bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accuracy of Patient Height, Weight and Ideal Body Weight Estimates in the Emergency Department
Authors: Boehm Kevin , Welt Cassie , Grimaldi Jeanette 
Published: February 2021

CONTEXT The purpose of this study was to establish the accuracy of emergency medicine professionals’ estimates of a sample of patients’ heights, weights and ideal body weights (IBW). METHODS This was a cross-sectional survey study with 69 emergency medicine professionals concerning estimates of five standardized patients. Board-certified emergency physicians, emergency medicine residents and emergency department nurses were asked to estimate patient height, weight and (IBW) by looking at a series of photographs of five standardized patients with varied body types. Repeated measure analysis of variance procedures were used to examine for estimates-to-actual measurement differences. RESULTS Overall height, weight and IBW estimate differences did vary significantly for the majority of the five standardized patients. Respondents’ clinical position (i.e., attending physician, resident, or nurse) and years of clinical experience did show a significant level of influence on estimate-to-actual differences for some proportion of patient estimates. CONCLUSION Our results support the common belief that the accuracy of overall weight and height estimates in emergency department settings is unacceptably low, and that a patient’s stated weight and height is likely to be more accurate. Further work is required in this area of emergency medicine practice since these types of inaccuracies could potentially compromise the effectiveness of therapies and treatments during emergent situations.
The Influence of Social Isolation and Medical Comorbidities on Geriatric Congestive Heart Failure Hospital Readmissions
Authors: Keyes Daniel , Sheremeta Greg , Yang Jerrit , Davis Naomi , Zhang Shiling , Boehm Kevin 
Published: February 2021

CONTEXT Social isolation and comorbidities are likely to have a significant level of influence on the healthcare use patterns of geriatric patients with ongoing congestive heart failure (CHF)-related needs. METHODS A retrospective study was conducted in a specialized emergency department (ED) with a sample of 286 geriatric CHF patients who initially received CHF-related care over a six-month period. Social isolation levels were assessed using a pre-existing four-point screening tool used in the study setting and composite comorbidity was gauged using the Charlson Comorbidity Index method. Subjects were categorized into either “less than 30-day readmission” or “greater than 30-day readmission/non-readmitted” sample subgroups. The setting was a single 304-bed community hospital with approximately 45,000 annual ED visits. The analytic sample was comprised of geriatric patients 65+ years of age with an ICD-9 code corresponding to CHF. RESULTS There were no statistically significant differences between earlier hospital readmission versus later/non-readmitted sample patients when grouped by age, race, gender or level of measured social isolation. However, composite comorbidity scores were significantly lower for patients in the >30-day/non-readmitted subgroup compared to earlier readmission patients. CONCLUSIONS These initial study results suggest that a larger proportion of CHF hospital readmissions may be more heavily influenced by clinical factors than social living arrangements. Future studies with larger samples and validated measures of social isolation are needed to inform the development and testing of programs for geriatric CHF patients striving to avoid unnecessary hospital readmissions and adverse health outcomes.
Thermal Energy Produced by Medium Velocity Pistol Projectiles and the Effects on Peripheral Nerve Tissue
Authors: Colen Alexander J. , Hanson Logan F. , Frits Germaine R. , Hanson Cameron G. 
Published: February 2021

CONTEXT Sidearm pistols are more frequently involved in violent crimes due to their relatively small size and ability to be concealed. The extent to which the thermal energy released from such medium velocity pistol projectiles contributes to peripheral nerve injury requires further testing. The purpose of this paper is to describe a method to quantify how much thermal energy is released during impact of medium velocity pistol projectiles and report how thermal energy contributes to peripheral nerve injury. METHODS Eleven seven-centimeter segments of radial, median, and ulnar nerves were dissected from a thawed fresh frozen cadaver. The nerve segments were placed in a 10% ballistics gel block, one centimeter from the end of the block nearest the shooter. A series of 115-grain 9 mm. NATO-classified ammunitions were fired through the nerve and ballistics gel construct with a pistol. The impacts were recorded with a high-speed infrared camera and nerve samples were sent for histologic analysis by two board-certified pathologists. RESULTS The average velocity of the projectiles were 391m/s, 95% CI [387-395 m/s], with an average kinetic energy of 572.0 J, 95% CI [560.0-583.0J]. The average observable temperature of the ballistics gel/nerve prior to impact was 28.8°C±0.6ºC, 95% CI [26.4-30.3°C]. Average observable temperature of the surrounding ballistics gel/nerve during projectile impact was 55.1°C±2.4ºC, 95% CI [51.3- 62.1°C], yielding an average observable increase of 26.4°C±3.2ºC, 95% CI [20.2- 35.4°C]. An adjusted temperature increase was also surprisingly high 63.4°C ± 3.2, 95% CI [57.2 – 72.4ºC]. Histology reports of the impacted nerve tissue failed to show any sign of thermal or even crush injury. CONCLUSIONS Medium velocity handgun projectiles release a significant amount of heat energy when impacting a substance similar to human tissue. The authors’ temperature data points were greater than those previously reported to cause thermal injury to peripheral nerves. The authors’ findings suggest that nerve injury after collision with pistol projectiles may be secondary to thermal injury in addition to the classic model of concussion and penetration given our documented levels of heat generated during impact.
Endoscopic Combined Snare-Forceps Technique for Removing Flat Sessile Polyps
Authors: Jones Mark W. , Henning Werner 
Published: February 2021

