Mixed effect of increasing outflow of medical patients from an emergency department

The SARS-COV-2 (COVID-19) pandemic has placed unprecedented challenges on the health care system in the United States with New York City at its epicenter. By the end of the 8 week (4/23/2020) since the virus's emergence in New York City, there have been 142,432 confirmed COVID-19 cases and 10,977 deaths attributed to complications from COVID-19-related illnesses. Secondary to policies enacted by the New York State government to limit spread of the virus, Orthopedic Surgery departments at hospitals around the area have witnessed an abrupt change in clinical demands. At a local level one trauma hospital in Queens, New York, Orthopedic Surgery elective cases have been cancelled, trauma consult volume has experienced a sharp decline, and both residents and attendings have been repurposed to meet the new clinical demands of this medical crisis. Our own orthopedic surgery service has adopted care for patients normally admitted to an internal medicine service in a novel Ortho-Medical COVID-19 management team. We prepared this primer to make our experience with caring for COVID-19 patents available as a reference for other surgical subspecialty services preparing to adjust the clinical focus of their hospital teams during this or future pandemics. LEVEL OF EVIDENCE:: Level V.

Ultrasonography (US) is an invaluable tool in the management of many types of patients in Internal Medicine and Emergency Departments, as it provides rapid, detailed information regarding abdominal organs and the cardiovascular system, and facilitates the assessment and safe drainage of pleural or intra-abdominal fluid and placement of central venous catheters. Bedside US is a common practice in Emergency Departments, Internal Medicine Departments and Intensive Care Units. US performed by clinicians is an excellent risk reducing tool, shortening the time to definitive therapy, and decreasing the rate of complications from blind invasive procedures. US can be performed at different levels of practice in Internal Medicine, according to the experience of ultrasound practitioners and equipment availability. In this review, the indications for bedside US that can be performed with basic or intermediate US training will be highlighted.

Use of laryngeal electromyography in prediction of recovery after vocal cord paralysis.

IntroductionPrehospital information is valuable but often under-used by physicians. In both the emergency and inpatient settings, information about a patient’s condition prior to their arrival is important to provide optimal care. Historically, prehospital responders’ electronic patient care reports (ePCR) have not been integrated with the hospital’s electronic health record (EHR). In this study, we aimed to assess physician attitudes towards the ePCR and patient care decisions before and after integration of prehospital ePCR and hospital EHR systems. We hypothesized that this would increase accessibility and use of prehospital ePCR in patient care decisions.MethodsIn 2023, our local academic health center implemented software that made prehospital documentation available to hospital staff within 30 minutes of patient arrival to the emergency department (ED). Before this, we surveyed attendings, fellows, and residents from both the ED and internal medicine (IM) department on their attitudes and behaviors regarding ePCR and clinical practice. We administered the same survey six months after implementation, and compared responses with a Wilcoxon signed-rank test.ResultsSixty-six physicians responded to the pre survey, including 39 (59.1%) from the ED and 27 (40.9%) from the IM department. Fifty-two completed the post survey, including 33 (63.5%) emergency physicians and 19 (36.5%) IM physicians. The pre- survey response rates were 92.9% and 54% for the ED and IM groups, respectively, while the post-survey response rates were 84.6% and 70.4%. Change in rank was significant (P < .01) for the following categories: knowledge;, ability; ease of use; time to access; and frequency of accessing the ePCR. Change in rank was not significant for the importance of ePCR in patient care and medical decision-making, and whether the ePCR would be used more frequently if it were easier to access.ConclusionPre- and post-survey responses regarding accessibility showed a significant change in rank, while the importance of the ePCR on clinical decision-making did not. This suggests that while system integration increased accessibility to prehospital information, it did not significantly alter patient care decision-making.

What we have learned from a decade of ED crowding research.

