Etiology and Clinical Course of Abdominal Pain in Senior Patients: A Prospective, Multicenter Study.
Lewis Lawrence M; Banet Gerald A; Blanda Michelle; Hustey Fredric M; Meldon Stephen W; Gerson Lowell W
Journals of Gerontology Series A: Biological Sciences & Medical Sciences
2005
2005-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1093/gerona/60.8.1071" target="_blank" rel="noreferrer noopener">10.1093/gerona/60.8.1071</a>
Does functional decline prompt emergency department visits and admission in older patients?
80 and over; Activities of Daily Living; Age Distribution; Aged; Cross-Sectional Studies; Decision Making; Emergency Service; Female; Frail Elderly/*statistics & numerical data; Health Surveys; Hospital/*statistics & numerical data; Humans; Male; Ohio; Patient Acceptance of Health Care/statistics & numerical data; Patient Admission/*statistics & numerical data; Patient Discharge/statistics & numerical data; Prospective Studies; Sex Distribution
BACKGROUND: Older patients may visit the emergency department (ED) when their illness affects their function. OBJECTIVES: To quantify the function of older ED patients, to assess whether functional decline (FD) had occurred, and to determine whether function contributes to the ED visit and hospital admission. METHODS: The authors performed an institutional review board-approved, prospective, cross-sectional study in a community teaching hospital ED. Eligible patients were older than 74 years of age, with an illness at least 48 hours old. Patients from a nursing facility and those without a proxy who were unable or unwilling to complete the questions were excluded. The Older Americans Resources and Services Questionnaire, which tests seven instrumental activities of daily living (IADL) and seven physical ADLs (PADL), was used. Data are presented as means or proportions with 95% confidence intervals (95% CI), and comparisons as 95% CI for the difference between proportions. RESULTS: The authors enrolled 90 patients (mean age, 81.6 yr [SD +/- 4.9], 40% male). Dependence in at least one IADL was reported by 68% (95% CI = 57% to 77%), and in at least one PADL by 61% (95% CI = 50% to 71%). Functional decline was reported by 74% (95% CI = 64% to 83%). Two thirds of those with IADL decline and three quarters of those with PADL decline said that this contributed to their ED visit. Seventy-seven percent with, and 63% without, IADL decline were admitted (14% difference, 95% CI = -6.1% to 33%). Seventy-nine percent with and 61% without PADL decline were admitted (18% difference, 95% CI = -1.4% to 38%). CONCLUSIONS: Functional decline is common in older ED patients and contributes to ED visits in older patients; its role in admission is unclear.
Wilber Scott T; Blanda Michelle; Gerson Lowell W
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2006
2006-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1197/j.aem.2006.01.006" target="_blank" rel="noreferrer noopener">10.1197/j.aem.2006.01.006</a>
An evaluation of two screening tools for cognitive impairment in older emergency department patients.
*Psychiatric Status Rating Scales; Aged; Cognition Disorders/*diagnosis; Cross-Sectional Studies; Emergency Medicine/*instrumentation; Emergency Service; Female; Geriatrics/*instrumentation; Hospital; Humans; Male; Prospective Studies; Sensitivity and Specificity
OBJECTIVES: Screening for cognitive impairment in older emergency department (ED) patients is recommended to ensure quality care. The Mini-Mental State Examination (MMSE) may be too long for routine ED use. Briefer alternatives include the Six-Item Screener (SIS) and the Mini-Cog. The objective of this study was to describe the test characteristics of the SIS and the Mini-Cog compared with the MMSE when administered to older ED patients. METHODS: This institutional review board-approved, prospective, randomized study was performed in a university-affiliated teaching hospital ED. Eligible patients were 65 years and older and able to communicate in English. Patients who were unable or unwilling to perform testing, who were medically unstable, or who received medications affecting their mental status were excluded. Patients were randomized to receive the SIS or the Mini-Cog by the treating emergency physician. Investigators administered the MMSE 30 minutes later. An SIS score of
Wilber Scott T; Lofgren Samuel D; Mager Thomas G; Blanda Michelle; Gerson Lowell W
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2005
2005-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1197/j.aem.2005.01.017" target="_blank" rel="noreferrer noopener">10.1197/j.aem.2005.01.017</a>
Reclining chairs reduce pain from gurneys in older emergency department patients: a randomized controlled trial.
