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Biomedical subjects

D Houry

Publications and source records attributed to D Houry.

At least 19 recordsLinked to original sources
PubMed2001

Abdominal pain in a child after blunt abdominal trauma: an unusual injury.

We report a case of perforation of a walled off appendiceal abscess in a 5-year-old boy who sustained blunt abdominal trauma. The past medical history was significant only for a 4-day episode of abdominal pain 1 month prior to this presentation. Initial laboratory studies were unremarkable, and radiographic studies showed free fluid in the pelvis with no evidence of solid organ injury, but inflammation of the right colon. The final diagnosis was made at laparotomy. We emphasize this unique presentation and review the literature on traumatic appendicitis in children.

Abdominal Injuries↗
PubMed2001

Ovarian torsion: a fifteen-year review.

STUDY OBJECTIVE: Our purpose was to describe the history, physical, and laboratory findings in women with ovarian torsion (OT). METHODS: A retrospective chart review was conducted at 2 urban teaching hospitals. All women admitted from 1984 to 1999 with surgically proven OT were included in the study. RESULTS: The 87 women ranged in age from 14 to 82 years (mean 32 years). Twelve were pregnant, 15 were postmenopausal, and 7 were posthysterectomy. Thirty-five (40%) had prior pelvic surgery; 18 of these (21% of the total) had undergone tubal ligation. Twenty-two (25%) women had a history of an ovarian cyst. Sixty-five (75%) patients were seen in the emergency department. Pain characteristics were variable: the onset was sudden in 51 (59%); "sharp" or stabbing in 61 (70%); and radiated to the flank, back, or groin in 44 (51%) patients. Only 3 had peritoneal signs at presentation. The majority of patients (70%) had nausea or vomiting. Fever was rare (2 patients). OT was considered in the admitting differential diagnosis in 41 (47%) patients. An enlarged ovary (>5 cm) was found in 77 (89%) patients at surgery. Only 26 patients had surgery within 24 hours. In 8 (9%) patients, detorsion was possible; of these, 3 had surgery within 24 hours. CONCLUSION: The diagnosis of OT is often missed and ovarian salvage is rare. Pain characteristics are variable and objective findings are uncommon in OT.

Adolescent↗
PubMed2001

Does sharing process differences reduce patient length of stay in the emergency department?

STUDY OBJECTIVE: We assess the ability of the best demonstrated processes (BDP) methodology to decrease emergency department patient length of stay (LOS) in EDs in a large multihospital system. METHODS: Two hundred ninety-one EDs were ranked by LOS, and the fastest and slowest EDs were observed to identify the BDPs. The resulting "meaningful differences" were shared with all EDs throughout the hospital system. LOS studies were repeated after the BDP intervention. Five separate LOS measures were performed during a 19-month period, with 223 to 273 EDs participating in each measure. Three interval times were calculated: arrival to examination room, examination room to physician evaluation, and physician evaluation to discharge. RESULTS: Two hundred ninety-one EDs participated, and 386,837 patient visits were evaluated. Before intervention, the average LOS was 147 minutes for all EDs and 186 minutes in the slowest third. At 19 months after intervention, the average LOS was 139 minutes for all EDs and 157 minutes in the slowest third. Between the initial and final measurement period, there was an 8-minute (5.4%) improvement in LOS on a system-wide basis, and the slowest third of EDs improved LOS by 29 minutes (15.6%). Before intervention, arrival to examination room time was 27 minutes, examination room to physician evaluation was 20 minutes, and evaluation to discharge was 100 minutes. After intervention, these times decreased to 22 (P <.001), 18 (P <.001), and 99 (P =.33) minutes, respectively. The slowest one third of EDs went from 37 to 24 minutes for arrival to examination room time (P <.001), from 25 to 20 minutes for examination room to evaluation time (P <.001), and from 124 to 113 minutes for evaluation to discharge time (P <.001). CONCLUSION: Implementing observed BDP meaningful differences resulted in decreased patient LOS in EDs, particularly in the slowest one third of EDs in the hospital system.

Benchmarking↗
PubMed2001

Does participation in the electronic residency application service (ERAS) affect the quality of applications to a residency program?

