Emergency department categorization by SAEM is a bad idea. Society for Academic Emergency Medicine.
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Biomedical subjects
Publications and source records attributed to K Frumkin.
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We are perhaps America's greatest source of unquestioned and unquestioning care for the poor. The acutely ill and injured need us desperately, every hour of every day. No one who comes to the door of any ED needing our services fails to receive our best efforts. Emergency physicians freely place themselves at risk from violence and the deadliest of diseases. We should be at the pinnacle of public and professional admiration and respect. Yet parents are told their children are at risk, no one knows our names, and hospital administrators and medical staffs watch us come and go with equanimity. Our work is occasionally thrilling, often repetitive, quite frequently sad, sometimes dangerous, generally described as stressful, and on occasion incredibly rewarding. Both one's individual job satisfaction and the collective survival of our specialty depend on the mix of these factors being satisfying enough to justify going to work every day. Some of that job satisfaction must come from outside ourselves, the perception that what we do is valued by others. How much "burnout" derives from a growing awareness of how negatively we are viewed and how little that perception has changed. To the extent that organized emergency medicine wishes to keep the specialty alive and healthy, it must address this image crisis in emergency medicine. What is the purpose of looking past the year 2000 with lofty goals and aspirations if, through the eyes of our peers and patients, we have come such a little way? As much as I appreciate the opportunity to write this editorial, we in emergency medicine need to do more than preach to ourselves. A little at a time, in every way we can, in academic centers or 40-bed hospitals, as members of the medical staffs and hospital committees, and in our day-to-day interactions with our peers, students, and the public, we must demand our name and demand the recognition we have won for our (apparently) still fledgling specialty. Our organizations must represent us in these areas by forcefully directing their public relations efforts away from ourselves and toward the public and our colleagues.
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Three children aged 13 to 15 months had been pulled by the wrist. Subsequent pain and limitation of motion were typical of nursemaid's elbow. On radiographs, a line drawn through the longitudinal axis of the radius failed to bisect the humeral capitellum as is normally seen. Both the symptoms and the radiographic abnormalities resolved after successful manipulative reduction.
Many nonpharmacologic (behavioral) techniques are being proposed for the therapy of essential hypertension. The research in this area is reviewed and divided roughly into two categories: the biofeedback and relaxation methodologies. While feedback can be used to lower pressures during laboratory training sessions, studies designed to alter basal blood pressure levels with biofeedback have not yet been reported. The absence of evidence for such changes through biofeedback limits the usefulness of this technique in hypertension control. The various relaxation methods, such as yoga, transcendental meditation, progressive muscle relaxation, and others have shown more promise. With varying degrees of experimental vigor, many of these techniques have been associated with long-lasting changes in blood pressure. The strengths and weaknesses of the various authors' research designs, data and conclusions are discussed, and suggestions for further experimentation are offered.
Morphine dependent rats that underwent naloxone-precipitated withdrawal in the presence of both gustatory and audiovisual stimuli subsequently avoided the taste cue, but not the audiovisual one. All environmental stimuli do not associate equally with withdrawal in the rat. The role of stimulus factors should be investigated in other forms of narcotic-related conditioning.
Attempts were made to condition taste aversions to the objects of two mineral-specific hungers. Both the innate preference of adrenalectomized rats for sodium and the learned preference of parathyroidectomized rats for calcium were studied. None of the sodium-deficient rats poisoned after drinking sodium chloride (NaCl) reached a taste-avoidance criterion, even after nine pairings of salt ingestion with aversive lithium chloride injections. Six of 11 calcium-deficient rats did not meet the salt-avoidance criterion after 10 pairings. Nondeficient control subjects learned to avoid these salt solutions completely after an average of only three such pairings. Besides unmasking a surprising degree of similarity between the learned and innate specific hungers studied, the results clearly demonstrate a powerful influence of physiological need on aversion conditioning.
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