A case-based emergency medicine curriculum for senior medical students

OBJECTIVE: To determine the effects of a case-based, core content-oriented emergency medicine (EM) curriculum on the basic EM knowledge of senior medical students. METHODS: All senior medical students rotating through the Milwaukee County EM elective during the 1992-1993 academic year were assigned specific chapter readings from a case-oriented EM textbook. A course curriculum consisting of goals and objectives for each chapter and two to three representative cases for the discussion topic also was distributed to each student. Interspersed with the cases was a series of questions directed at pathophysiology, diagnosis, management, and disposition. The EM faculty and residents conducted case discussions three times per week. All students completing the rotation were given a pretest at the beginning and a final examination at the end of the rotation. In addition, the students rated the textbook, coursebook, and lecture series at the end of the rotation using a five-point Likert scale. RESULTS: Seventy-five students rotated through the elective. The students showed a significant improvement in their EM knowledge base as judged by improvement in final examination scores compared with pretest scores (pretest score 62.2 +/- 7.1%; final examination score 76.2 +/- 6.3%; p < 0.0001). The mean change in scores was 14.8%, with a range of -1.6% to 34%. The students also rated the textbook, coursebook, and lecture series as effective, as shown by high median scores on a Likert scale. CONCLUSIONS: A case-based EM curriculum coupled with ED clinical experience improves basic EM diagnostic and management knowledge of senior medical students.     

Idealized inflight airline medical kit: a committe report

To avoid the difficult problem of upper shoulder scarring, a plea is made for vaccination in the lower deltoid region.     

Organization of emergency medical service

A total of 552 strains of Pseudomonas aeruginosa were obtained in 1970-1975 from different hospitals; the strains were isolated from various sources. Serotyping of these cultures was carried out with the aid of a set of agglutinating sera (20 in all) prepared by the author, and 97.5% of these cultures were typed. A high percentage of the strains belonging to the II, III, and IV serological groups and to the serotype 011 pointed to the epidemiological significance of these serological groups. The results obtained showed the expediency of introduction of the method of serological typing of the Ps. aeruginosa cultures into the public health practice for the purpose of epidemiological analysis.     

Early defibrillation by emergency physicians or emergency medical technicians? A controlled, prospective multi-centre study

In a controlled, prospective multi-centre study, defibrillation by emergency medical technicians (EMTs) was compared with the current standard of care in Germany--defibrillation by emergency physicians (EPs)-in order to answer the following questions: can EMTs in a two-tiered emergency medical services (EMS) system with physicians in the field defibrillate earlier than, and as safely as EPs? Does defibrillation by EMTs (study group) affect survival rate and long-term prognosis of patients in ventricular fibrillation (VF), as compared with the current national standards in resuscitation (basic cardiopulmonary resuscitation (CPR) by EMTs, and defibrillation by physicians: control group? METHODS: Prior to the onset of the study, all EMTs completed retraining in basic life support (BLS). Randomly assessed EMTs were then trained to use semi-automatic defibrillators. With the help of on-line tape recordings, the complete resuscitation sequence was evaluated. Follow-up of the patients was carried out with the help of the Glasgow Coma Scale as well as Pittsburgh Cerebral and Overall Performance Categories. RESULTS: A total of 159 patients with VF were included in the study. In 121 cases, collapse was witnessed. Of the patients receiving defibrillation by EMTs 25% were discharged from hospital alive, compared to 24% of the patients defibrillated by EPs. Of the study patients 67% were defibrillated within 12 min, while the percentage of control patients was 46%. Study patients were defibrillated earlier (P < 0.01), the return of spontaneous circulation (ROSC) was achieved earlier (P < 0.05), and the rate of patients requiring no adrenalin during resuscitation was higher in the study group (P < 0.05). The total amount of adrenalin administered in the study group was lower (P < 0.05). No statistically significant differences were found concerning the neurologic long-term prognosis. CONCLUSIONS: In our study, EMT defibrillation was equally effective as defibrillation by EPs, but failed to improve survival rates or long-term outcome of patients in VF significantly, compared to EP defibrillation. Due to a reduction in the time intervals from collapse to defibrillation and to ROSC, as well as in adrenalin doses, by EMT-defibrillation, EMTs in Germany should defibrillate if they reach a patient prior to an EP, provided they have received continuous medical training and supervision.     

Organizational problems in emergency medical care and reorganization of emergency services in hospitals

Entropic properties of the neural signal space, the neurodynamic basis of Weber's and Steven's law. Acta Physiol. Pol., 1977, 28 (2): 113--116. Taking into account the number of neural units, number of their efferent synapses and the average impulse frequency as well as the notion of neural momentum the dependence of neural entropy on neural tonus was examined. Based on the above model the neurodynamic basis of the Weber's and Steven's law was considered.     

