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Biomedical subjects

R Shesser

Publications and source records attributed to R Shesser.

18 recordsLinked to original sources
PubMed1991

The contribution of impurities to the acute morbidity of illegal drug use.

Although emergency physicians treat many patients who use illegal drugs, little is known about the relative toxicities of the abused drug versus those that result from drug impurities and additives. Although case reports suggest significant contribution of contaminants to the morbidity and mortality of street drugs, most physicians' clinical experience and a comprehensive review of the clinical and forensic science literature demonstrate that impurities and additives play only a minor role in the majority of drug-related emergency department presentations. The strengths and weaknesses of several of the currently available drug abuse information data bases are reviewed, and qualitative information concerning the scope of contaminants that have been reported in preparations of cocaine, heroin, and phencyclidine is presented. More research is needed in this area, and a closer liaison between law enforcement, forensic scientists, and emergency physicians should be developed.

Cocaine↗
PubMed1991

Safety of immediate treadmill testing in selected emergency department patients with chest pain: a preliminary report.

To determine the feasibility and safety of an immediate, symptom-limited, treadmill test on selected emergency department (ED) patients, a convenience sample of 28 patients underwent an exercise treadmill test (ETT) within the first several hours after hospital arrival using the modified Bruce protocol. Patients were included in the study if they presented with otherwise unexplained chest pain consistent with (but not characteristic for) angina pectoris and had a normal electrocardiogram. A negative ETT was seen in 23 of 28 patients, and five of 28 patients had a positive ETT. No patients had serial enzyme or electrocardiogram evolution suggestive of myocardial ischemia, and all patients with a negative ETT were discharged after a full inpatient evaluation designed to rule out unstable coronary disease. At a mean follow-up period of 6.1 months there has been no cardiac morbidity or mortality in the patients with negative ETTs. It was concluded that early ETTS of selected ED patients with chest pain is safe, and an exercise test administered during the ED visit which is negative can preclude unnecessary hospitalization.

Adult↗
PubMed1991

An analysis of emergency department use by patients with minor illness.

STUDY OBJECTIVE: To describe the motivation for emergency department use by patients with minor illnesses and compare the demographics and social class characteristics of these patients with those of the general ED population. DESIGN: Observational, case-control study. SETTING: Urban ED. TYPE OF PARTICIPANTS: A sample group of 325 adult, nongeriatric patients with minor illnesses was selected by screening all patients registering in the ED between 9:00 AM and 6:00 PM on 15 randomly selected weekdays. A patient was included in this study group if the chief complaint, method of arrival, and subsequent evaluation met predetermined criteria for minor illness. A comparison group (control) was composed of all ED patients (224) who presented during two randomly selected 24-hour periods that did not overlap with the times of study group enrollment. INTERVENTIONS: Sample group patients were interviewed concerning their socioeconomic backgrounds, reasons for using the ED, and perceptions of the urgency of their conditions. Comparison group patients' interviews were confined to the collection of demographic and socioeconomic information. MEASUREMENTS AND MAIN RESULTS: There were more men (P = .12), more self-pay patients (P = .017), and fewer Medicare patients (P less than .001) in the study group. There also was a strong trend toward higher income (P = .059) in the study group. The racial, marital, employment, and educational backgrounds of the two groups were similar. Eighty-two percent of the study group had no chronic illness, and only 36% reported a problem of more than three days' duration. Patients chose to use the ED because of its convenience (23.7%), the absence of previous provider relationships (22.1%), and the inability to make a prompt appointment with their regular provider (19.0%). Major differences existed between the reasons for which different demographic and socioeconomic groups chose ED care. Study group patients believed that less than 24 hours should elapse between the onset of their problem and the time at which they receive medical care. CONCLUSION: There are no major differences in ED use for minor illness patients from different racial, educational, and economic backgrounds. These patients tend to have a low frequency of chronic illness and often have no established health care provider. They choose the ED for its ease of access and the wide scope of care that can be delivered.

Adult↗
PubMed1990

An unusual case of proctalgia.