PURPOSE: To determine whether the quality of applicants to an emergency medicine (EM) residency would improve during a year that the program did not participate in the Electronic Residency Application Service (ERAS). METHODS: Applications to the Denver Health Medical Center Residency in Emergency Medicine (DHMCREM) were retrospectively compared for three consecutive years: 1996-97, during which ERAS was not available to EM programs; 1997-98, during which DHMCREM did not participate in ERAS; and 1998-99, during which DHMCREM participated in ERAS. The quality of applicants was based on their application scores, which were determined using a 20-point equation that rated individual attributes: U.S. Medical Licensing Examination Step 1 score, medical school, research, extracurricular activities, personal statement, letters of recommendation, and dean's letter. T-tests were used to compare application scores and individual attributes among applicants, those invited for an interview, and those who matched to the program. In addition, numbers of applications to the DHMCREM were compared with national trends. RESULTS: A total of 1,318 complete applications were reviewed for the three-year study period. There was a 50% reduction in applications during 1997-98 when DHMCREM did not participate in ERAS, which did not correlate with the national trend in applications to residency programs. However, there was no statistically significant difference in the quality of applicants, interviewees, or matched candidates as defined by the overall application score. In addition, applicants who matched to the program were higher on the rank-order list during the 1997-98 application year than were applicants who matched for the year prior to ERAS and for the year DHMCREM participated in ERAS. CONCLUSIONS: Participation in ERAS increased the number of applicants, but did not correlate with an increase in the quality of applicants.

Electronic Data Processing↗
PubMed2001

Evaluation of a residency program's experience with a one-week emergency medicine resident rotation at a medical liability insurance company.

INTRODUCTION: The authors' residency program implemented a one-week rotation at the office of a medical liability insurance company. Residents examined 30 closed malpractice claims cases and sat in on settlement discussions. OBJECTIVE: To review the residents' evaluations of their experiences and to determine whether this was a worthwhile addition to the emergency medicine (EM) residency curriculum. METHODS: This was a five-year retrospective study that reviewed residents' annual evaluations from 1994 to 1999 regarding the medical liability rotation. A five-point scale was used to score specific categories in the rotation and an open-ended section was used to collect general comments. RESULTS: A total of 179 resident evaluations were reviewed. The quality of teaching ranked in the 80th percentile, the clinical caseload ranked in the 85th percentile, and level of responsibility ranked in the 79th percentile for all EM rotations. Specific comments included "All MDs should do this in their training"; "Quite an eye opener"; and "Good exposure to legal aspects of EM." CONCLUSIONS: Overall, EM residents found the one-week rotation to be invaluable and a good learning experience. This rotation ranked above average when compared with all of our other EM residency rotations.

Attitude of Health Personnel↗
PubMed2000

Analysis of 1,076 cases of sexual assault.

STUDY OBJECTIVE: Rates of sexual assault are increasing, and evidence exists that its demographics and characteristics are changing. The purpose of our study was to describe victim, assailant, assault, and treatment characteristics for sexual assault victims and to provide descriptive data on the evidentiary examination. METHODS: Prospective data were collected on all sexual assault victims presenting to an urban Level I trauma center from January 1992 to December 1995 for treatment and evidentiary examination. Data from crime laboratory records were retrospectively reviewed. RESULTS: One thousand one hundred twelve patients presented after a sexual assault. A total of 1,076 (97%) patients consented to the medical and evidentiary examination and were enrolled in the study. Age ranged from 1 to 85 years (mean, 25 years; median, 23 years), with 96% (1,036/1,076) female and 4% (41/1,076) male victims. The number of assailants was greater than 1 in 20% (208/1,044) of cases, and the assailant was a stranger only 39% (409/1,094) of the time. Force was used in 80% (817/1,027) of reported assaults, and in 27% (275/1,014) of cases a weapon was present. Vaginal intercourse was involved in 83% (851/1,023) of female victims. Oral assault was involved in 25% (271/1,053) of all cases, and anal penetration was involved in 17% (178/1,058) of all cases. Overall, general body trauma was seen 67% (621/927) of the time, and genital trauma occurred in 53% (388/736) of cases. Twenty percent (147/1,712) of patients had no trauma noted on examination. Sperm were noted on the emergency department wet mount in only 13% (93/716) of the victims, and of the 612 cases with both ED sperm data and crime laboratory semen data available, evidence of sperm and semen were found 48% (296/612) of the time by either. CONCLUSION: Health care professionals should be aware that general body trauma is common, that the assailant is often someone known to the victim, and that evidence of semen is commonly found by the crime laboratory even when it is not found in the ED analysis of a wet mount.

Adolescent↗
PubMed2000

Lifetime sexual assault prevalence rates and reporting practices in an emergency department population.