144 Hospital Strategies for Reducing Emergency Department Crowding: A Mixed-Methods Study

Achieving Diversity in Academic Internal Medicine: Recommendations for Leaders

Background: Despite the central role of Internal Medicine (IM) in emergency admission management, both users and health planners do not seem to recognize the distinct features of the activities relative to IM. According to the Literature, the role of IM is characterized by: (1) Acute, critical, multiple pathology and complex patient management; (2) Difficult clinical diagnosis; (3) Individuation of priorities; (4). Hospitalterritory pathways promoting integration of diverse specialist activities. Objective: To determine the proportion of correct and missed emergency department (ED) diagnoses compared to IM discharge diagnoses. Methods: ED diagnoses and hospital IM discharge diagnoses were compared. By using the consensus among experts method a diagnosis evaluation grid was formed. Diagnosis was defined as follows: (1) The “gold standard” diagnosis (correct diagnosis), according to ICD10 (10th International Classification of Diseases and Related Health Problems), independently made by two experienced IM specialists and reported in the discharge letter. (2) ED diagnosis made by the Emergency Physician and reported in the patient acceptance or transfer record to the Internal Medicine Unit; (3) Priority Error: the correct diagnosis appears as a secondary diagnosis in the ED diagnosis; (4) Incomplete diagnosis: diagnostic orientation without a precise diagnosis; (5) Diagnosis Error: the correct diagnosis was not made in the ED. The first 13 diagnoses made in ED are defined as the most frequent in number within the sample being examined. Results: 317 non trauma patients presenting to the ED from June to September 2016 and admitted to the INI (Italian Neurotraumatology Institute) IM department were included for final analysis. The final diagnosis at IM discharge was taken to be the correct “gold standard” diagnosis. In 180 patients (56,7%) this corresponded with the primary ED diagnosis, in 104 patients (32,8%) the diagnosis was missed and in the remaining 10.5%, the diagnosis (33 patients) was incomplete or a priority error occurred. The most frequent final diagnoses were cardiac failure (n =53), pneumonia (n= 43), TIA (Transient Ischemic Attack) (n=31); respiratory failure (n=28); COPD (Chronic Obstructive Pulmonary Disease) (n=21), correctly diagnosed in the ED in 37, 26, 19, 20, and 11 patients, respectively. Conclusion: Patients presenting to ED with acute symptoms represent a diagnostic challenge that in 43.3% of cases is explained by the clinical activity carried out by the Internal Medicine specialist during hospitalization. The study confirms the central role of Internal Medicine in defining the correct diagnosis in acute and complex patients. It is likely time to instigate awareness campaigns for patients and policy makers promoting the central role of Internal Medicine in hospital organization and hospital-territory integration and to duly recognize the complexity of IM activity through the endorsement of appropriate DRGs (Diagnosis Related Groups) in the Medical Area.

