Hourly work productivity and acuity increased with experience within this ACGME-accredited EM residency. The progression in workload and acuity by PGY is measurable and commensurate with the graduated level of responsibility desired in an EM program.

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Cutaneous infestation by the human botfly, Dermatobia hominis, results in furuncular myiasis. This condition is endemic to the forested areas of Mexico, Central and South America. However, because of widespread travel, furuncular myiasis has become more common in North America. Misdiagnosis and mismanagement can occur owing to limited awareness of the condition outside endemic areas. To our knowledge, there is only a single report of botfly myiasis in the recent emergency medicine literature, which is surprising since the emergency department is likely to be the place many patients with this condition first seek attention. We present and discuss the case of a 50-year-old man with furuncular myiasis acquired in Belize. Parasitic infestation should be included in the differential diagnosis of a new skin lesion in patients who have travelled to endemic areas. RÉSUMÉ L'infestation cutanée par l'oestre humain, Dermatobia hominis, cause une myiase furonculeuse. Le problème est endémique dans les régions boisées du Mexique, de l'Amérique centrale et de l'Amérique du Sud. À cause des voyages généralisés, la myiase furonculeuse s'est répandue en Amérique du Nord. Il peut y avoir erreur de diagnostic et de traitement parce que le problème est peu connu en dehors des régions endémiques. Sauf erreur, on trouve un seul rapport de myiase causée par l'oestre dans les récentes publications sur la médecine d'urgence, ce qui est étonnant puisque le service d'urgence est probablement le premier endroit vers lequel se tourneront de nombreux patients atteints de ce problème. Nous présentons et décrivons le cas d'un homme de 50 ans atteint d'une myiase furonculeuse acquise au Belize. Il faudrait inclure l'infestation parasitaire dans le diagnostic différentiel d'une nouvelle lésion cutanée chez les patients qui ont voyagé dans des régions endémiques.

Objectives: To evaluate the progression in productivity of emergency medicine (EM) residents by postgraduate year, as measured by hourly work in relative value units (RVUs).Methods: This retrospective study was conducted at an Accreditation Council for Graduate Medical Education (ACGME)-accredited EM residency with a postgraduate year (PGY) 1-2-3 configuration. A query of an electronic billing database composed of more than 230,000 visits from academic years July 2003 to December 2006, representing at least four classes at each PGY level, was conducted. The main outcome was change in productivity in RVUs generated per hour, compared by resident PGY level. This measure encompasses not only volume of patients seen but also patient acuity in terms of evaluation and management services and procedures provided and supported by documentation adequate for coding. Descriptive statistics and Tukey's test were used for data analysis.Results: Over the three-year study period, 70 EM residents were assessed at various levels of training. Productivity, as measured by mean RVUs generated per hour, was 2.51 (95% confidence interval [CI] = 2.20 to 2.82) for PGY-1 residents, 3.51 (95% CI = 3.12 to 3.90) for PGY-2 residents, and 3.61 (95% CI = 3.41 to 3.80) for PGY-3 residents (p < 0.001). Patient acuity (RVUs generated per patient) increased 5%-8% with each PGY progression: 3.05 (95% CI = 2.96 to 3.13) for PGY-1, 3.20 (95% CI = 3.09 to 3.31) for PGY-2, and 3.46 (95% CI = 3.42 to 3.50) for PGY-3 (p < 0.001). There was a statistically significant increase in productivity (p < 0.001) and acuity (p = 0.03) from PGY-1 to PGY-2, with acuity also increasing between PGY-2 and PGY-3 (p < 0.001).Conclusions: Hourly work productivity and acuity increased with experience within this ACGMEaccredited EM residency. The progression in workload and acuity by PGY is measurable and commensurate with the graduated level of responsibility desired in an EM program.

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This study aimed to examine the pattern of alcohol use among those attending a General Hospital and to explore the perception of safe drinking. The Alcohol Use Disorders Identification Test (AUDIT) questionnaire was given for self-completion to all inpatients and outpatients on separate days and to all adults attending the Accident and Emergency Department (A&E) on both a midweek and a weekend period. Additional questions to determine attitudes to, and intake of, alcohol were also given. Of the 464 people approached, 82% completed the questionnaire. Twenty-nine per cent of outpatients, 37.5% of inpatients and 20% of those attending A&E were leetotal. Fifteen per cent of outpatients, 16% of inpatients and 38.5% of those attending A&E scored as misusers of alcohol according to the AUDIT questionnaire. Males were three times more likely to misuse alcohol than females. Younger women were much more likely to misuse alcohol than older women. An unexpectedly large number of those attending the gynaecological clinic reported alcohol misuse. Of the inpatient alcohol misusers identified by AUDIT, only 50% were independently detected by either nursing or medical staff, the lower misuse scores being more frequently missed. We conclude that there continues to be a significant identifiable proportion of alcohol misuse that goes undetected. These individuals attend throughout the hospital and a simple self-completion questionnaire would considerably aid their detection.