bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric Resuscitation Mock Code Practice Impacts Selected Skills
Authors: Mackey Jennifer , D’Agostino James , Cherry Richard , Mihai Aurel , Grant William , Miner Bonnie 
Published: May 2008

Objectives:  Determine the utility of a computer‐controlled mannequin in training and assessment of resident pediatric resuscitation skills. Determine if mock code practice is beneficial in maintaining mastery of critical pediatric resuscitation skills.Methods:  A prospective randomized study of 22 interns (12 pediatric, 10 emergency medicine) randomized to: Group 1 (cases who participated in 3 mock codes over a 6 month period) and Group 2 (controls who did not receive mock code practice). Each intern was randomly paired in teams of two who participated at baseline in two code scenarios using the Laerdal Simbaby. The interns alternated airway and circulatory management responsibility. At 6 months all interns returned to the simulator in pairs to participate in another two pediatric code scenarios. All sessions were videotaped and time of computer initiation of scenario events recorded. Videos were examined by a pediatric emergency physician (blinded to Group participation) using a structured recording form. A general linear model was used to assess differences in response times and Fisher's exact tests for categorical data.Results:  Whether in charge of airway or circulatory management, at post test interns who had completed mock codes required less time to: recognize the need for bag mask ventilation (Diff 5.6 seconds, p < 0.005), initiate BVM (Diff 2.7 seconds, p < 0.006), intubate (Diff 22 seconds, p < 0.03), and recognizing the need for chest compressions (Diff 24 seconds, p < 0.03). There were no differences in times for recognizing the need for fluid resuscitation or for factors such as appropriate mask size, rate of ventilation, intubation success (including number of attempts), compression techniques, or IO placement.Conclusions:  Computer controlled mannequins provide reproducible measurable experiences. This study demonstrates that mock code practice may impact some, but not all, aspects of pediatric resuscitation skill retention.
Blood Pressure Response to the ImpedanceThreshold Device in Hypotensive Emergency Department Patients
Authors: Luber Samuel , Roppolo Lynn , Idris Ahamed , Sharda Rohit 
Published: May 2008

Background:  An impedance threshold device (ITD) has been found to enhance circulation during CPR by increasing cardiac preload. Additionally, in the spontaneously breathing patient, the ITD has been found to create a small degree of inspiratory resistance (‐6 cm H2O at flow rate of 20L/min). Hypothesis: We sought to determine the effects of the ITD on awake patients with hypotension presenting to the emergency department. We hypothesized that the ITD would improve blood pressure when compared to standard therapy. The main outcome measure was the systolic blood pressure (SBP) change during 10 minutes of ITD use.Methods:  A convenience sample of patients with SBPs <95 mmHg were randomized in double‐blind fashion to active or sham ITDs. Patients were enrolled if they were between the ages of 18 and 70 and their hypotension was felt to be due to non‐traumatic blood loss or dehydration by the treating physician. Patients were excluded if they were experiencing shortness of breath, chest pain, failed the abbreviated mini‐mental status exam, or had predefined cardiac/pulmonary history criteria. After consent and baseline measurements, patients spontaneously breathed through a mouthpiece attached to an active or sham ITD for a 10 minute period during which vital signs and patient status were recorded.Results:  12 patients were enrolled (5 randomized to the active device, 7 to the sham device). Mean baseline SBPs were similar between groups with the active and sham devices having baseline SBPs of 84.5 mmHg (SD 5.45) and 83.67 mmHg (SD 10.02), respectively. The active ITD produced a statistically significant (p = 0.03) increase in SBP of 13.0 mmHg (SD 4.69) compared to the sham ITD, 2.33 mmHg (SD 0.58).Conclusions:  In spontaneously breathing hypotensive ED patients, the ITD was well‐tolerated and increased the SBP. If these results are validated with a larger sample, the ITD may be a useful adjunct in the treatment of hypotension due to volume loss in the ED.
Assessment of a Cross‐Disciplinary Domestic Violence Training for Emergency Medicine Residents and Law Students
Authors: Crandall Cameron , Sedillo‐Lopez Antoinette , McLaughlin Steve , Rimple Diane , Campos Gabriel , McCarty Teresita 
Published: May 2008

