A 27-year-old male presented to the emergency department with acute exercise induced rhabdomyolysis (EIR) following low intensity, high repetition physical activity. It is paramount for the clinician to consider this diagnosis in the differential of the patient presenting with a complaint of musculoskeletal pain. This case highlights the necessity of staying vigilant for a condition that can develop with seemingly minor, repetitive training of a single muscle group, such as in the exercise of calf raises. CASEA 27-year-old male medical student presented to the emergency department with report of bilateral lower leg pain. The patient described the pain as crampy in nature, localized to the posterior aspect of both legs in the distribution of the gastrocnemius-soleus complex. Three days prior to arrival the patient engaged in an intensive exercise routine consisting of over 200 calf raises. The patient reported this activity as the only exercise he had preformed and that he did not engage in any routine exercise prior to the episode. Over the course of the preceding two days, the patient developed intense calf pain which impaired his ability to ambulate. The patient also reported the development of brown-colored urine and a generalized sense of weakness which caused him to seek medical attention. The patient had a past medical history significant for an unspecified mood disorder, gastroesophageal reflux disease, and obesity with a body mass index of 36. Surgical history was significant for wisdom teeth extraction. Outpatient medications included omeprazole, ritalin, and wellbutrin. He denied any drug allergies. Social history was negative for alcohol, tobacco, or illicit drug use.His initial presenting vital signs were signifi cant for relative hypertension with a blood pressure of 151/77 mmHg, heart rate of 96 beats per minute, respiratory rate of 16 breaths per minute, and he was afebrile with an oral temperature of 98.4 degrees Fahrenheit. Physical exam revealed a well appearing male in no acute distress. His pulmonary, cardiovascular, and abdominal exams were all unremarkable. On musculoskeletal exam, the patient was noted to have tenderness upon palpation over the posterior aspects of his bilateral lower legs. Of note, the patient was found to have full range of motion, full and symmetric strength testing of the lower extremity muscle groups, and no evidence of edema or calf asymmetry was identifi ed.The emergency physician ordered a complete blood count, basic metabolic panel, total creatine kinase, and urine analysis with associated microscopic evaluation. Results included blood urea nitrogen of 19 mg/dL, creatinine of 1.12 mg/dL, without an available baseline value in the record for comparison, white blood cell count of 9.2×10 3 /μL, hemoglobin of 16.0 g/dL, platelets of 184×10 3 /μL, and a total creatine kinase of 31 166 U/L. Urine analysis revealed a clear yellow appearing urine with a specific gravity of >1.030, qualitatively large blood, and no evidence of nitrates or leukocyte esterase. Microscopic an...
Background:The field of healthcare is becoming more aware of the need for patients to be able understand the consent forms we provide. Health literacy is often defined as the ability to read, understand, and act correctly on health information. Health literacy surveys have consistently shown that about 24% of the population cannot read at the 5th grade level. About 66% of the population can read at the 6 th grade level. It is for this reason that the target grade level for most newspapers and lay periodicals is set at a goal of a 6 th grade reading level. [1-2] How can one study the reading level and reading ease of a document? A well-known formula for determining the reading grade level of a document is the Flesch-Kincaid Grade Score (FKGS). The Flesch Reading Ease Score (FRES) is a well-known formula for determining reading ease. One advantage of these two tests is that they are both available on a widely-available word processing platform. Methods:The purpose of this project was to identify a random sample of consent forms, open source, from the internet. The Flesch-Kincaid Grade Level and Flesch Reading Ease tests were applied to the random sample. Then two simple strategies were tested-reduction in sentence length and reduction of multi-syllable words. Sentence length was tested in isolation as well as in tandem with reduction of multi-syllable words.Results: All of the documents in the sample frame were at or above the FKGS of 8 th grade reading level. The minimum FKGS grade level was 8. The maximum FKGS grade level was 21. The median FKGS was 11. The mean FKGS was 12.05. The overall paragraph sample Flesch Reading Ease Score (FRES) was 40.6% (Minimum 15, maximum 60, median 40). The sentence length intervention and sentence/syllable intervention both showed the effect of decreasing the reading grade level as expressed in the FKGS and of increasing reading ease as expressed in the FRES. These effects were highly statistically significant. The effects were incremental stepwise-sentence length intervention with word length reduction was statistically significantly lower in grade level and higher in reading ease than sentence length reduction alone. Conclusions: The sentence length intervention and sentence/syllable intervention both showed the
Purpose of the Study:The purpose of this study was to determine if emergency physician's opioid prescribing habits in three emergency departments of a three hospital community healthcare system changed following the revision of a state Prescription Monitoring Program (NJPMP). Materials and Methods: Design: A retrospective time series analysis Methods: A random sample of 50 days was be chosen from the year period prior to revised NJPMP) and a random sample of 50 days was chosen from the following two years. Data source: Retrospective data from an emergency department information system. Setting: Three campuses of a community emergency department system, with yearly visits to the ED in excess of 140,000. Inclusion Criteria: Retrospective, patients >18 years of age who present to the ED with pain and are prescribed opioid medication. Exclusion Criteria: Patients < 18 years of age, pregnant patients Data abstracted from EDIS was coded on entry into study and will thus had no unique identifiers. Variables: Percent opioid scripts written per given day (number of prescriptions/total adult patient volume) pre and post statewide prescription monitoring system. Average number of individual opioid pills written per prescription pre and post statewide prescription monitoring system. Average number of days' supply of opioid prescription for each day ) pre and post statewide prescription monitoring system. Results: Opiate prescriptions written decreased from a mean of 35.14 (StDev 7.43) in the pre-intervention period to a mean of 21.70 (StDev 7.99) in the post intervention system.This difference was highly significant. ( p=0.001). The average number of pills prescribed decreased from a mean of 18.097 (StDev 2.245) in the pre-intervention period to a mean of 15.06 (StDev 3.101 in the post intervention period. This difference was highly significant (p< 0.001). The
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