STUDY OBJECTIVE: Studies suggest significant rates of female sexual assault (SA); the majority of SAs remain unreported, and few victims receive medical care. The purpose of this study was to determine lifetime prevalence rates of SA in an emergency department population and to assess reporting patterns to police, physicians, and social service agencies. METHODS: A verbally administered survey was given to all female patients during 4-hour randomized periods in an urban Level I trauma center. All English-speaking, noncritically ill women who presented during the study period were eligible. RESULTS: Four hundred forty-two women were eligible; 360 (81%) women agreed to participate. The lifetime prevalence rate of SA was 39% (n=139). Ninety-seven women (70%) were older than 15 years at the time of SA. Of these 97 SAs occurring in adulthood, 49 (52%) reported assault by an acquaintance, family member, or friend; 28 (30%) by a stranger; and 17 (18%) by a partner. Forty-five (46%) women reported the crime to the police, 42 (43%) sought medical care, and 23 (25%) contacted a social service agency. Reporting patterns for victims assaulted by a stranger versus those assaulted by a partner were: reported to police 79% (95% confidence interval [CI] 62 to 95) versus 18% (95% CI 0 to 38); P <.001), received medical care 70% (95% CI 46 to 95) versus 29% (95% CI 11 to 48; P<.01), contacted a social service agency 30% (95% CI 5 to 47) versus 24% (95% CI 1 to 46; P=.63). CONCLUSION: Lifetime female SA rates in ED populations are significant. Fewer than half of SA victims report the assault to the police or seek medical care. Women assaulted by a partner are significantly less likely to report the SA to police or seek medical care.

Adolescent↗
PubMed2000

Domestic violence awareness in a medical school class: 2-year follow-up.

BACKGROUND: [corrected] Previous studies have examined short-term effectiveness of domestic violence instruction. We studied the long-term effectiveness (LTE) and long-term retention (LTR) of formal instruction about domestic violence. METHODS: A general knowledge survey on domestic violence was given before, 1 month after, and 2 years after 3 hours of instruction to medical students. Good LTE was defined as significant improvement in responses between the first and third surveys. Good LTR was defined as lack of a significant decrease in results between the second and third surveys. RESULTS: Two years after the instruction, 104 of 148 (70%) participated. Knowledge of rates of domestic violence against women showed neither good LTE nor good LTR. Responses showed good LTE and LTR concerning domestic violence incidence among men, ethnic and socioeconomic groups being equally represented, victims not being personally responsible for the abuse, and physicians not being required to report domestic violence in the survey state. Responses showed poor LTR and LTE regarding rates of domestic violence in women and abused persons being unable to simply leave their situation. CONCLUSIONS: Some improvement in domestic violence awareness was seen 2 years after instruction. However, some information was not retained. Domestic violence instruction should be reemphasized throughout medical school.

Adult↗
PubMed1999

Emergency department documentation in cases of intentional assault.

STUDY OBJECTIVE: Emergency department records are an important source of injury surveillance data. However, documentation regarding intentional assault has not been studied and may be suboptimal. The purpose of this study was to analyze physician documentation of assailant, site, and object used in intentional assault. METHODS: The ED log of an urban Level I trauma center was retrospectively reviewed to identify eligible patients presenting consecutively in November 1996. All acutely injured patients not involved in a motorized vehicle crash were identified. RESULTS: From the ED log, 1, 483 patients were identified as possible study subjects; 1,457 (98%) charts were located and reviewed and 971 (67%) met inclusion criteria. Of these, 288 (30%) cases resulted from intentional assault. In 67% of patients, there was no documentation of the identity of the assailant. For 13% of cases, there was no documentation regarding the object or force used in the assault. In 79% of cases there was no documentation regarding the site of assault. For 24 cases (8%), the assailant was documented as an intimate partner or ex-partner. Police involvement in these cases was documented 54% of the time, despite the fact that this state mandates police reports for cases of acute partner violence. Social service involvement and shelter referrals were documented in less than one fourth of domestic violence cases. CONCLUSION: Although the ED commonly treats patients who have been assaulted, basic surveillance data are often omitted from the chart. Structured charting may provide more complete data collection.

Colorado↗
PubMed1999

Mandatory reporting laws do not deter patients from seeking medical care.