We report the case of a 21-year-old man with the sudden onset of severe proctalgia followed by headaches and fever. The patient had a lumbar puncture consistent with subarachnoid hemorrhage. After a normal four-vessel cerebral arteriogram, a myelogram and computed tomography scan of the spine were performed and revealed a mass lesion of the L1 level. Pathologic evaluation after resection of the mass resulted in a diagnosis of hemorrhage from a myxopapillary ependymoma. These relatively benign tumors of the cauda equina-filum terminale respond well to treatment. The differential diagnosis of proctalgia is reviewed, and the need for emergency physicians to consider spinal subarachnoid hemorrhage when a patient presents with the acute onset of rectal pain is emphasized.

Adult↗
PubMed1989

Medical aspects of commercial air travel.

Commercial airline travel is so fast and easy that it attracts many people with significant underlying chronic disease. Although most airlines claim no ill effects from the stresses of air travel, airlines that fly longer routes tend to report a higher incidence of in-flight emergencies and sudden deaths than those that fly shorter routes. Reasons for these differences are discussed. The Federal Aviation Administration has recently upgraded the first aid kits carried by the airlines. Airlines must now report all untoward medical incidents to the government; this policy will permit the collection of better data concerning the true incidence of in-flight emergencies. Future studies should be oriented toward an analysis of the first aid kit's effectiveness and deficiencies. Emergency physicians are often required to make recommendations concerning the advisability of travel for patients who become ill away from home. Better criteria exist for making well-informed decisions for patients with obstructive pulmonary disease than for patients with other chronic diseases. A series of studies has suggested that physicians should recommend supplemental oxygen for normocapnic jet passengers who have a resting preflight Pao2 (at sea level) less than 67 mmHg. If available, preflight altitude stress testing should be performed on hypercapnic obstructive airways patients who request permission to fly. Poorly supported recommendations have been promulgated by several major professional organizations concerning flight advisability in a wide variety of other diseases. If these recommendations are followed strictly, people who become ill away from home can expect significant difficulty in returning home shortly after hospital discharge.

Aircraft↗
PubMed1989

Testing for syphilis.

Explore the source record for details and available documents.

Emergency Service, Hospital↗
PubMed1987

Headache caused by serious illness. Evaluation in an emergency setting.

Severe headache is a common problem among patients in the emergency facility. Because early therapy reduces deaths from subarachnoid hemorrhage, the physician must use advanced technological and sometimes invasive tests to diagnose this serious condition in patients with equivocal signs and symptoms. In patients with meningitis, the physician must assume there will be only one opportunity to make the correct diagnosis. Because patients often seek emergency care early in the course of meningitis, when accurate detection on clinical grounds is more difficult, a conservative approach and liberal use of all appropriate diagnostic techniques are essential.

Diagnosis, Differential↗
PubMed1986

A nonpuerperal traumatic vulvar hematoma.

A case is presented where a nonpuerperal traumatic vulvar hematoma was initially mistaken for a Bartholin's gland duct abscess. Since the treatment may be different, the importance of clinical differentiation between these two entities is stressed. Proper management of the vulvar hematomas involves bed rest, close observation, and early surgical intervention only when absolutely necessary. Patients with significant vulvar hematomas should be hospitalized and closely followed.

Abscess↗
PubMed1986

Comparison of a videotape instructional program with a traditional lecture series for medical student emergency medicine teaching.

An emergency medicine faculty has reported that the use of the videotape medium for presenting curricular material to medical students is both cost effective and well suited to the educational milieu of the emergency department. In order to compare the effectiveness of videotape instruction with that of a traditional lecture, groups of students received instruction in one topic by videotape and in another topic by lecture. The students' retention of material was tested by a multiple-choice examination administered ten days later. The students scored 76.1% (683 of 898 questions) on material taught by lecture and 76.2% (673 of 883 questions) on material taught by videotape (P greater than 0.7). We conclude that videotape instruction is as effective an educational tool as the traditional lecture for an emergency medicine course.

Curriculum↗
PubMed1986

The effectiveness of an organized emergency department follow-up system.