British Journal of HaematologyVolume 72, Issue 3 p. 473-474 HYPERFERRITINAEMIA AS A SIGNIFICANT INDICATOR SUGGESTING MALIGNANT HISTIOCYTOSIS M. Okano, M. Okano Department of Dermatology, Internal Medicine and Pathology, Osaka University School of Medicine, and Department of Dermatology, Aizenbashi Hospital, Osaka, JapanSearch for more papers by this authorR. Kanda, R. Kanda Department of Dermatology, Internal Medicine and Pathology, Osaka University School of Medicine, and Department of Dermatology, Aizenbashi Hospital, Osaka, JapanSearch for more papers by this authorT. Tanigaki, T. Tanigaki Department of Dermatology, Internal Medicine and Pathology, Osaka University School of Medicine, and Department of Dermatology, Aizenbashi Hospital, Osaka, JapanSearch for more papers by this authorY. Kobayashi, Y. Kobayashi Department of Dermatology, Internal Medicine and Pathology, Osaka University School of Medicine, and Department of Dermatology, Aizenbashi Hospital, Osaka, JapanSearch for more papers by this authorT. Yamamura, T. Yamamura Department of Dermatology, Internal Medicine and Pathology, Osaka University School of Medicine, and Department of Dermatology, Aizenbashi Hospital, Osaka, JapanSearch for more papers by this authorK. Yoshikawa, K. Yoshikawa Department of Dermatology, Internal Medicine and Pathology, Osaka University School of Medicine, and Department of Dermatology, Aizenbashi Hospital, Osaka, JapanSearch for more papers by this authorE. Miyoshi, E. Miyoshi Department of Dermatology, Internal Medicine and Pathology, Osaka University School of Medicine, and Department of Dermatology, Aizenbashi Hospital, Osaka, JapanSearch for more papers by this authorK. Wakasa, K. Wakasa Department of Dermatology, Internal Medicine and Pathology, Osaka University School of Medicine, and Department of Dermatology, Aizenbashi Hospital, Osaka, JapanSearch for more papers by this author M. Okano, M. Okano Department of Dermatology, Internal Medicine and Pathology, Osaka University School of Medicine, and Department of Dermatology, Aizenbashi Hospital, Osaka, JapanSearch for more papers by this authorR. Kanda, R. Kanda Department of Dermatology, Internal Medicine and Pathology, Osaka University School of Medicine, and Department of Dermatology, Aizenbashi Hospital, Osaka, JapanSearch for more papers by this authorT. Tanigaki, T. Tanigaki Department of Dermatology, Internal Medicine and Pathology, Osaka University School of Medicine, and Department of Dermatology, Aizenbashi Hospital, Osaka, JapanSearch for more papers by this authorY. Kobayashi, Y. Kobayashi Department of Dermatology, Internal Medicine and Pathology, Osaka University School of Medicine, and Department of Dermatology, Aizenbashi Hospital, Osaka, JapanSearch for more papers by this authorT. Yamamura, T. Yamamura Department of Dermatology, Internal Medicine and Pathology, Osaka University School of Medicine, and Department of Dermatology, Aizenbashi Hospital, Osaka, JapanSearch for more papers by this authorK. Yoshikawa, K. Yoshikawa Department of Dermatology, Internal Medicine and Pathology, Osaka University School of Medicine, and Department of Dermatology, Aizenbashi Hospital, Osaka, JapanSearch for more papers by this authorE. Miyoshi, E. Miyoshi Department of Dermatology, Internal Medicine and Pathology, Osaka University School of Medicine, and Department of Dermatology, Aizenbashi Hospital, Osaka, JapanSearch for more papers by this authorK. Wakasa, K. Wakasa Department of Dermatology, Internal Medicine and Pathology, Osaka University School of Medicine, and Department of Dermatology, Aizenbashi Hospital, Osaka, JapanSearch for more papers by this author First published: July 1989 https://doi.org/10.1111/j.1365-2141.1989.tb07737.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume72, Issue3July 1989Pages 473-474 RelatedInformation

Utility and Patterns of Vitamin B12 and Folate Testing in Patients with Isolated Thrombocytopenia

Public Health Initiatives in the Emergency Department: Not So Good for the Public Health?

Cutting-edge Discussions of Management, Policy, and Program Issues in Emergency Care