STUDY OBJECTIVE: As of March 1994, 45 states had laws that, to varying extents, required health practitioners to report cases of domestic violence (DV). Colorado passed a mandatory DV reporting law in 1995. Laws that mandate police involvement in cases of DV injuries have been criticized because of concerns that these laws deter victims from seeking medical care. We hypothesized that these laws would deter DV victims from seeking medical care. METHODS: A questionnaire was administered in 3 stages: stage 1, convenience time blocks at 2 emergency departments and a primary care clinic; stage 2, prospective randomized blocks at an inner-city ED; and stage 3, a targeted population of women at risk for DV. All English-speaking, noncritical adult patients who presented during the time blocks were eligible to participate. RESULTS: Five hundred seventy-seven patients participated; 55% of the patients were aware of the mandatory DV reporting law. Twenty-seven percent of the patients would be more likely to seek medical care because of this law. Only 12% of patients stated that they would be less likely to seek medical care for a DV-related injury because of this law (15% of men and 9% of women; P =.001). There was no difference between ED patients and targeted female patients at risk for DV in seeking medical care ( P =.833). CONCLUSION: Only rarely did mandatory reporting laws appear to adversely affect a patient's decisions to seek medical care in this study. The benefits of mandatory reporting must be measured to assure that they justify deterrence to a small minority of patients.

Adult↗
PubMed1999

Use of the Amplatz thrombectomy device for severe deep venous thrombosis.

Venous thromboembolism is a significant cause of morbidity in the United States. Thrombectomy devices are not currently the standard of treatment in deep venous thromboses. The Amplatz thrombectomy device is used for arterial occlusions and pulmonary emboli, but its regular use in venous thromboses has not been documented in the literature. We report a unique case of treatment of lower extremity deep venous thrombosis with the Amplatz thrombectomy device.

Catheterization↗
PubMed1999

Bivalve polymicrobial infective endocarditis.

Polymicrobial infective endocarditis is uncommon, particularly vancomycin-resistant endocarditis and fugal endocarditis. The incidence of these infections is likely to. increase with advances in mediCAl technology and widespread use of central venous catheters. We report a case of bivalve endocarditis in which four organisms were identified, including vancomycin-resistant Enteroocausfaecium and Torulopsis glabrata.

Adult↗
PubMed1999

Ketorolac versus acetaminophen for treatment of acute fever in the emergency department.

BACKGROUND: The purpose of this preliminary study was to compare acetaminophen to ketorolac for treating patients with fever in the emergency department (ED). METHODS: In this prospective, randomized, double-blind pilot study, patients were enrolled as a convenience sample during a 6-month study period. All subjects 18 years or older with a temperature of 100.4 degrees F or higher were eligible. Investigators gave patients 10 mg of oral ketorolac or 750 mg of oral acetaminophen. The temperature and pulse were rechecked at 30, 60, and 90 minutes. Patients recorded discomfort on a visual analog scale (VAS) at 30, 60, and 90 minutes. RESULTS: A total of 17 patients were enrolled. A t test showed no difference in temperatures, and the Mann-Whitney nonparametric test showed no difference in VAS scores. CONCLUSION: In this preliminary study comparing ketorolac with acetaminophen for febrile illness in the ED, we found no difference in efficacy between the two medications.

Acetaminophen↗
PubMed1998

Domestic violence awareness and prevalence in a first-year medical school class.

OBJECTIVE: To determine knowledge about domestic violence (DV), the effectiveness of formal instruction about DV, and the prevalence of DV in a first-year medical school class. METHODS: A general-knowledge survey of DV was given before and approximately 1 month after 3 hours of instruction provided by emergency medicine and internal medicine faculty. A previously validated scale, the Index of Spouse Abuse (ISA), was offered to determine baseline levels, of DV within the group. Differences in first-year medical student knowledge of facts about DV and differences in responses by men vs women were determined before and after the instruction. RESULTS: In the pre-instruction series, 144 of 148 (97%) participated. After the instruction, 141 of the same 148 students participated (95%). The prevalence of DV against women was correctly identified by 45% of the students as "15-30%" prior to instruction, and 65% after instruction. The prevalence of DV against males was correctly identified as "0-15%" by 48% of the students prior to instruction, and 70% after instruction. Before instruction, 29% of the students knew that "DV rates are equal in different socioeconomic groups," vs 72% after instruction. Similarly, prior to instruction 58% of the students knew that the victim is not responsible for the abuse, and 84% knew this after instruction. Before instruction 14 (10%) of the students believed they were victims of DV in the past, representing 7% of the men and 13% of the women. Before instruction neither group believed they were present victims of DV. However, according to ISA scoring, 6% of the women were positive for violence in the past, and approximately 5% were positive for present violence. No men were positive for ISA-determined past or present violence. CONCLUSION: Improvement in awareness was demonstrated after 3 hours of instruction in a first-year medical school class. There was DV among female medical students in this first-year class and self-reporting was not reliable. These results support instruction on DV for medical students.

Adult↗