Half the patients discharged home from our emergency department with the diagnoses of acute infection, cervicolumbar strain, bronchospasm, allergic reaction, headache, syncope, vaginal hemorrhage, and undiagnosed chest/abdominal pain were randomly assigned to receive a follow-up telephone call two to three days after their visit. Patients in the follow-up call group were telephoned by an ED nurse who questioned them about changes in their clinical status and clarified the aftercare and referral instructions received during the ED visit. Seven days after the visit, a questionnaire that rated patient satisfaction about six aspects of the ED visit was sent to those patients who had been contacted successfully (study group), and to a diagnosis-matched group of patients (control) who did not receive a follow-up call. A nurse was able to reach 144 of the 297 patients assigned to the study group. Significant referral and aftercare interventions were made in 53 (37%) cases including three patients who were instructed to return to the ED. Questionnaires were returned by 83 of 144 (49%) of the study group and by 94 of 262 (35%) of the control group. Male study group patients consistently rated five of six aspects of their visit higher than did the male controls. No difference was observed in questionnaire ratings between the female study and control groups. We conclude that male patients reached by a follow-up telephone call have a more positive perception of their ED visit. A follow-up call also can be useful for reinforcing aftercare instructions, follow-up referrals, and problem-patient identification.

Adult↗
PubMed1985

Recreational softball injuries.

Every patient who presented to an urban teaching hospital's emergency department during one season complaining of an injury sustained while playing softball was interviewed to determine the parameters of play associated with the injury. Trends were noticed toward increased frequency of injury to experienced players late in the season. A fall was the most common mechanism of injury, and player location at the time of injury was equally divided between the basepath and defense. Very few players were injured at bat. No conclusion could be drawn about the protection afforded a player from the use of a mitt or cleats. The relative rate of injury was estimated to be 2.26 injuries per 1,000 players per day, making the risk of injury for softball participants about 50% of that for recreational skiers.

Adolescent↗
PubMed1985

A student emergency medicine clerkship that uses new information technologies.

The effective teaching of clinical emergency medicine to medical students requires efficiency in the management of both student and faculty time. Presented is a course outline that makes use of the following elements to structure and augment clinical time in the emergency department (ED): Videotape to present a 19.7-hour series of faculty-produced lectures covering a "core" emergency medicine curriculum. A microcomputer to facilitate staggered scheduling of clinical time. A microcomputer test generation program that permits a secretary to formulate, administer, and grade a different final exam with each rotation. Computer-assisted recordkeeping for faculty evaluation of a student's clinical performance. Once established, this program can be administered with fewer than five faculty hours per month assisted by a part-time (25% full-time equivalent) clerical coordinator. The total cost for the instructional program is $86.37 per student using the new technologies, and $144.15 per student when presenting the same program using traditional teaching techniques. The use of new technologies in student teaching will therefore result in significant savings.

Clinical Clerkship↗
PubMed1985

A cost-effective emergency medicine clerkship.

Programs in emergency medicine for medical students are expected to become increasingly organized over the next several years with the development of emergency medicine teaching faculties by medical schools. In this article, the authors describe a clerkship design with three fundamental elements--clinical instruction, classroom instruction, and evaluation--that should be included in an emergency medicine clerkship. Through the use of optimal student scheduling and new information technologies, the yearly cost per student for the classroom teaching and student evaluation sections of the clerkship is $86.65.

Clinical Clerkship↗
PubMed1984

Emergency medicine.

Explore the source record for details and available documents.

Clinical Clerkship↗
PubMedDate not supplied

A survey of emergency department communicable disease reporting practices.

A group of physicians, nurses, and administrators at all 11 hospitals in the District of Columbia were interviewed to elucidate each hospital emergency department's (ED) system for patient and public health notification of the diagnosis of legally reportable communicable diseases. The hospitals' reporting systems were divided into two groups. Three hospitals (27%) had reporting systems that were centered in the emergency department (EDS). Eight hospitals (73%) had disease reporting systems that depended primarily on extradepartmental personnel (HBS) for disease reporting. The EDS outperformed the HBS in several key areas of system performance. Greater attention needs to be paid by ED directors to assuring that their hospital's system is as accurate as possible and fulfills their jurisdiction's legal requirements for communicable disease reporting.

Communicable Diseases↗
PubMedDate not supplied

Post-triathalon delirium.

This is a case presentation of acute delirium in a previously healthy man. It was originally discussed during Morbidity and Mortality Conference at The George Washington, Georgetown Residency Program in Emergency Medicine, December 1989.

Adult↗