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The presence of the EPh significantly increased the likelihood of at-risk patients receiving empiric antimicrobial therapy consistent with guideline recommendations.

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the Patient Self-Determination Act in a hospital setting: an initial evaluation. Arch Intern Med. 1995; 155:502-10. 11. Fried T, Rosenberg R, Lipsitz L. Older community-dwelling adults' attitudes toward and practices of health promotion and advance planning activities. J Am Geriatr SOC. 1995; 43545-9. 12. Cugliari A, Miller T, Sobal J. Factors promoting completion of advance directives in the hospital. Arch Intern Med. 1995; 155:1893-8. 13. Perry E, Buck C, Newsome J, Berger C. Messana J. S w a m R. Dialysis staff influence patients in formulating their advance directives. Am J Kidney Dis. 1995; 25:262-8. 14. Richter K. Langel ABSTRACTObjective: To assess the cardiovascular physical examination skills of emergency medicine (EM) housestaff and attending physicians. Methods: Prospective, cohort assessment of EM housestaff and faculty performance on 3 valvular abnormality simulations (mitral regurgitation, mitral stenosis. and aortic regurgitation) conducted on the cardiology patient simulator, "Harvey." Participants examined each of the 3 study disease simulations and proposed a diagnosis (session I). They were then given a cardiac examination form and repeated the programmed simulations (session 11). The examination form was used to prompt physicians to interpret 23 separate cardiac findings for each simulation in a multiple-choice format.Results: Forty-six EM housestaff (PGY 1-3) and attending physicians were tested over a 2-month study period. Physician responses did not differ significantly among the different levels of postgraduate training. The overall correct response rates for participants were 59% for aortic regurgitation, 48% for mitral regurgitation, and 17% for mitral stenosis. For aortic regurgitation, recognition of a widened pulse pressure and recognition of diastolic decrescendo murmur were associated with a correct diagnosis (p < 0.01). For mitral regurgitation, comect assessment of the contour of the holosystolic murmur predicted a correct diagnosis (p < 0.001). For mitral stenosis, proper characterization of the mitral area diastolic murmur predicted a correct diagnosis (p c 0.001). Conclusion: Housestaff and faculty had difficulty establishing a correct diagnosis for simulations of 3 common valvular heart diseases. However, accurate recognition of a few critical signs was associated with a correct diagnosis in each simulation. Training programs may need to focus attention on selected key components of the cardiovascular examination to facilitate teaching of physical diagnosis.

Introduction:The majority of prehospital emergency medical services (EMS) personnel lack specific training relating to elder abuse and neglect.Objectives:To develop and test an audio visual training program that focuses on the identification and reporting of domestic violence in the elderly.Methods:A videotape was designed to be used as a 45-minute training course for prehospital personnel using one-half inch, super-VHS recording. A convenience sample of 60 EMS personnel working in Kent County then were asked to evaluate the videotape program. Each volunteer completed a pre-test on elder abuse and neglect, watched the 45-minute videotape, and then answered 12 questions on a post-test.Results:Participants had an average of 12.4 years (range: 1–30 years) prehospita emergency-care experience. Only four (7%) could recall any previous training relating to elder abuse or neglect during their career. Although the prevalence of elder abuse in their community was described as “rather rare” by most (60%) of the subjects, 85% (51/60) had seen a suspected case of elder abuse or neglect during their careers; 47% (28/60) had seen a case during the past six months. Only 29% of these suspected cases were reported to county authorities. Approximately 40% of the questions on the pre-test were answered correctly (mean score, 4.8 ± 3.0). In comparison, 83% of the questions on the post-test were answered correctly (10.0 ± 3.0). Although participants had a number of suggestions to improve the video program, 78% (47/60) expected this material to change the way they will evaluate elderly patients in the future.Conclusion:Prehospital personnel do not feel confident identifying or reporting victims of elder abuse or neglect. A videotape training program may be an effective way of presenting this information as a means of continuing education.