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Timothy Jang

Publications and source records attributed to Timothy Jang.

10 recordsLinked to original sources
PubMed2006

Point-of-care urine trypsinogen testing for the diagnosis of pancreatitis.

OBJECTIVES: To assess a point-of-care (POC) urine trypsinogen (UT) test for the diagnosis of pancreatitis in the emergency department (ED). METHODS: This was a prospective cohort study of a convenience sample of patients presenting to the ED with abdominal pain or symptoms suggestive of pancreatitis. A 3-minute POC UT test (Actim Pancreatitis; Medix Biochemica, Kauniainen, Finland) was compared with plasma lipase and amylase measurements, imaging results when performed, and final discharge diagnoses. The criterion standard was a final discharge diagnosis of acute pancreatitis. RESULTS: Of 191 patients included in this study, 17 patients were diagnosed with either acute or acute-on-chronic pancreatitis. The sensitivity and specificity of UT for acute pancreatitis were, respectively, 100% (95% confidence interval [CI] = 77% to 100%) and 96% (95% CI = 92% to 98%). Seven of the 17 patients with pancreatitis (41%) had diagnostic findings on CT and positive UT tests but had nondiagnostic plasma lipase and amylase levels. CONCLUSIONS: A POC UT screening test for pancreatitis in the ED compared favorably with plasma lipase and amylase levels. Future studies should be performed to explore whether this test in the ED setting has better clinical utility than plasma lipase or amylase.

Abdominal Pain↗
PubMed2004

Minimum training for right upper quadrant ultrasonography.

The objective of this study was to assess if 10 right upper quadrant (RUQ) ultrasound (US) examinations could be used as a minimum standard for training. This was a retrospective review of patients with suspected gallbladder pathology who underwent resident-performed RUQ US before operative or department of radiology evaluation. Two hundred twenty-four patients were examined using resident-performed RUQ US followed by gold standard evaluations. One hundred seventy-eight patients were evaluated by 13 residents who met the "minimum training" standard of 10 prior examinations. The results of resident-performed RUQ US for gallstones and/or cholecystitis are shown subsequently. Previous suggestions that 10 examinations could be used as a minimum standard for training in focused abdominal sonography for trauma examinations cannot be used for RUQ US. The ACEP 2001 guidelines for 25 examinations are more consistent with the learning curve suggested by our data.

Cholecystitis↗
PubMed2004

Ultrasonography of the internal jugular vein in patients with dyspnea without jugular venous distention on physical examination.

STUDY OBJECTIVE: Accurate physical examination of patients with dyspnea is important. Jugular venous distention, however, can be difficult to assess in patients. The purpose of this case series is to serve as a pilot study of how ultrasonographic examination of the internal jugular vein compares with other measures of dyspnea. METHODS: This was a case series of 8 patients presenting with dyspnea without jugular venous distention on physical examination. Each patient underwent ultrasonographic examination of the internal jugular vein and inferior vena cava by an emergency physician sonographer blinded to all other clinical information after initial evaluation by another emergency physician for dyspnea. Results of ultrasonographic examination of the internal jugular vein and inferior vena cava were subsequently compared with initial emergency physician physical examination findings, initial chest radiography interpreted by radiologists, initial B-type natriuretic peptide levels, and final hospital discharge diagnosis. RESULTS: Ultrasonographic examination of the internal jugular vein compared more favorably with B-type natriuretic peptide levels and chest radiographic findings than ultrasonographic examination of the inferior vena cava in these patients with dyspnea but not jugular venous distention on physical examination. It was able to identify every patient diagnosed with cardiogenic pulmonary edema on hospital discharge. CONCLUSION: Ultrasonographic examination of the internal jugular vein appears to be helpful in patients who present with dyspnea but do not have evidence of jugular venous distention on physical examination.

Adult↗
PubMed2004

Resident-performed compression ultrasonography for the detection of proximal deep vein thrombosis: fast and accurate.