*Emergency Service; *Wheelchairs; Aged; Female; Hospital; Humans; Male; Pain Measurement; Pain/*prevention & control; Patient Satisfaction; Prospective Studies
OBJECTIVES: Pain related to the gurney is a frequent complaint of older emergency department (ED) patients. The authors hypothesized that these patients may have less pain and higher satisfaction if allowed to sit in a reclining hospital chair. METHODS: A single-blind, randomized controlled trial was performed. Patients 65 years old or older who were able to sit upright, transfer, and engage in normal conversation were eligible. Severely ill or cognitively impaired patients were excluded. Patients were randomized to either remain on the gurney or transfer to the chair after initial evaluation. Patients reported pain at arrival (t0), at one hour (t1), and at two hours (t2) using a 0-10 pain scale, and satisfaction at study completion on a 0-10 scale. The primary outcome was a decrease in pain between t0 and t1 or no pain at both t0 and t1. This outcome was analyzed using a 95% confidence interval for the difference between proportions; exclusion of zero was considered significant. RESULTS: Sixty-six patients in each group were enrolled. There was no difference in demographics between groups, but the chair patients were more likely to have pain at t0 than the gurney patients. More chair patients than gurney patients had a successful primary outcome (97% vs. 76%, 21% difference, 95% CI=10% to 32%). The mean satisfaction score was higher in the chair group than in the gurney group (8.1 vs. 6.0, 2.1 difference, 95% CI=1.4% to 2.8%). CONCLUSIONS: The simple modification of allowing older ED patients to sit in reclining chairs resulted in less pain and higher satisfaction.
Wilber Scott T; Burger Barbara; Gerson Lowell W; Blanda Michelle
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2005
2005-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1197/j.aem.2004.10.016" target="_blank" rel="noreferrer noopener">10.1197/j.aem.2004.10.016</a>
Short-term functional decline and service use in older emergency department patients with blunt injuries.
*Activities of Daily Living; 80 and over; 80 and Over; Academic Medical Centers; Activities of Daily Living; Aged; Bone/physiopathology/therapy; Clinical Assessment Tools; Comorbidity; Confidence Intervals; Descriptive Statistics; Emergency Care – In Old Age; Emergency Patients – In Old Age; Emergency Service; Family; Female; Fisher's Exact Test; Fractures; Functional Status – In Old Age; Geriatric Assessment; Geriatric Functional Assessment; Health Resource Utilization – In Old Age; Hospital/*statistics & numerical data; Hospitals; Human; Humans; Logistic Models; Logistic Regression; Longitudinal Studies; Male; Mental Status Schedule; Nonpenetrating – In Old Age; Nonpenetrating/*physiopathology/*therapy; OARS Multidimensional Functional Assessment Questionnaire; Odds Ratio; Ohio; Outcome Assessment; Outpatients; P-Value; Predictive Value of Tests; Prospective Studies; Questionnaires; Record Review; ROC Curve; Scales; Summated Rating Scaling; Surveys and Questionnaires; T-Tests; Teaching; Treatment Outcome; Treatment Outcomes; Wounds
BACKGROUND: Injuries are a common reason for emergency department (ED) visits by older patients. Although injuries in older patients can be serious, 75% of these patients are discharged home after their ED visit. These patients may be at risk for short-term functional decline related to their injuries or treatment. OBJECTIVES: The objectives were to determine the incidence of functional decline in older ED patients with blunt injuries not requiring hospital admission for treatment, to describe their care needs, and to determine the predictors of short-term functional decline in these patients. METHODS: This institutional review board-approved, prospective, longitudinal study was conducted in two community teaching hospital EDs with a combined census of 97,000 adult visits. Eligible patients were \textgreater or = 65 years old, with blunt injuries \textless48 hours old, who could answer questions or had a proxy. We excluded those too ill to participate; skilled nursing home patients; those admitted for surgery, major trauma, or acute medical conditions; patients with poor baseline function; and previously enrolled patients. Interviewers collected baseline data and the used the Older Americans Resources and Services (OARS) questionnaire to assess function and service use. Potential predictors of functional decline were derived from prior studies of functional decline after an ED visit and clinical experience. Follow-up occurred at 1 and 4 weeks, when the OARS questions were repeated. A three-point drop in activities of the daily living (ADL) score defined functional decline. Data are presented as means and proportions with 95% confidence intervals (CIs). Logistic regression was used to model potential predictors with functional decline at 1 week as the dependent variable. RESULTS: A total of 1,186 patients were evaluated for eligibility, 814 were excluded, 129 refused, and 13 were missed, leaving 230 enrolled patients. The mean (+/-SD) age was 77 (+/-7.5) years, and 70% were female. In the first week, 92 of 230 patients (40%, 95% CI = 34% to 47%) had functional decline, 114 of 230 (49%, 95% CI = 43% to 56%) had new services initiated, and 76 of 230 had an unscheduled medical contact (33%, 95% CI = 27% to 39%). At 4 weeks, 77 of 219 had functional decline (35%, 95% CI = 29% to 42%), 141 of 219 had new services (65%, 95% CI = 58% to 71%), and 123 of 219 had an unscheduled medical contact (56%, 95% CI = 49% to 63%), including 15% with a repeated ED visit and 11% with a hospital admission. Family members provided the majority of new services at both time periods. Significant predictors of functional decline at 1 week were female sex (odds ratio [OR] = 2.2, 95% CI = 1.1 to 4.5), instrumental ADL dependence (IADL; OR = 2.5, 95% CI = 1.3 to 4.8), upper extremity fracture or dislocation (OR = 5.5, 95% CI = 2.5 to 11.8), lower extremity fracture or dislocation (OR = 4.6, 95% CI = 1.4 to 15.4), trunk injury (OR = 2.4, 95% CI = 1.1 to 5.3), and head injury (OR = 0.48, 95% CI = 0.23 to 1.0). CONCLUSIONS: Older patients have a significant risk of short-term functional decline and other adverse outcomes after ED visits for injuries not requiring hospitalization for treatment. The most significant predictors of functional decline are upper and lower extremity fractures.
