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T Stair

Publications and source records attributed to T Stair.

13 recordsLinked to original sources
PubMed1999

Academic emergency medicine's future. The SAEM Task Force on Emergency Medicine's Future. Society for Academic Emergency Medicine.

Emergency medicine (EM) will change over the next 20 years more than any other specialty. Its proximity to and interrelationships with the community, nearly all other clinicians (physicians and nonphysicians), and scientific/technologic developments guarantee this. While emergency physicians (EPs) will continue to treat both emergent and nonemergent patients, over the next decades our interventions, methods, and place in the medical care system will probably become unrecognizable from the EM we now practice and deliver. This paper, developed by the Society for Academic Emergency Medicine (SAEM) Task Force on Academic Emergency Medicine's Future, was designed to promote discussions about and actions to optimize our specialty's future. After briefly discussing the importance of futures planning, it suggests "best-case," "worst-case," and most probable future courses for academic EM over the next decades. The authors predict that EPs will practice a much more technologic and accurate form of medicine, with diagnostic, patient, reference, and consultant information rapidly available to them. They will be at the center of an extensive consultation network stemming from major medical centers and the purveyors of a sophisticated home health system, very similar to or even more advanced than what is now delivered on hospital wards. The key to planning for our specialty is for EM organizations, academic centers, and individuals to act now to optimize our possible future.

Academic Medical Centers↗
PubMed1998

Computerized follow-up of discrepancies in image interpretation between emergency and radiology departments.

Radiographs are ordered and interpreted for immediate clinical decisions 24 hours a day by emergency physicians (EP's). The Joint Commission for Accreditation of Health Care Organizations requires that all these images be reviewed by radiologists and that there be some mechanism for quality improvement (QI) for discrepant readings. There must be a log of discrepancies and documentation of follow up activities, but this alone does not guarantee effective Q.I. Radiologists reviewing images from the previous day and night often must guess at the preliminary interpretation of the EP and whether follow up action is necessary. EP's may remain ignorant of the final reading and falsely assume the initial diagnosis and treatment were correct. Some hospitals use a paper system in which the EP writes a preliminary interpretation on the requisition slip, which will be available when the radiologist dictates the final reading. Some hospitals use a classification of discrepancies based on clinical import and urgency, and communicated to the EP on duty at the time of the official reading, but may not communicate discrepancies to the EP's who initial read the images. Our computerized radiology department and picture archiving and communications system have increased technologist and radiologist productivity, and decreased retakes and lost films. There are fewer face-to-face consultants of radiologists and clinicians, but more communication by telephone and electronic annotation of PACS images. We have integrated the QI process for emergency department (ED) images into the PACS, and gained advantages over the traditional discrepancy log. Requisitions including clinical indications are entered into the Hospital Information System and then appear on the PACS along with images on readings. The initial impression, time of review, and the initials of the EP are available to the radiologist dictating the official report. The radiologist decides if there is a discrepancy, and whether it is category I (potentially serious, needs immediate follow-up), category II (moderate risk, follow-up in one day), or category III (low risk, follow-up in several days). During the working day, the radiologist calls immediately for category I discrepancies. Those noted from the evening, night, or weekend before are called to the EP the next morning. All discrepancies with the preliminary interpretation are communicated to the EP and are kept in a computerized log for review by a radiologist at a weekly ED teaching conference. This system has reduced the need for the radiologist to ask or guess what the impression was in the ED the night before. It has reduced the variability in recording of impressions by EP's, in communication back from radiologists, in the clinical] follow-up made, and in the documentation of the whole QI process. This system ensures that EP's receive notification of their discrepant readings, and provides continuing education to all the EP's on interpreting images on their patients.

Emergency Service, Hospital↗
PubMed1988

Characteristics of emergency medicine fellowships.

Little has been reported in the literature on the characteristics of existing and planned emergency medicine fellowships. To help answer important questions about fellowships, a 28-question survey was developed by representatives from the University Association for Emergency Medicine education and fellowship committees, the Emergency Medicine Residents' Association, and a health services researcher. This questionnaire was sent to all emergency medicine residency directors and known emergency medicine fellowship programs. The results of our survey indicate that there are 18 current and 11 planned fellowships. The fellowships primarily last one year, are research oriented, and place a large emphasis on toxicology, emergency medical services, and critical care. They are based mostly in university or university-affiliated hospitals, and will graduate physicians who stay in academic emergency medicine. The major problems with fellowships include inadequate funding and lack of adequate candidates.

Emergency Medicine↗
PubMed1984

The prevalence of hepatitis B serological markers in emergency physicians.

