy makers, policy adviser, practitioners, the private sector and academics) elicited a long list of emergent policy issues in which science and technology would feature strongly and which would also necessitate public engagement as policies are developed. This was then refined to a short list of top priorities for policy makers. Thirty issues were identified within broad areas of business and technology; energy and environment; government, politics and education; health, healthcare, population and aging; information, communication, infrastructure and transport; and public safety and national security. PMID:24879444

  13. Fire Weather Products for Public and Emergency Use: Extending Professional Resources to the Public

    NASA Astrophysics Data System (ADS)

    Rogers, M. A.; Schranz, S.; Kriederman, L.

    2012-12-01

    Large wildfires require significant resources to combat, including dedicated meteorological support to provide accurate and timely forecasts to assist incident commanders in making decisions for logistical and tactical firefighting operations. Smaller fires often require the same capabilities for understanding fire and the fire weather environment, but access to needed resources and tools is often limited due to technical, training, or education limitations. Providing fire weather information and training to incident commanders for smaller wildfires should prove to enhance firefighting capabilities and improve safety for both firefighters and for the public as well. One of the premier tools used to support fire weather forecasting for the largest wildfires is the FX-Net product, a thin-client version of the Advanced Weather Interactive Processing System used by NWS incident meteorologists (IMETs) deployed to large wildfires. We present results from an ongoing project to extend the sophisticated products available from FX-Net to more accessible and mobile software platforms, such as Google Earth. The project involves input from IMETs and fire commanders to identify the key parameters used in fighting wildfires, and involves a large training component for fire responders to utilize simplified products to improve understanding of fire weather in the context of firefighting operations.

  14. Convergent Lines of Descent: Symptoms, Patterns, Constellations, and the Emergent Interface of Systems Biology and Chinese Medicine

    PubMed Central

    Scheid, Volker

    2015-01-01

    During the first decade of the twenty-first century, a network composed of politicians, regulators, bioscientists, clinical researchers, and Chinese medicine specialists has emerged that seeks to bridge an imagined gulf between the modern West and ancient China in order to create a new type of personalized medicine. The central building block of this bridge is the Chinese medical concept of zheng 證/証, variously translated into English as syndrome, pattern, or type. My paper places side by side two different genealogies of how zheng assumed this central role. The first genealogy examines the process by means of which zheng came to be considered as something shared by both ancient China and cutting-edge biological science and, by extension, how it manages to hold together the entire institutional, political, and economic framework into which this bridge is embedded and which it co-creates. The second genealogy shows zheng to be central to a much older series of redefinitions of Chinese medicine and Chinese medical practice that extend from the eleventh century to the present. Read together, these two genealogies—neither of which should be seen as exhaustive—raise three important issues that are further discussed in the conclusion of the paper. First, I explore how the concept of zheng has come to tie a medical tradition derided by its adversaries for being a pseudoscience to one of the most cutting-edge fields of bioscience research. I ask what is at stake in this synthesis, for whom, and why, and how it transforms Chinese medicine and/or systems biology along the way. Second, I am interested in finding out how and why the very same concept can be at the heart of two apparently agonistic visions of Chinese medicine’s future as it is popularly imagined in China today. Finally, I insist that the medical humanities need to become actively involved in the construction of emergent articulations such as the ones I am exploring. Merely writing a history of the

  15. Why and when to use CT in children: perspective of a pediatric emergency medicine physician.

    PubMed

    Frush, Karen

    2014-10-01

    The Emergency Department is a risk-laden environment for clinicians caring for children. A number of factors can increase the risk of medical errors and adverse events, including lack of standardized medication dosing because of size variation in the pediatric age range, unique physical and developmental characteristics of children that affect treatment strategies, and the inability of young or non-verbal children to provide a medical history or to clearly communicate pain and other symptoms. The Emergency Department (ED) setting is often hectic and chaotic, with lots of interruptions. Many EDs lack the pediatric-specific supplies deemed essential for managing pediatric emergencies, and long hours or overnight shifts, while necessary for maintaining 24-hour emergency services, can cause provider fatigue that can lead to increased medical errors. It is in this environment that ED physicians make decisions about the use of CT scans in children, often without evidence-based guidelines to help them weigh risks and benefits. Although recent efforts have raised the awareness of the risk of exposure to radiation, many pediatric providers and families lack adequate information to guide decisions about the use of CT. Pediatricians and emergency physicians need to collaborate with radiologists to maintain current knowledge of the risks and benefits of CT scans, to advocate for pediatric protocols and evidence-based guidelines, and to engage families in decisions regarding the evaluation and treatment of pediatric patients in the Emergency Department. PMID:25304696

  16. Emergency medical kit for commercial airlines. Air Transport Medicine Committee, Aerospace Medical Association.

    PubMed

    Thibeault, C

    1998-11-01

    While it has been of general interest for a long time, the issue of a Medical Kit for Commercial Airlines is now close to the top of the priority list because of recent activities in Europe within the Joint Aviation Authorities (JAA) and in the United States at the Congressional Level. The Aerospace Medical Association (AsMA) requested its Air Transport Medicine Committee to review the situation and make recommendations for a basic medical kit for international airlines. After reviewing the contents of existing kits, and the limited amount of available data, a proposal was submitted to and accepted by the AsMA Council. This is just a beginning. The Air Transport Medicine Committee will continue to follow the evolution and periodically adapt the kit accordingly. PMID:9819172