Adequacy of medical referrals to hospital emergency service

OBJECTIVE: To assess the correctness and diagnostic concordance in referrals of patients to hospital Casualty Departments (CD); and the possible differences between rural and urban health centres (HC) as well as between general practitioners (GP) and family and community medicine (FCM) specialists. DESIGN: Observational study of a crossover nature. SETTING: Health area 1 in the province of Badajoz. PATIENTS AND OTHER PARTICIPANTS: 800 patients, referred to their local hospital Casualty Department. MEASUREMENTS AND MAIN RESULTS: 50.5% of all referrals were considered justified. 15.1% of the patients referred were admitted to hospital. 50.7% of referrals from GPs were found to be correct, against 47% from FCM specialists; and 49% of those referred from rural HCs were correct, as against 45.9% of those referred from urban HCs (no significant differences). Only 54% of referrals had a diagnostic hypothesis, with diagnostic concordance at 50%. There was diagnostic concordance in 28.1% of GP referrals, against 33.3% of FCM specialists; and in 27.5% of those from rural HCs against 26.1% from urban HCs (no significant differences). CONCLUSIONS: We found no differences in the correctness of referrals or diagnostic concordance of patients seen in the CD of our city's health area, neither between patients referred from rural and urban HCs, nor between patients referred by GPs and FCM specialists.     

A GP looks abroad: emergency medical services in the Federal Republic of Germany

1. The methylester derivative of DNP-amino acid was examined by gas-chromatography and amino acid shown in fig. 1 was detected. 2. The gaschromatography was more sensitive than the ion-exchange chromatography, but detectable peaks were few, and it must be further studied. 3. The measurements of five amino acids in food were almost coincident with those obtained by the ion-exchange method in literatures.     

New vision for the role of emergency medical services

Genital human papillomavirus (HPV) infection is the major causal factor of cervical intraepithelial neoplasia (CIN). The potential role of nutrition as an additional, independent risk factor for CIN has not been appropriately addressed in the context of HPV. This case-control study evaluated the etiologic role of HPV in terms of viral type and load and examined the association between CIN and plasma levels of micronutrients adjusting for HPV. Cases (n = 378) with histo-pathologically confirmed CIN and controls (n = 366) with no history of abnormal Pap smears were recruited from colposcopy and gynecology clinics, respectively. Risk of CIN was significantly increased among women who were infected with multiple HPV types (odds ratio [OR] = 21.06), a high viral load (OR = 13.08) and HPV 16 (OR = 62.49). After adjusting for HPV positivity and demographic factors, there was an inverse correlation between plasma alpha-tocopherol and risk of CIN (OR = 0.15). Plasma ascorbic acid was protective at a high level of > or = 0.803 mg/dl (OR = 0.46). CIN was not associated with plasma retinol and beta-carotene levels. The effect of genital HPV infection on CIN development is highly influenced by oncogenic viral type and high viral load. Vitamins C and E may play an independent protective role in development of CIN that needs to be confirmed in prospective studies.     

Emergency medical kit for commercial airlines. Air Transport Medicine Committee, Aerospace Medical Association

While it has been of general interest for a long time, the issue of a Medical Kit for Commercial Airlines is now close to the top of the priority list because of recent activities in Europe within the Joint Aviation Authorities (JAA) and in the United States at the Congressional Level. The Aerospace Medical Association (AsMA) requested its Air Transport Medicine Committee to review the situation and make recommendations for a basic medical kit for international airlines. After reviewing the contents of existing kits, and the limited amount of available data, a proposal was submitted to and accepted by the AsMA Council. This is just a beginning. The Air Transport Medicine Committee will continue to follow the evolution and periodically adapt the kit accordingly.     

Work-related stress and psychological distress in emergency medical technicians.

Emergency medical technicians (n?=?65) participated in a study on work environment characteristics, work-related stress, and psychological distress. Data were collected at baseline and 6 months. Work-related stress was associated with lower work group support and poor supervisory behavior. Work-related stress was strongly related to psychological distress. Changes in work-related stress were significantly related to changes in psychological distress. Findings support the work-related stress, psychological distress model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Invasive aspergillosis of the paranasal sinuses: a medical emergency

A rare case of invasive aspergillosis of the paranasal sinuses in a previously healthy individual is presented. The disease caused severe complications and proved fatal. Classification, aetiology and presentation of sinus aspergillosis are discussed. Early diagnosis and management is stressed to avoid the high incidence of morbidity and mortality.