This retrospective review of a methicillin-resistant Staphylococcus aureus decolonization protocol using CHG bath/shower and PI-SNA nasal painting revealed a significant decrease in the infection rate of patients undergoing lower extremity fracture repairs. We recommend its use without contraindications, but recognize that additional investigations are necessary.
IntroductionWith the recent merger of the American Osteopathic Association (AOA) and the Accreditation Council for Graduate Medical Education (ACGME) a heightened pressure for publication may become evident. Our objective was to determine whether there was a gap in the type of both medical degree designation and advanced degree designation among authorship in three United States-based academic emergency medicine journals.MethodsWe reviewed the Journal of Emergency Medicine, Academic Emergency Medicine and Annals of Emergency Medicine for the type of degree designation that the first and senior authors had obtained for the years 1995, 2000, 2005, 2010 and 2014.ResultsA total of 2.48% of all authors held a degree in osteopathic medicine. Osteopathic physician first authors contributed to 3.26% of all publications while osteopathic physician senior authors contributed 1.53%. No statistical trend could be established for the years studied for osteopathic physicians. However, we noted an overall trend for increased publication for allopathic senior authors (p=0.001), allopathic first authors with a dual degree (p=0.003) and allopathic senior authors with a dual degree (p=0.005). For each journal studied, no statistical trend could be established for osteopathic first or senior authors but a trend was noted for allopathic first and senior authors in the Journal of Emergency Medicine (p-value=0.020 and 0.006). Of those with dual degrees, osteopathic physicians were in the minority with 1.85% of osteopathic first authors and 0.60% of osteopathic senior authors attaining a dual degree. No statistical trend could be established for increased dual degree publications for osteopathic physicians over the study period, nor could a statistical trend be established for any of the journals studied.ConclusionVery few osteopathic physicians have published in the Journal of Emergency Medicine, Academic Emergency Medicine or Annals of Emergency Medicine over the last two decades. Despite a trend for increased publication by allopathic physicians in certain journals, there appears to be no trend for increased publication of osteopathic physicians in emergency medicine.
Context With the transition to a single accreditation system for graduate medical education, the scholarly activity among core faculty in osteopathic and allopathic residency programs has come under scrutiny. Currently, major differences in scholarly activity requirements exist between core faculty in obstetrics and gynecology residencies accredited by the Accreditation Council for Graduate Medical Education and those accredited by the American Osteopathic Association. Objective To determine whether there is a disparity between osteopathic and allopathic physicians among authors with original research published in 4 high-impact obstetrics and gynecology journals during 4 select years. Methods The authors reviewed Obstetrics & Gynecology (Obstet Gynecol), the American Journal of Obstetrics and Gynecology (Am J Obstet Gynecol), Fertility and Sterility (Fertil Steril), and Menopause for the degree designation of the first and senior (last) author of each original manuscript for the years of 2000, 2005, 2010, and 2015. Data were analyzed using simple descriptive statistics and linear regression. Results In total, 3311 articles and 5909 authors were reviewed. Of these authors, 0.80% (47) had a DO degree. Of 1692 authors with dual advanced degrees, only 0.53% (9) had a DO degree. On subgroup analysis of each journal, 0.87% (13 of 1494) of identified authors in Obstet Gynecol, 1.03% (21 of 2038) in Am J Obstet Gynecol, 0.44% (9 of 2030) in Fertil Steril, and 2.20% (4 of 347) in Menopause were osteopathic physicians. During the years studied, no statistically significant trend could be established for first or senior author publication by osteopathic physicians over time, for all 4 journals or for any individual journal. Conclusion Very few osteopathic physicians have served as either the first or the senior author in articles published in Obstet Gynecol, Am J Obstet Gynecol, Fertil Steril, or Menopause during the years studied, and no trend was seen for increased publication by osteopathic physicians in these journals over time.
Background: Medication reconciliation is the process of comparing a patient's medication orders to all of the medications that the patient has been taking. Unfortunately, medication errors are common in our health system accounting for significant proportion of patient harm. The main objective of our study was to explore the effect of self-designed intervention in improving the accuracy of patient current medication list in the outpatient settings. Methods: The study designed entailed collection of data from October 2013 to March 2014. The data collected in October (The pre-intervention) was compared to the post-intervention data in March 2014. Following interventions were performed: Education of residents, nurses and patients, frequent reminders to the residents to perform medication reconciliation, sending notifications to the residents who failed to perform medication reconciliation, reminding the patients get all refills at the time of appointment and reminding the patients to bring pill bottles at each appointment. The pre-intervention data was compared with the post-intervention data for different types of medication errors. Normality of the variables was pre assessed. Non-parametric analysis using Fisher's exact test was performed for comparison of categorical variables. Conclusion: In conclusion, our intervention improved the accuracy of patient current medication list in the electronic records as accurate as possible. For clinics and hospitals, medication reconciliation can enhance delivery of high value cost conscious care to the patients by reducing medication errors.
Empowering patients to contribute subjective information to their electronic health record has the potential to improve the diagnostic process. When conducting a medical encounter, the authors recommend having patients complete a prehistory form beforehand to improve the patient experience while accommodating federal law.
Health care-associated pneumonias (HAPs) are a significant comorbidity seen in hospitalized patients. Traumatic injury is a known independent risk factor for the development of HAP. Trauma-related injuries also contribute to an increase in the rate of pneumonia in mechanically ventilated patients requiring intensive care unit (ICU) treatment. In 2011, the ventilator-associated pneumonia (VAP) rate among ICU patients at our institution (CMMC) increased dramatically. As a result, our infection control specialists performed a focused review of these patients and found a likely association between these infections and patients requiring pre-hospital intubation. Their determination prompted a July 2012 revision of the CMMC Trauma/Surgery Admission ICU protocol for ventilated patients to include bronchoscopy for all patients who have been intubated pre-hospital providing no contraindications were present. Our aim was to ascertain any influence of the protocol change on the rate of VAP. We conducted a retrospective medical record review of trauma patients who were intubated in the field or ED and seen at our institution (an accredited Level 1 trauma center) from 2012 to 2018. Applying the current definition of VAP from the Centers for Disease Control and Prevention (CDC) to data collected from the CMMC trauma registry, we observed a 13% lower VAP rate in the bronchoscopy group ( YB) as compared to the group that did not receive bronchoscopy (NB) ( P < .025). Based on our results, we determined that bronchoscopy performed in this setting does support a statistically significant decrease in the rate of ventilator-associated pneumonia.
Improved autoregulation was associated with PRx values near zero. Controlling those parameters that affect PRx, namely MAP, ICP and CPP and more importantly cerebral oxygen perfusion (COP), would likely increase the probability of a better outcome while guarding against secondary insult.
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