CONTEXT Current endoscopes have limitations during use in polypectomies. Specifically, polyps that are flat, broad-based and sessile are more difficult to resect. Routine polypectomy procedures allow one endoscopic device to be used at a time limiting the endoscopist. More advanced scopes are not readily available at smaller community hospitals, limiting the endoscopist to using the resources available to them. METHODS The modification of the standard polypectomy method described here employs both an endoscopic forceps and an endoscopic snare to be used simultaneously during colonoscopy with a single lumen colonoscope. The forceps is introduced into the endoscope so the head is just projecting from the distal end of the scope. The snare is then placed just proximal to the head of the forceps outside of the endoscope. The endoscope is reinserted into the colon until the polyp is reached. Using the snare the polyp is elevated and then the snare secured around the base. RESULTS This resulted in easier, faster, and more complete removal of flat sessile and poorly located pedunculated polyps on the first try. This technique has been employed successfully in over 20 patients at our institution. CONCLUSIONS This new method adds another technique for endoscopists when presented with difficult polypectomies.
Effectiveness of a Faculty Development Course on Delivering Learner-Centered Feedback Utilizing the Flipped Training Model
Authors: Church Brandy , Corser William D. , Harrison Angela 
Published: February 2021

CONTEXT Effective feedback is an important step in the acquisition of residents’ clinical skills and a key component of most adult learning strategies. Faculty-resident feedback discussions can facilitate resident self-assessment and reflection on their performance and motivate them to study and ask questions in areas where their knowledge may be evaluated as deficient. The flipped training model approach, a type of blended learning that reverses the traditional learning environment by delivering instructional content outside of the classroom, has garnered increased support within both graduate medical education (GME) and other healthcare disciplines. METHODS The overall purpose of this exploratory pilot project was to examine the pre-post impact of a faculty feedback flipped training model course provided to a convenience sample of community-based faculty learners. After receiving campus IRB approval, the authors developed a set of five primary course goals and objectives. A convenience sample of n = 17 community-based faculty who had completed the entire course were administered a pair of pre and post-course surveys regarding their overall feedback satisfaction and comfort levels for supervising residents. RESULTS In summary, five of the 13 total survey items increased at statistically significant levels from pre-course levels. The majority of qualitative faculty comments also positively evaluated the flipped training model approach. CONCLUSIONS These promising pilot findings suggest that a flipped GME faculty feedback skills training model can help improve faculty learners’ satisfaction and confidence as they supervise residents and/or medical students. The impact of these types of flipped training models for GME faculty needs to be more rigorously examined in project settings with larger samples to identify what specific types of curricular activities might prove to be most effective for diverse faculty learners in GME programs across the nation.
Ripping the Myth: Patients’ Symptomatic Descriptions of Acute Thoracic Aortic Dissection
Authors: Nagabhushan Meghna , Webley James 
Published: February 2021

CONTEXT The objective of this retrospective project was to assess the frequency with which patients presenting to an emergency department had used the descriptive terms “ripping” and “tearing” to describe their symptoms from later-confirmed acute thoracic aortic dissection. METHODS The authors conducted a retrospective chart review from 58 patients who had presented to two suburban and urban emergency departments with suspected acute thoracic dissection between 1997 and 2015. They reviewed charts for patients’ pain descriptors in ambulance personnel records and initial notes and dictations from ED triage nurses, staff nurses, and physicians. These pieces of documentation would have been made before the diagnosis of acute thoracic aortic dissection could been confirmed. RESULTS The authors identified a sample subset of 29 (50% of total charts pulled) patients later confirmed to have had an acute thoracic aorta dissection. They found that no sample patients used either the descriptors “ripping” or “tearing” when communicating their presenting symptoms. In this paper, the authors will provide several alternative terms patients have been shown to offer for this life-threatening condition. CONCLUSIONS Although the terms “ripping” and “tearing” have historically been associated with acute thoracic aortic dissections, these project results indicate that clinicians may consider other descriptive symptomatic terms from patients when evaluating patients’ symptoms for this potential life-threatening condition.
Implementation of an Antibiotic Therapy Protocol for Open Fractures in the Emergency Department
Authors: Endres Terrence , Danielson Kristopher , O'Neil Stephen , Brandenburg Shawn , Hall Teresa , Ross Hunter 
Published: February 2021