  17. Public Health Emergency Preparedness at the Local Level: Results of a National Survey

    PubMed Central

    Savoia, Elena; Rodday, Angie Mae; Stoto, Michael A

    2009-01-01

    Objective To study the relationship between elements of public health infrastructure and local public health emergency preparedness (PHEP). Data Sources/Study Setting National Association of County and City Health Officials 2005 National Profile of Local Health Departments (LHDs). Study Design Cross-sectional. Principal Findings LHDs serving larger populations are more likely to have staff, capacities, and activities in place for an emergency. Adjusting for population size, the presence of a local board of health and the LHDs' experience in organizing PHEP coalitions were associated with better outcomes. Conclusions The results of this study suggest that more research should be conducted to investigate the benefit of merging small health departments into coalitions to overcome the inverse relationship between preparedness and population size of the jurisdiction served by the LHD. PMID:19686254

  18. Ebola Hemorrhagic Fever as a Public Health Emergency of International Concern; a Review Article.

    PubMed

    Safari, Saeed; Baratloo, Alireza; Rouhipour, Alaleh; Ghelichkhani, Parisa; Yousefifard, Mahmood

    2015-01-01

    Ebola hemorrhagic fever (EHF) was first reported in 1976 with two concurrent outbreaks of acute viral hemorrhagic fever centered in Yambuku (near the Ebola river), Democratic Republic of Congo, and in Nzara, Sudan. The current outbreak of the Ebola virus was started by reporting the first case in March 2014 in the forest regions of southeastern Guinea. Due to infection rates raising over 13,000% within a 6-month period, Ebola is now considered as a global public health emergency and on August 8(th), 2014 the World Health Organization (WHO) declared the epidemic to be a Public Health Emergency of International Concern. With more than 5000 involved cases and nearly 3000 deaths, this event has turned into the largest and most dangerous Ebola virus outbreak in the world. Based on the above-mentioned, the present article aimed to review the virologic characteristics, transmission, clinical manifestation, diagnosis, treatment, and prevention of Ebola virus disease. PMID:26512362

  19. What Can Emergency Medicine Learn From Kinetics: Introducing an Alternative Evaluation and a Universal Criterion Standard for Emergency Department Performance

    PubMed Central

    Pan, Chih-Long; Chang, Chin-Fu; Chiu, Chun-Wen; Chi, Chih-Hsien; Tian, Zhong; Wen, Jyh-Horng; Wen, Jet-Chau

    2016-01-01

    Abstract This research focuses on developing an improved and robust measurement for emergency department (ED) performance and a criterion standard for global use via kinetic analysis. Based on kinetic approach, the input-throughput-output conceptual model of ED crowding is compared to the procedure of enzyme catalysis. All in average, the retented patients in EDs are defined as substrate ( ), whereas the patients who depart the EDs as product ( ). Therefore, the average ED departure velocity ( ) can be presented as   divided by a given time (t) of the ED length of stay (LOS). The   and   plots are depicted hourly for the kinetic analysis. The long-term stability of the kinetic parameters is ascertained by the method of coefficient of variation (CV). The participants collected for this study are from the EDs of Changhua Christian Medical Center and the five branched hospitals, all located in Taiwan. Based on the   plot analysis, the results clearly show 2 curves, an upper and a lower curve. The timeline of the lower curve includes approximately the total ED busy hours, and thus it can be used for the subsequent kinetic analysis. In order to explore the adequate kinetic parameters for ED performance, the try-and-error process was followed in this study. As a result, the   plots adapted from the lower curves show the best linear regression of   on   with a good coefficient of determination (R2). The Pan-Wen constant (PW), which is the slope of the liner regression line, and the ED medical personnel unit turnover number (EDMPU TON) were deduced from the kinetic meanings of   plots. In this research, the 2 kinetic parameters, PW and EDMPU TON were applied for the ED performance evaluations. An innovative relationship between the ED retented patients and the ED departure velocity is verified as PW; whereas, a feasible kinetic parameter, the EDMPU TON explicates the teamwork efficiency of the ED providers. Moreover, the EDMPU TON may not only be a reliable

  20. What Can Emergency Medicine Learn From Kinetics: Introducing an Alternative Evaluation and a Universal Criterion Standard for Emergency Department Performance.

    PubMed

    Pan, Chih-Long; Chang, Chin-Fu; Chiu, Chun-Wen; Chi, Chih-Hsien; Tian, Zhong; Wen, Jyh-Horng; Wen, Jet-Chau

    2016-03-01

    This research focuses on developing an improved and robust measurement for emergency department (ED) performance and a criterion standard for global use via kinetic analysis. Based on kinetic approach, the input-throughput-output conceptual model of ED crowding is compared to the procedure of enzyme catalysis. All in average, the retented patients in EDs are defined as substrate (S), whereas the patients who depart the EDs as product (P). Therefore, the average ED departure velocity (V) can be presented as (P)divided by a given time (t) of the ED length of stay (LOS). The S-V and S²-P plots are depicted hourly for the kinetic analysis. The long-term stability of the kinetic parameters is ascertained by the method of coefficient of variation (CV). The participants collected for this study are from the EDs of Changhua Christian Medical Center and the five branched hospitals, all located in Taiwan. Based on the S-V plot analysis, the results clearly show 2 curves, an upper and a lower curve. The timeline of the lower curve includes approximately the total ED busy hours, and thus it can be used for the subsequent kinetic analysis. In order to explore the adequate kinetic parameters for ED performance, the try-and-error process was followed in this study. As a result, the S²-V plots adapted from the lower curves show the best linear regression of S² on V with a good coefficient of determination (R). The Pan-Wen constant (PW), which is the slope of the liner regression line, and the ED medical personnel unit turnover number (EDMPU TON) were deduced from the kinetic meanings of (Equation is included in full-text article.)plots. In this research, the 2 kinetic parameters, PW and EDMPU TON were applied for the ED performance evaluations. An innovative relationship between the ED retented patients and the ED departure velocity is verified as PW; whereas, a feasible kinetic parameter, the EDMPU TON explicates the teamwork efficiency of the ED providers. Moreover, the EDMPU