OBJECTIVES: To assess whether emergency medicine residents (EMRs) could quickly perform accurate compression ultrasonography (CUS) for the detection of proximal lower extremity deep vein thromboses (PLEDVTs) with minimal training. METHODS: A prospective, observational study using a convenience sample of patients presenting with signs and/or symptoms for PLEDVT. Vascular laboratory and department of radiology studies were considered the criterion standard. CUS of the femoral vessels was performed. Incompressibility or visualized thrombus was considered "positive." RESULTS: Eight residents with limited ultrasound (US) experience and no prior experience with deep vein thrombosis (DVT) US volunteered to participate in this study, enrolling 72 patients. Their average scan time was 11.7 minutes (95% CI = 9.4 to 14). There were 23 true positives, 4 false positives, 45 true negatives, and 0 false negatives. The test characteristics for PLEDVT gave a sensitivity of 100% (95% CI = 82.2 to 100) and a specificity of 91.8% (95% CI = 79.5 to 97.4). CONCLUSION: Emergency medicine residents with limited US experience were able to quickly perform CUS after minimal training for the detection of PLEDVT in a select group of patients.

Clinical Competence↗
PubMed2004

Residents should not independently perform focused abdominal sonography for trauma after 10 training examinations.

OBJECTIVES: To assess whether 10 focused abdominal sonography for trauma (FAST) examinations could be used as a minimum standard for training, as suggested previously. METHODS: This was a retrospective review of patients with abdominal trauma who underwent resident-performed FAST examinations before surgical or Department of Radiology evaluation. RESULTS: Six hundred ninety-eight patients were examined by resident-performed FAST followed by reference standard evaluations. Four hundred twelve patients were evaluated by residents who previously performed 10 FAST examinations; 154 were evaluated by 29 residents performing their 11th through 30th examinations; and 258 were evaluated by 10 residents performing their 31st and subsequent examinations. The results of resident-performed FAST for intraperitoneal free fluid were as follows: 11 to 20 examinations--sensitivity, 73.9% (95% confidence interval, 51.3%-88.9%); specificity, 98.8% (92.5%-99.9%); true-positive findings, 17; true-negative, 81; false-positive, 1; false-negative, 6; total patients, 105; 21 to 30 examinations--sensitivity, 100% (73.2%-100%); specificity, 97.1% (83.3%-99.9%); true-positive, 14; true-negative, 34; false-positive, 1; false-negative, 0; total patients, 49; 31 and more examinations--sensitivity, 94.8% (88.6%-97.9%); specificity, 98.6% (94.5%-99.8%); true-positive, 110; true-negative, 140; false-positive, 2; false-negative, 6; total patients, 258. CONCLUSIONS: The suggestion that 10 examinations could be used as a minimum standard for training in FAST examinations was not validated.

Abdominal Injuries↗
PubMedDate not supplied

Prehospital spirituality: how well do we know ambulance patients?

OBJECTIVE: To assess the religious spirituality of EMS personnel and their perception of the spiritual needs of ambulance patients. METHODS: Emergency medical technicians (EMTs) and paramedics presenting to an urban, academic emergency department (ED) were asked to complete a three-part survey relating to demographics, personal practices, and perceived patient needs. Their responses were compared to those of ambulance patients presenting to an ED during a previous study period and administered a similar survey. RESULTS: A total of 143 EMTs and 89 paramedics returned the surveys. There were 161 (69.4%) male and 71 (30.6%) female respondents with a median age range of 26-35 years old. Eighty-seven percent believed in God, 82% practiced prayer or meditation, 62% attended religious services occasionally, 55% belonged to a religious organization, 39% felt that their beliefs affected their job, and 18% regularly read religious material. This was similar to the characteristics of ambulance patients. However, only 43% felt that occasionally ambulance patients presented with spiritual concerns and 78% reported never or rarely discussing spiritual issues with patients. Contrastingly, > 40% of ambulance patients reported spiritual needs or concerns at the time of ED presentation, and > 50% wanted their providers to discuss their beliefs. Twenty-six percent of respondents reported praying or meditating with patients, while 50% reported praying or meditating for patients. Females were no more religious or spiritual than males, but were more likely to engage in prayer with (OR = 2.38, p = 0.0049) or for (OR = 6.45, p < 0.0001) patients than their male counterparts. CONCLUSION: EMTs and paramedics did not perceive spiritual concerns as often as reported by ambulance patients, nor did they commonly inquire about the religious/spiritual needs of patients.

Adult↗