, Abstract-Background: Differences in productivity between off-service residents rotating in the emergency department (ED) and their emergency medicine (EM) resident counterparts have never been directly quantified. Objectives: We sought to quantify the difference between off-service residents rotating in the ED and their EM resident counterparts. We also sought to find whether shift cards could be used to increase the productivity of off-service residents rotating in the ED. Methods: This is a prospective cohort study conducted at an urban, tertiary, Level I trauma center. We implemented the use of shift cards for off-service residents during their EM rotation. Completion of the shift card involved recording patients seen and their dispositions, procedures done, and documenting a learned bedside teaching point from their shift that day. Productivity was measured in terms of patients seen per hour (PPH) and relative value units per hour (RVU/h). Results: Off-service residents showed a productivity of 0.529 PPH (95% confidence interval [CI] 0.493-0.566) and 1.40 RVU/h (95% CI 1.28-1.53) prior to implementation of shift cards. With the introduction of shift cards, productivity increased to 0.623 PPH (95% CI 0.584-0.663, p = 0.001) and 1.77 RVU/ h (95% CI 1.64-1.91, p = 0.001). In comparison, first year EM resident productivity was 0.970 PPH (95% CI 0.918-1.02) and 3.01 RVU/h (95% CI 2.83-3.19). Conclusions: Shift cards can be used to foster motivation for off-service residents rotating in the ED, and is a simple and costeffective method to improve system-based practices and utilization of resources. Ó 2015 Elsevier Inc.
Background: Cord blood serum levels of IgM are normally below 200 g/mL (20 mg%) while no IgE is usually present in healthy newborns. Since these immunoglobulins are not transferred from the mother, abnormally high levels at birth may reflect fetal exposition to infectious agents or response to antigens traversing the placenta. A test which allows detection of altered levels of IgM or IgE in filter paper embedded blood (FPEB) could be used to screen congenital infections or allergies. The aim of this study was to correlate the levels of IgM and IgE eluted from FPEB in Guthrie cards to their corresponding serum concentration. Methods: Forty eight cord blood samples were obtained at the General Hospital "Manuel Gea González" of Mexico City. Guthrie cards and serum samples were prepared by standard procedures. Both samples were tested using antigen-capture ELISAs to determine IgM and IgE concentrations. Those cases with abnormal values were localized and clinically attended to diagnose specific congenital infections, as well as maternal history of allergy, vaccination or clinical problems. Results: Mean IgM concentration in cord blood serum was 104.5 ± 19.6 g/mL; four out of the 48 cases (8.3%) presented abnormally high levels. The mother of the newborn with the highest IgM level (>400) had prolonged cystitis along pregnancy, and other mothers had been vaccinated agaisnt tetanus. A high correlation (r = 0.89) between serum and FPEB was obtained, with 39% elution efficiency (figure). Correlation between first and second samples (taken 7-10 days later) was r = 0.99, with an increase of around 25% of the original concentration due to aging. Only two (4.2%) serum samples were positive for IgE (above 2 g/mL) but no relation to maternal or newborn clinical or exposition factor was found. FPEB samples gave more erratic IgE results than sera. e198 15th ICID Abstracts / International Journal of Infectious Diseases 16S (2012) e158-e316 sanitation and health education can be expected to have substantial impact on childhood morbidity.
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