Wilber Scott T; Blanda Michelle; Gerson Lowell W; Allen Kyle R
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2010
2010-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2010.00799.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2010.00799.x</a>
DNAR does not equate to "do not care".
*Resuscitation Orders; Attitude to Death; Decision Making; Humans; Physician's Role; Terminal Care/*ethics
Blanda Michelle
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2008
2008-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2008.00067.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2008.00067.x</a>
Assessment of emergency medicine residents' computer knowledge and computer skills: time for an upgrade?
*Computer Literacy; *Internship and Residency/statistics & numerical data; Computer User Training; Computers/*statistics & numerical data; Cross-Sectional Studies; Emergency Medicine/*education; Humans; Prospective Studies; Surveys and Questionnaires; Task Performance and Analysis
OBJECTIVE: To describe emergency medicine residents' (EMRs') personal computer (PC) use and educational needs and to compare their perceived and actual PC skills. METHODS: This was a prospective, cross-sectional study. Subjects were all EMRs at seven midwestern Accreditation Council for Graduate Medical Education (ACGME) residency programs. The EMRs completed a questionnaire about their PC use and ability to perform 23 tasks derived from two national retail-training programs. The tasks covered word processing, slide making, and Internet use. The EMRs then took a three-part test performing the skills in the questionnaire. Two independent raters scored the tests. Frequencies with 95% confidence intervals (95% CIs) were calculated for categorical data. Positive and negative predictive values were used to report information comparing residents' performance with their self-assessment of skills. Cohen's kappa was used to test agreement between raters. RESULTS: One hundred twenty-four of 158 (79%) eligible EMRs participated. Since not all participants engaged in all parts of the study, the sample size varies between 121 and 124. One hundred one of 122 (83%; 95% CI = 75 to 89) owned a PC. The EMRs use home PCs a mean of 3.8 hours/week for physician duties and use residency PCs 1.9 hours/week (range 0-20). Ninety-six of 122 (79%; 95% CI = 70 to 86) EMRs reported no formal PC training during residency. Thirty-five percent (43/122; 95% CI = 27 to 44) passed the word-processing test and 50% (62/123; 95% CI = 41 to 60) passed the slide-making test. Reasons for failure were because of errors and not having a presentable product. Thirty-eight of 122 (31%; 95% CI = 23 to 40) failed the literature search, including 33 who said they could perform it. One hundred fifteen of 123 (94%; 95% CI = 88 to 98) EMRs were able to find an Internet address, including ten who stated they could not. Twenty-one percent of the residents who attempted any test (26/124; 95% CI = 14 to 29) passed all three tests. There was no association between year of training and success on the tests (p = 0.374). Thirty-seven of 115 (32%; 95% CI = 24 to 42) EMRs said they had insufficient PC training to meet their physician needs. CONCLUSIONS: Emergency medicine residents have much access to computer technology and possess some computer skills; however, many are unable to produce a usable product or conduct a literature search. Emergency medicine residents have not had sufficient computer training prior to residency. The computer skills of EMRs should be assessed through skills testing rather than self-assessment, and computer training during residency should be improved.
Jwayyed Sharhabeel; Park Tammy K; Blanda Michelle; Wilber Scott T; Gerson Lowell W; Meerbaum Sharon O; Beeson Michael S
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2002
2002-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2002.tb00231.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2002.tb00231.x</a>
When the business of healthcare overshadows the value of academic faculty: A community's loss of a residency program.
Academic faculty; Business; Contract negotiations; Faculty; Health Care Industry; Hospital administration; Internship and Residency; Medical – Psychosocial Factors
Ahmed Rami A; Blanda Michelle; Jwayyed Sharhabeel; Stiffler Kirk; Nielson Jeff; Southern Alison; McQuown Colleen M
The American journal of emergency medicine
2018
2018-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.ajem.2017.09.036" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2017.09.036</a>
Financial planning and satisfaction across life domains among retired emergency physicians in the United States.
*Personal Satisfaction; Adult; Aged; Cross Sectional Studies; Cross-Sectional Studies; Emergency – United States; Emergency Medicine/*economics; Female; Financial Management; Financial Management/economics; Human; Humans; Male; Middle Age; Personal Satisfaction; Physicians; Physicians/*economics/psychology; Prospective Studies; Questionnaires; Retirement; Retirement/economics/*psychology; Surveys; Surveys and Questionnaires; United States
Kuhn Gloria J; Marco Catherine A; Mallory Mary Nan S; Blanda Michelle; Kaplan Jay A; Schneider Sandra M; Joldersma Kevin B; Martin Sandra I; Choo Esther K
The American journal of emergency medicine
2018
2018-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.ajem.2017.06.059" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2017.06.059</a>