CONTEXT Well established in the Emergency Department (ED) literature is that the most important factor in decreasing subsequent infection rate in open fractures is the time to first administration of antibiotics. As such, the authors developed a new ED open fracture antibiotic protocol to facilitate more expeditious antibiotic administration and appropriate choice of antibiotics. METHODS During Phase 1 of this project, the authors identified the 2012 - 2016 historical length of time from presentation of an open fracture to the possible initiation of antibiotic therapy at their institution. Results demonstrated critical areas for improvement in both timing and types of antibiotics administered. Phase 2 of the study evaluated the effect of the new open fracture antibiotic protocol. Sample cases from both phases were then further identified based on type of open fracture, time to initiation of antibiotics from ED presentation, type of antibiotics, and time to definitive treatment. Analyses were performed using GraphPad proprietary software. RESULTS A random sample of 110 patients were included from Phase 1 and 27 patients from Phase 2. A total of 43 Phase 1 patients were administered cefazolin (Kefzol, Ancef); the remainder of the patients received a number of different antibiotics. During Phase 2, all 27 patients received cefazolin and Gentamycin if necessary per the new protocol. The average time to initiation of antibiotics was 0.907 hours during Phase 1 compared to 0.568 hours in Phase 2. The new protocol also significantly decreased the average time to antibiotics in ED from 2.17 hours to 1.82 hours when including EMS transfer time. Average time to definitive treatment in the operating room was 6.63 hours during Phase 1 and was significantly lowered to 3.97 hours during Phase 2. CONCLUSIONS Timing to initiation of antibiotics after open fractures is the most important aspect to decrease infection rates. In order to decrease these times, the authors implemented a new ED protocol that specifically stated the type of antibiotic to be given based on the open fracture without orthopedics needing to be notified before administration. Ideally, the use of such protocols in ED settings will serve to greatly decrease infection risks after open fracture.
Project to Improve the Transcription of Clinical Order Information into a Radiology Information System
Authors: Mills Michael J. , Nguyen John X. , Himelhoch Ben , Souala Abdelouahid , Khashola Anthony , Joseph Sumita , Rathousky Phillip , Gonda Roger , Juan Michael C.Y. 
Published: February 2021

CONTEXT Inaccurate and incomplete imaging order information presented to interpreting radiologists is a persistent problem in many radiology settings. Computerized Physician Order Entry processes in clinic-based settings are often inconsistent, and radiology transcription clerks continue to play a critical role in transmitting accurate content and information from referring physician orders to the radiology information system. (RIS) The purpose of this quality improvement project was to a) identify common transcription areas of deficient RIS imaging order information and b) test outcomes from an intervention to improve the content and concordance of transcribed patient information entered into the RIS. METHODS A random convenience sample of 500 outpatient radiographic orders were categorized according to degree and quality of concordance between the transcribed patient information documented in the RIS and the corresponding original imaging order information. During Phase I, the authors used a root-cause analysis to determine the possible etiologies for discordance between the information in original imaging orders and the information transcribed into the RIS. The intervention that was delivered included a short education session with radiology transcription clerks with placement reminder posters at transcription workstations. During Phase 2, a second random sample was obtained following the intervention, with data collection and analyses replicating the process from Phase I. A set of inferential comparisons were conducted using chi-square tests to examine for statistical significance. RESULTS There was an overall 44% decrease in transcription discordance (p < 0.001), and the number of cases with perfectly concordant RIS order indication documentations increased by 21% (p < 0.001). A total of 34% of transcriptions from Phase I were partially discordant due to an inadequate imaging study indication, compared to 15% during Phase II (p < 0.001). There was also a 22% increase in the number of completely concordant transcriptions free of grammatical errors (p < 0.001). CONCLUSIONS A short education session with radiology transcription clerks along with placement of reminder posters may significantly improve both the concordance and quality of transcribed imaging order information presented to interpreting radiologists using the RIS.
Topical Tranexamic Acid Reduces Postoperative Blood Loss in Primary Total Hip and Knee Arthroplasty
Authors: Caruthers Corey M. , Brazier Brett G. , Blackmer Michael J. , Raehtz Sandra , Etienne Gracia 
Published: February 2021