Objectives:  Domestic violence (DV) patients often have complex medical, social and legal issues that challenge assessment, treatment and referral. We designed a brief cross‐disciplinary training for emergency medicine residents and upper level law students to determine the baseline level of resident and law student competence in assessment and management of patients with a history of domestic violence.Methods:  The study included 23 emergency medicine residents and 28 upper level law students at an urban university. The design included pretest, intervention, and retest with 4 standardized patient assessments. The intervention included for each 2 hours of cross‐disciplinary lectures on DV and one joint case‐based 2 hour learning session with the medical and legal learners. Communication skills (CSs) were assessed using a validated criterion standard. History taking competence (HX) was assessed with a prespecified checklist of critical elements designed to elicit key medico‐legal factors relevant to each case. Data were compared with t tests.Results:  18 (78%) residents and 26 (93%) law students completed the study. Pre‐intervention, residents scored 63% (8% standard deviation (SD)) on CS and gathered 71% (13%) of critical HX elements. Law students scored 62% (8%) on CS and gathered 66% (8%) of critical HX elements. Residents (64% (6%)) and law students (63% (6%) showed similar post‐intervention CS scores. Both residents (77% (10%), improvement 6%, p = 0.13) and law students (71% (14%), improvement 8%, p = .15) showed modest but non‐significant improvement in critical HX gathering.Conclusions:  A brief cross‐disciplinary training between medical and legal learners demonstrated low baseline scores in DV assessment for both learning groups with modest, but non‐significant improvements in gathering of critical HX elements following intervention. Longer didactic training or more focused skill building might improve skills.
10 A Rapid, Simple and Inexpensive Method for Construction of Peripheral Vascular Ultrasound Phantoms
Authors: Minnigan Hal 
Published: May 2008

Background and Introduction:  Emergency department bedside ultrasound has grown to include ultrasound guidance of vascular access, most recently, peripheral IV access has been described with ultrasound guidance. Simulation of procedures that are crucial to clinical practice is an efficient and reliable way to train and assess competency prior to performance on an actual patient. Ultrasound phantoms that simulate patient anatomy allow the development of hand‐eye coordination, orientation and manipulation of the instruments in a controlled setting. In an effort to obviate the cost of commercial products I have developed a very simple and rapid method for building vascular ultrasound phantoms for teaching ultrasound guided peripheral IV placement.Materials and Methods:  Using easily obtainable and inexpensive materials, a simple method is described which allows construction of the phantom in less than 1 hour. This method requires no special tools or construction skills. The total cost for 1 phantom is about $30.00. Most of the components can be reused when the phantom needs to be repoured – the cost to repour a phantom is less than 2.Results:  These phantoms are realistic in terms of visualization of deep upper extremity veins, and include fluid filled vessels which are gravity fed by colored saline. The system is versatile and can be customized to fit the needs of the individual user. Attendees will be provided with a CD comprising a complete materials list with sources of supply, a PowerPoint presentation to guide construction with each step detailed using digital photographs, and videos of use of the phantom.
14 The Use of Medical Simulation to Enhance the Clinical Exposure to International Emergency Medicine
Authors: Bouslough David 
Published: May 2008

Study Objectives:  Increasing numbers of immigrants and returned travelers use emergency departments for health care. Many physicians‐in‐training are interested in participating in health electives abroad, yet residency curricula generally address global health inadequately. Advanced medical simulation (SIM) is an educational modality used to artificially re‐create clinical experiences. Authors explored the application of SIM and standardized patient encounters to teach emergency medicine residents select topics in tropical medicine, public health, and decision‐making in varied‐resource settings.Methods:  International Emergency Medicine (IEM) faculty created four case scenarios interspersed into the established residency simulation curriculum. Moulaged manikins and standardized patients in immersive IEM clinical settings provided history and physical exam cues to learners during the following clinical encounters:‐ “Tent‐side” mobile clinic, East Africa: “Dizzy” pregnant patient (Hookworm).‐ Rural health clinic, Southeast Asia: Infant with “altered mental status” (Dengue).‐ Emergency department, North America: Central American immigrant with “dyspnea” (Chagas).‐ Emergency department, North America: Returned traveler from East Africa with “fever” (Typhoid).Post‐scenario debriefings addressed unique elements of IEM including
19 A Novel Approach to Residency Education in EMS: The MD‐PM Ambulance
Authors: Fiege Angela 
Published: May 2008