Hepatitis B (HBV) is a well-documented, increasing occupational hazard to those in the medical and dental professions. While the prevalence of markers of hepatitis B in the general population in the United States is approximately 3% to 5%, the prevalence in the health professions has been found to be higher. The prevalence of markers in 260 emergency physicians, consisting of teaching and nonteaching staff and emergency medicine residents, was the focus of this study. Two hundred fourteen participants had not received hepatitis B vaccine; 46 had received the vaccine. Hepatitis B surface antigen (HBsAg), surface antibody (anti-HBs) and core antibody (anti-HBc) were tested. The overall prevalence of markers in the nonvaccinated group was 11.7% (25/214). Forty-one of 46 participants (89%) who had received hepatitis B vaccine demonstrated anti-HBs, evidence of immunity to hepatitis B. Thirty-nine of them had anti-HBs alone, and two had anti-HBs and anti-HBc. Of the five vaccinees who failed to demonstrate anti-HBs, one demonstrated anti-HBc alone. There was no statistically significant difference between the three groups in prevalence or type of markers. The prevalence of hepatitis B serological markers in this survey of emergency physicians was two and a half to four times that of the general population. Because of the increased risk of exposure to hepatitis B virus, early immunization against this disease through the use of hepatitis B vaccine should be considered by physicians in the practice of emergency medicine.

Emergency Medicine↗
PubMed1983

Malaria in the emergency department.

Eleven patients with malaria seen over five years in one emergency department demonstrate a trend toward more efficient diagnosis and outpatient treatment. Ten patients were diagnosed using a routine Wright's stained peripheral blood smear (three fortuitously). Because treatment of hospitalized patients consists of no more than oral chloroquine, the current regimen allows for outpatient management. Determination of species and extent of drug resistance, as well as eradication of Plasmodium vivax and P ovale, are referred to a consultant after 2 days of oral chloroquine therapy.

Adolescent↗
PubMed1982

Reye's syndrome.

Explore the source record for details and available documents.

Diagnosis, Differential↗
PubMed1980

Accidental beta radiation burns from an electron accelerator.

A 61-year-old man presented to the emergency department after accidental exposure to beta radiation and low dose x radiation from an industrial linear electron accelerator. Over 40 days he developed burns on the extremities, abdomen, and face which eventually healed with topical silver sulfadiazine treatment, but suffered no acute x or gamma radiation symptoms. Beta burns and other radiation effects are discussed.

Administration, Topical↗
PubMed1980

Appendicitis over forty.

Charts of 616 patients over the age of 40 presenting to a community hospital emergency department with lower abdominal pain were reviewed to estimate the incidence and establish the profile of appendicitis in older patients. Appendicitis remains the commonest cause of undiagnosed lower abdominal pain, and retains a common presentation at all ages. Much of the pre-operative delay in patients who perforated appendices occurred in the hospital. Barium enema was a useful and safe diagnostic procedure used in 22 cases.

Abdomen↗
PubMedDate not supplied

A new system for sternal intraosseous infusion in adults.

BACKGROUND: Intraosseous (IO) infusion provides an alternative route for the administration of fluids and medications when difficulty with peripheral or central lines is encountered during resuscitation of critically ill and injured patients. OBJECTIVE: To report the first 50 uses of a new system for emergency IO infusion into the sternum in adults, the Pyng F.A.S.T.1 IO infusion system. METHODS: Six emergency departments and five prehospital emergency medical services (EMS) sites in Canada and the United States provided clinical and/or research data on their use of the IO system in a pilot study of success rates, insertion times, and complications. Indications for use included adult patient, urgent need for fluids or medications, and unacceptable delay or inability to achieve standard vascular access. A basic data set was standardized for all sites, and some sites collected additional data. RESULTS: The overall success rate for achieving vascular access with the system was 84%. Success rates were 74% for first-time users, and 95% for experienced users. Failure to achieve vascular access occurred most frequently in patients (5 of 9) described subjectively by the user as "very obese," in whom there was a thick layer of tissue overlying the sternum. Mean time to achieve vascular access was 77 seconds. Flow rates of up to 80 mL/min were reported for gravity drip, and more than 150 mL/min by syringe bolus. Pressure cuffs were also used successfully, although fluid rate was controlled by clamping the line. Further research on flow rates is needed. No complications or complaints were reported at two-month follow-up. CONCLUSION: These early data indicate that sternal IO infusion using the new F.A.S.T.1 IO system may provide rapid, safe vascular access and may be a useful technique for reducing unacceptable delays in the provision of emergency treatment.

Adolescent↗