CONTEXT The purpose of this study was to assess the effectiveness of topical pre-closure application of tranexamic acid (TXA) to reduce postoperative blood loss and blood transfusion rates in primary total hip and knee arthroplasty (THA and TKA) in a private, high-volume orthopedic specialty hospital setting. METHODS This was a retrospective study examining 140 consecutive patients undergoing primary hip or knee arthroplasty at the sample setting by a single surgeon. The first 70 patients did not receive topical TXA (2 gm./20ml.), the final 70 did receive topical TXA. We compared the postoperative hemoglobin levels of both sample subgroups at postoperative days 1, 2, and 3. RESULTS Overall, the postoperative hemoglobin levels were significantly higher in the TXA group on postoperative days 1, 2, and 3 (p < 0.05). When patients who underwent THA (n = 70) were investigated separately, the hemoglobin levels were significantly higher on postoperative days 1, 2, and 3 in the group that received TXA. In the TKA group (n = 70), there was not a significantly higher hemoglobin level in patients who received TXA. There were no blood transfusions in the entire study cohort. Possibly due to the more restrictive transfusion criteria employed in this study, the total estimated prospective cost savings from use of TXA was calculated at about $116 per patient. CONCLUSIONS Based on these results from a high volume orthopedic specialty hospital, pre-closure topical TXA application may prove effective in reducing postoperative blood loss for some patients but have a relatively small impact on cost outcomes.
Contacting Patients After an Emergency Department Visit to Influence their Follow-Up Care Preferences
Authors: Bombard Matthew C. , Koaches Hannah CM , Francis Omar J. 
Published: February 2021

CONTEXT Emergency Departments (ED) have faced increasing challenges in providing quality, cost-effective patient care. In addition, healthcare administrators have sought specific techniques to improve patient perceptions of care and satisfaction as a component of Medicare reimbursement and physician contract retention. This five-month study sought to examine whether contacting patients per phone or leaving them a voicemail message after an ED visit might influence their perceptions of care and subsequent follow-up care preferences. METHODS A sample of 95 discharged ED patients were contacted by phone and mailed surveys rating their likelihood of return directly for future ED as well as scheduling office-based visits. Patients were stratified by whether they were: a) directly spoken to over the phone, b) left a voicemail message, or c) never successfully contacted. Mailed patient surveys utilized a five-point Likert-type scale items concerning future follow-up care preferences. Sample patients were also monitored in the electronic health record to correlate self-reported intentions with whether they actually returned to the same ED for the same chief complaint within 30 days of their initial visit. RESULTS Those patients who were directly contacted after ED discharge tended to be more likely to report they would return to the same ED, although not significantly (p = 0.060). Patients who were left a voicemail message were not more likely to return to the ED (p = 0.230). However, patients who were contacted directly indicated that they were more likely to adhere to received discharge instructions (p = 0.010). Neither did phoning patients significantly influence whether they followed-up with clinic providers (p = 0.999) or return to the same ED within 30 days (p = 0.999). CONCLUSIONS Although there are often many complex factors influencing patients’ post-ED care decisions, the results from this smaller project indicated that contacting patients after ED discharge may help influence their perceptions of care and influence some follow-up care preferences.
Examination of How the Affordable Care Act Influenced Use of Lower-Acuity Emergency Department Services
Authors: Haddad Joe , Fink Kyle , Pitus Katherine 
Published: February 2021

CONTEXT The Affordable Care Act (ACA) was implemented to make insurance accessible and reduce healthcare costs. The purpose of this study was to examine for changes in the use of lower-acuity types of Emergency Department (ED) services at two suburban Detroit facilities before, and after implementation of the ACA. METHODS A retrospective chart review of patients presenting to the ED at a two-campus suburban hospital system was performed over two 18-month pre- and post-ACA periods. The authors completed a review of electronic health record data and used ICD-9 code and ED visit billing and collections data. Sample patients included those who had received lower-acuity ED care within the two designated time periods. A total of 16 lower-acuity ICD-9 codes were included to gauge pre and post changes in use of ED services. RESULTS The authors identified 2,099 patients meeting study criteria during the pre-ACA period and 2,158 patients within the post-ACA period. A subgroup of 166,483 ED patients received care during the pre-ACA time period and 179,879 post-ACA. There was no statistically significant difference between the volume of lower-acuity ED visits during the two analytic periods (i.e., 1.26% seen pre-ACA implementation and 1.20% seen post-ACA). (p = 0.420) Neither did the absolute number of all ED visits significantly change. As could be anticipated, however, the proportion of self-pay patients pre-ACA significantly decreased from 506 (24.1%) to 191 (8.9%) post-ACA. (p < 0.001) Medicaid HMO payments also increased significantly from 824 visits pre-ACA to 1,086 visits post-ACA. (p < 0.001) In addition, Blue Cross coverage increased from 54 visits pre-ACA to 98 visits post-ACA. (p < 0.001) CONCLUSIONS In summary, our results revealed no significant change in the absolute volume of all ED visits or proportions of lower-acuity ED visits between the pre- and post-ACA periods. As the authors had anticipated, pre and post changes in the number of self-pay patients and those with certain types of insurance coverage were dramatic. The authors conclude that changes in lower-acuity visits to the ED in these study settings had not decreased as envisioned by ACA developers. Future studies with larger longitudinal samples are warranted to more fully investigate the longer-term implications of the ACA on use of ED services.