Challenge:  Indiana University EM residents have actively provided prehospital care as crew members on a hospital‐based air ambulance service. This service functions as a secondary responder for high acuity patients who have already had first tier evaluation and care. First response, ground EMS experiences have been observational only as residents have ridden along with a two‐paramedic team on an urban ambulance service for 24 hours during their residency careers. Resident understanding of first response care and challenges faced by initial EMS providers has been limited to that gleaned during their observational period.Solution:  Most EM residencies do not provide opportunities for residents to function as first response providers. Therefore, we developed a Physician‐Paramedic team to provide first response care within a busy metropolitan area. This two‐member team operates within a “geozone” that includes a diverse patient population with both medical and trauma complaints. Unlike other residency ground EMS programs, the MD‐PM truck responds primarily to all ambulance requests within their designated geozone and assists outside their designated geozone for multi‐patient casualties in which a physician response would benefit patient care (fires, motor vehicle accidents, multiple gunshot victims). Residents on the MD‐PM truck not only provide care equivalent to that expected of a nationally certified paramedic (IVs, drug administration, splinting, packaging), but also perform advanced skills such as RSI which is outside the scope of a traditional two‐paramedic team. Immersion into the first response ground EMS system will provide valuable insight into the challenges of providing care outside of the hospital.
7 Layered Simulation: A Novel Approach to Medical Malpractice Education
Authors: Schlicher Nathaniel 
Published: May 2008

Overview:  We present a novel approach to the use of simulation in medical education with a two‐event layered simulation. A patient care simulation with an adverse outcome was followed by a delayed simulated deposition.Process:  Senior residents in an academic emergency medicine program were solicited as simulation research volunteers. Other than stating that the research involved adverse outcomes, no identifying information was given. Seven volunteers participated in a simulation involving a forced error (nurse confederate gave an incorrect medication dose). Based on the initial simulation, one physician completed a simulated deposition in a teaching conference six weeks later conducted by a licensed attorney with malpractice experience. The audience, consisting of residents, attendings, and students, watched a recording of the patient care, witnessed the deposition, and evaluated the experience using a 13 question survey with five‐point Likert scales.Outcome:  Participants felt that, overall, the training program was a useful educational tool (average Likert score of 4.63) that would change aspects of their practice (3.31). Participants stated that they would be more careful in their documentation (3.88), review high risk situations with staff (4.00), and monitor more carefully for errors (3.95). Overall, there was a degree of increased fear of the litigation process (3.95), but participants felt they would improve the risk profile of their practices (3.70).Conclusion:  A novel approach to medical education was successful in changing attitudes and provided an expanded educational experience for participants. Layered simulation can be successfully incorporated into educational programs for numerous issues including medical malpractice.
8 The Observed Teaching Encounter: Providing Residents Feedback on Their Teaching Skills
Authors: Doshi Ankur 
Published: May 2008

Introduction:  Emergency medicine residents spend a significant portion of their time teaching junior residents and medical students in the clinical setting. Feedback is an integral component of any teaching curriculum, and therefore, feedback on residents’ skill in teaching abilities is an essential part of their learning to teach. We have developed a structured method of providing feedback to senior residents on their teaching competence.Methods:  Upcoming senior residents receive an 8‐hour course on clinical teaching during their useful conference time. In our ED, attending faculty and senior “teaching” residents are matched with medical student learners. The Observed Teaching Encounter (OTE) is used during usual clinical ED shifts to reinforce concepts in teaching. During the OTE, the teaching resident is directly observed by a faculty physician while teaching a student learner. A checklist is completed by both the faculty member and the student learner in order to provide feedback to the teaching resident. Assessed skills correlate with teaching theory provided to residents in their didactic curriculum. Written formative comments are provided to the resident from faculty, as well.Results:  Attending faculty, senior residents, and student learners have all provided positive feedback on the OTE. Assessment of residents’ retention of knowledge on methodology of teaching is presently in progress as a tool to evaluate the efficacy of the OTE.
Nordic consensus on treatment of undescended testes
Authors: Martin Ritzén E. , Bergh A , Bjerknes R , Christiansen P , Cortes D , Haugen SE , Jörgensen N , Kollin C , Lindahl S , Läckgren G , Main KM , Nordenskjöld A , Rajpert‐De Meyts E , Söder O , Taskinen S , Thorsson A , Thorup J , Toppari J , Virtanen H 
Published: May 2008