Journal of Medical VirologyVolume 93, Issue 12 p. 6458-6459 LETTER TO THE EDITOR SARS-CoV2-triggered acute arthritis: Viral arthritis rather than reactive arthritis Shigeto Kobayashi, Corresponding Author Shigeto Kobayashi [email protected] orcid.org/0000-0002-1939-3380 Department of Rheumatology and Internal Medicine, Juntendo University Koshigaya Hospital, Saitama, Japan Correspondence Shigeto Kobayashi, Department of Rheumatology and Internal Medicine, Juntendo University Koshigaya Hospital, 560 Fukuroyama, Koshigaya-shi, Saitama 3430032 Japan. Email: [email protected]Search for more papers by this authorYoshinori Taniguchi, Yoshinori Taniguchi orcid.org/0000-0002-8621-7790 Department of Endocrinology, Metabolism, and Nephrology, School of Medicine, Kochi University, Nankoku, JapanSearch for more papers by this authorIssei Kida, Issei Kida orcid.org/0000-0002-5477-0911 Department of Rheumatology and Internal Medicine, Juntendo University Koshigaya Hospital, Saitama, JapanSearch for more papers by this authorNaoto Tamura, Naoto Tamura orcid.org/0000-0003-1729-2954 Department of Internal Medicine and Rheumatology, Juntendo University, Tokyo, JapanSearch for more papers by this author Shigeto Kobayashi, Corresponding Author Shigeto Kobayashi [email protected] orcid.org/0000-0002-1939-3380 Department of Rheumatology and Internal Medicine, Juntendo University Koshigaya Hospital, Saitama, Japan Correspondence Shigeto Kobayashi, Department of Rheumatology and Internal Medicine, Juntendo University Koshigaya Hospital, 560 Fukuroyama, Koshigaya-shi, Saitama 3430032 Japan. Email: [email protected]Search for more papers by this authorYoshinori Taniguchi, Yoshinori Taniguchi orcid.org/0000-0002-8621-7790 Department of Endocrinology, Metabolism, and Nephrology, School of Medicine, Kochi University, Nankoku, JapanSearch for more papers by this authorIssei Kida, Issei Kida orcid.org/0000-0002-5477-0911 Department of Rheumatology and Internal Medicine, Juntendo University Koshigaya Hospital, Saitama, JapanSearch for more papers by this authorNaoto Tamura, Naoto Tamura orcid.org/0000-0003-1729-2954 Department of Internal Medicine and Rheumatology, Juntendo University, Tokyo, JapanSearch for more papers by this author First published: 23 July 2021 https://doi.org/10.1002/jmv.27229Citations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume93, Issue12Special Issue on New coronavirus (2019‐nCoV or SARS‐CoV‐2) and the outbreak of the respiratory illness (COVID‐19): Part‐XVIDecember 2021Pages 6458-6459 RelatedInformation

Tenures for Department Chairs: How Short Is Too Short?

Background: The ability to interpret electrocardiograms (ECG) is crucial for accurate diagnosis and treatment of the most relevant cardiac abnormalities. This study aims to assess the electrocardiographic interpretation abilities of resident doctors at internal medicine and emergency medicine departments in eight Arabic countries, emphasizing the most relevant cardiac abnormalities. Methods: An online cross-sectional study was conducted between 7 th October 2022 and 21 st October 2022 in 8 Arabic countries (Syria, Jordan, Iraq, Qatar, Yemen, Egypt, Sudan, and Algeria) to evaluate the ECG interpretation skills of resident doctors at internal medicine and emergency medicine departments. The questionnaire consisted of two main sections; the first section included sociodemographic information, while the second section contained twelve clinical case questions of the most severe cardiac abnormalities with their ECG recordings. We used the STATA and Excel Microsoft programs to conduct the analysis. Results: Out of 2509 responses, 630 were eligible for the data analysis (Response rate=25.1%). The average age was 26.85±1.7, and more than half of the participants were males (52.4 %). Internal medicine residents were (n=530, 84.1%), whereas emergency medicine residents were (n=100, 15.9%). Almost participants were in their first and second years of residency (79.8%). Only 36.2% of the inquired resident doctors have attended an ECG course. The majority of participants 85.6% recognized the ECG waves order correctly. 50.5% of the participants scored above 7.5/10 on the ECG interpretation scale. The proportions of participants who properly diagnosed atrial fibrillation, third-degree heart block, and atrial tachycardia were 71.1%, 76.7%, and 56.6%, respectively. No statistically significant difference was defined between the internal and emergency medicine residents regarding of knowledge toward ECG interpretation (P value=0.42). However, there was a significant correlation between ECG interpretation and medical residency year (P value&lt;0.001); which, the fourth-year resident doctors have the highest score (mean=9.24, SD =1.6). As well, participants in the third and second years of medical postgraduate residency have a probability of adequate knowledge of ECG interpretation more than participants in the first year of residency (OR=2.1, 95%CI: 1.57-4, P-value=0.001), (OR=1.88, 95%CI: 1.26-2.7, P-value=0.002) respectively. Conclusion: According to the findings of our research, resident doctors in departments of internal medicine and emergency medicine in Arabic nations have adequate ECG interpretation abilities; nevertheless, additional development is required to avoid misconceptions about critical cardiac conditions.