AbstractAim: To reach consensus among specialists from the Nordic countries on the present state‐of‐the‐art in treatment of undescended testicles.Methods: A group of specialists in testicular physiology, paediatric surgery/urology, endocrinology, andrology, pathology and anaesthesiology from all the Nordic countries met for two days. Before the meeting, reviews of the literature had been prepared by the participants.Recommendations: The group came to the following unanimous conclusions: (1) In general, hormonal treatment is not recommended, considering the poor immediate results and the possible long term adverse effects on spermatogenesis. Thus, surgery is to be preferred. (2) Orchiopexy should be done between 6 and 12 months of age, or upon diagnosis, if that occurs later. (3) Orchiopexy before age one year should only be done at centres with both paediatric surgeons/urologists and paediatric anaesthesiologists. (4) If a testis is found to be undescended at any age after 6 months, the patient should be referred for surgery—to paediatric rather than general surgeons/urologists if the boy is less than one year old or if he has bilateral or non‐palpable testes, or if he has got relapse of cryptorchidism.
Understanding diagnostic tests 3: receiver operating characteristic curves
Authors: Akobeng Anthony K 
Published: May 2008

AbstractThe results of many clinical tests are quantitative and are provided on a continuous scale. To help decide the presence or absence of disease, a cut‐off point for ‘normal’ or ‘abnormal’ is chosen. The sensitivity and specificity of a test vary according to the level that is chosen as the cut‐off point. The receiver operating characteristic (ROC) curve, a graphical technique for describing and comparing the accuracy of diagnostic tests, is obtained by plotting the sensitivity of a test on the y axis against 1‐specificity on the x axis. Two methods commonly used to establish the optimal cut‐off point include the point on the ROC curve closest to (0, 1) and the Youden index. The area under the ROC curve provides a measure of the overall performance of a diagnostic test. In this paper, the author explains how the ROC curve can be used to select optimal cut‐off points for a test result, to assess the diagnostic accuracy of a test, and to compare the usefulness of tests.Conclusion: The ROC curve is obtained by calculating the sensitivity and specificity of a test at every possible cut‐off point, and plotting sensitivity against 1‐specificity. The curve may be used to select optimal cut‐off values for a test result, to assess the diagnostic accuracy of a test, and to compare the usefulness of different tests.
Fetal exposure to cocaine and infections during the first 18 months of life in infants from a mediterranean city
Authors: García‐Algar Óscar , Felipe Aida , Puig Carme , Monleón Toni , Pacifici Roberta , Pichini Simona 
Published: May 2008

AbstractAim: The incidence of infections during the first 18 months of life was investigated in 36 infants prenatally exposed to cocaine and in 72 non‐exposed controls from Barcelona, Spain.Methods: Fetal exposure to cocaine was ascertained by meconium analysis, infections by structured questionnaire.Results: A higher incidence of infections, if excluding those acquired in utero, was not found in exposed infants versus non‐exposed infants of similar demographical and socioeconomic characteristics.Conclusions: A possible role for life style factor in those cases where increased infections are associated with fetal exposure to cocaine is hypothesized.
The opinions of clinical staff regarding neonatal procedural pain in two Norwegian neonatal intensive care units
Authors: Andersen Randi Dovland , Greve‐Isdahl Margrethe , Jylli Leena 
Published: May 2008

AbstractAim: Neonates are subjected to numerous painful procedures without sufficient pain management. The aim of this study was to describe the opinions of Norwegian physicians, nurses and nurse assistants who care for neonates, regarding procedural pain in neonates.Methods: A replication of a previous questionnaire study was conducted in two Norwegian neonatal intensive care units (NICU's). The questionnaire aimed at evaluating procedure painfulness, the current use of pharmacological agents and comfort measures and the optimal use of both.Results: Ninety members of the clinical staff participated, which is a response rate of 87%. Opinions on how procedural pain is currently and optimally managed differed significantly. Although most respondents rated a majority of the listed procedures as being more than moderately painful, pharmacological agents were rarely used, except for the insertion of a chest tube and endotracheal intubation. Comfort measures were also believed to be underutilized, but not to the same degree as pharmacological agents.Conclusion: Procedural pain in neonates is not sufficiently managed and both pharmacological agents and comfort measures are underutilized, according to clinicians at two Norwegian NICU's.
Characteristics of severely malnourished under‐five children hospitalized with diarrhoea, and their policy implications
Authors: Chisti Mohammod J , Hossain Mohammad I , Malek Mohammad A , Faruque Abu SG , Ahmed Tahmeed , Salam Mohammed A 
Published: May 2008

AbstractAim: Identify clinical and nutritional features, and complications among severely malnourished, under‐five children in an urban diarrhoeal disease facility in Bangladesh.Methods: For this case‐control design, children of both sexes, aged 0–59 months were studied. Severely (<−3 z‐score) underweight, stunted or wasted constituted cases and those with better nutritional status (z‐score ≥−3) constituted controls.Results: During 2000–2005, of the total 6881 children, 1103 (16%) were severely underweight, 705 (11%) severely stunted and 217 (3%) severely wasted. In logistic regression analysis, severely underweight children were more likely to be older than 11 months (OR 3.7, 95% CI 3.1–4.3, p < 0.001), non‐breastfed (OR 1.5, 95% CI 1.3–1.8, p < 0.001), have illiterate mothers (OR 2.6, 95% CI 2.2–3.0, p < 0.001), non‐sanitary toilet (OR 1.4, 95% CI 1.2–1.6, p < 0.001), a history of measles in preceding 6 months (OR 1.7, 95% CI 1.3–2.4, p = 0.001), dehydrating diarrhoea (OR 1.9, 95% CI 1.6–2.2, p < 0.001), abnormal findings in lung auscultation (OR 1.7, 95% CI 1.3–2.3, p < 0.001) and require hospitalization ≥48 h (OR 2.2, 95% CI 1.8–2.5, p < 0.001).Conclusion: There thus is a need to incorporate appropriate, cost‐effective and sustainable preventive strategies and improved management policies in the health systems as well as in social support systems in Bangladesh.
Neonatal end‐of‐life practice in a German perinatal centre
Authors: Schulz‐Baldes A , Huseman D , Loui A , Dudenhausen JW , Obladen M 
Published: May 2008

AbstractAim: To investigate the end‐of‐life practice in a large perinatal centre in Germany.Methods: Retrospective chart review was performed in all neonates deceased in the delivery room (n = 31) and the neonatal intensive care unit (n = 47) between 2002 and 2004.Results: Neonatal death was preceded by an end‐of‐life decision (EOLD) in 81% of cases in the delivery room and 83% in the neonatal intensive care unit. The majority of deceased neonates were born prematurely or with congenital malformation. Life‐sustaining treatment was not initiated in 74% of the infants deceased in the delivery room. In the unit, 52% died after withdrawal of therapy. Mechanical ventilation was withdrawn most frequently (79% of cases). Futility and immediate death were common considerations in EOLD, but the infant's suffering and future quality of life also played a role. Parents were involved in EOLD‐making in all but emergency cases. No active termination of life was performed.Conclusion: In our perinatal centre, the majority of neonatal deaths occurred after limitation of therapy. Treatment was actively withdrawn in half of the infants in the neonatal intensive care unit. Actual end‐of‐life practice in a large perinatal centre differs from the restrictive attitude towards EOLD reported for German neonatologists in previous surveys.