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>
Research Priorities for High-quality Geriatric Emergency Care: Medication Management, Screening, and Prevention and Functional Assessment.
Aged; Emergency Medicine; Middle Age; Emergency Service; Prescribing Patterns; Geriatrics; Patient Care – Methods; Patient Assessment – Methods; Disease – Prevention and Control; Drug Evaluation – Methods; Health Screening – Methods; Lorazepam – Administration and Dosage; Warfarin – Adverse Effects
Carpenter Christopher R; Heard Kennon; Wilber Scott T; Ginde Adit A; Stiffler Kirk; Gerson Lowell W; Wenger Neal S; Miller Douglas K
Academic Emergency Medicine
2011
2011-06
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/10.1111/j.1553-2712.2011.01092.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2011.01092.x</a>
High Yield Research Opportunities in Geriatric Emergency Medicine: Prehospital Care, Delirium, Adverse Drug Events, and Falls.
Carpenter Christopher R; Shah Manish N; Hustey Fredric M; Heard Kennon; Gerson Lowell W; Miller Douglas K
Journals of Gerontology Series A: Biological Sciences & Medical Sciences
2011
2011-07
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/10.1093/gerona/glr040" target="_blank" rel="noreferrer noopener">10.1093/gerona/glr040</a>
Measuring the Measurable: A Commentary on Impact Factor.
Emergency Medicine; Medline; Databases; Medical Organizations; Academic Performance – Evaluation; Serial Publications – Evaluation
Cone David C; Gerson Lowell W
Academic Emergency Medicine
2012
2012-11
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/acem.12003" target="_blank" rel="noreferrer noopener">10.1111/acem.12003</a>
Optimal Older Adult Emergency Care: Introducing Multidisciplinary Geriatric Emergency Department Guidelines From the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic...
Age Factors; Physicians; Emergency Medicine; Practice Guidelines; Medical Organizations; Multidisciplinary Care Team; Emergency Nurses Association; Geriatrics; Emergency; Patient Care – Methods; Emergency Care – Methods
Carpenter Christopher R; Bromley Marilyn; Caterino Jeffrey M; Chun Audrey; Gerson Lowell W; Greenspan Jason; Hwang Ula; John David P; Lyons William L; Platts-Mills Timothy F; Mortensen Betty; Ragsdale Luna; Rosenberg Mark; Wilber Scott T
Academic Emergency Medicine
2014
2014-07
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/acem.12415" target="_blank" rel="noreferrer noopener">10.1111/acem.12415</a>
Optimal Older Adult Emergency Care: Introducing Multidisciplinary Geriatric Emergency Department Guidelines from the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic...
Aged; Quality Improvement; Practice Guidelines; Emergency Patients; Multidisciplinary Care Team; American College of Emergency Physicians; American Geriatrics Society; Emergency Nurses Association; Society for Academic Emergency Medicine; Emergency Medicine – Standards; Geriatrics – Standards; Emergency Care – Standards – In Old Age; Gerontologic Care – Standards
In the United States and around the world, effective, efficient, and reliable strategies to provide emergency care to aging adults is challenging crowded emergency departments ( EDs) and strained healthcare systems. In response, geriatric emergency medicine clinicians, educators, and researchers collaborated with the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine to develop guidelines intended to improve ED geriatric care by enhancing expertise, educational, and quality improvement expectations, equipment, policies, and protocols. These Geriatric Emergency Department Guidelines represent the first formal society-led attempt to characterize the essential attributes of the geriatric ED and received formal approval from the boards of directors of each of the four societies in 2013 and 2014. This article is intended to introduce emergency medicine and geriatric healthcare providers to the guidelines while providing recommendations for continued refinement of these proposals through educational dissemination, formal effectiveness evaluations, cost-effectiveness studies, and eventually institutional credentialing.
Carpenter Christopher R; Bromley Marilyn; Caterino Jeffrey M; Chun Audrey; Gerson Lowell W; Greenspan Jason; Hwang Ula; John David P; Lyons William L; Platts-Mills Timothy F; Mortensen Betty; Ragsdale Luna; Rosenberg Mark; Wilber Scott T
Journal of the American Geriatrics Society
2014
2014-07
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/jgs.12883" target="_blank" rel="noreferrer noopener">10.1111/jgs.12883</a>
Geriatric emergency medicine and the 2006 Institute of Medicine reports from the Committee on the Future of Emergency Care in the U.S. health system.
*National Academies of Science; *Population Dynamics; 80 and over; Aged; and Medicine (U.S.) Health and Medicine Division; Disaster Planning; Emergency Service; Engineering; Health Policy/*trends; Health Services for the Aged/*trends; Hospital/*trends; Humans; United States
Three recently published Institute of Medicine reports, Hospital-Based Emergency Care: At the Breaking Point, Emergency Medical Services: At the Crossroads, and Emergency Care for Children: Growing Pains, examined the current state of emergency care in the United States. They concluded that the emergency medicine system as a whole is overburdened, underfunded, and highly fragmented. These reports did not specifically discuss the effect the aging population has on emergency care now and in the future and did not discuss special needs of older patients. This report focuses on the emergency care of older patients, with the intent to provide information that will help shape discussions on this issue.
Wilber Scott T; Gerson Lowell W; Terrell Kevin M; Carpenter Christopher R; Shah Manish N; Heard Kennon; Hwang Ula
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2006
2006-12
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.2006.09.050" target="_blank" rel="noreferrer noopener">10.1197/j.aem.2006.09.050</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>
Characteristics of emergency medicine program directors.
Adult; Career Mobility; Emergency Medicine/education/*organization & administration; Female; Health Care Surveys; Humans; Job Satisfaction; Male; Physician Executives/classification/*statistics & numerical data; United States; Workforce
OBJECTIVES: To characterize emergency medicine (EM) program directors (PDs) and compare the data, where possible, with those from other related published studies. METHODS: An online survey was e-mailed in 2002 to all EM PDs of programs that were approved by the Accreditation Council of Graduate Medical Education. The survey included questions concerning demographics, work hours, support staff, potential problems and solutions, salary and expenses, and satisfaction. RESULTS: One hundred nine of 124 (88%) PDs (69.7% university, 27.5% community, and 2.8% military) completed the survey; 85.3% were male. Mean age was 43.6 years (95% confidence interval [CI] = 42.6 to 44.7 yr). The mean time as a PD was 5.7 years (95% CI = 4.9 to 6.5 yr), with 56% serving five years or less. The mean time expected to remain as PD is an additional 6.0 years (95% CI = 5.2 to 6.8). A 1995 study noted that 50% of EM PDs had been in the position for less than three years, and 68% anticipated continuing in their position for less than five years. On a scale of 1 to 10 (with 10 as highest), the mean satisfaction with the position of PD was 8.0 (95% CI = 7.2 to 8.3). Those PDs who stated that the previous PD had mentored them planned to stay a mean of 2.0 years longer than did those who were not mentored (95% CI of difference of means = 0.53 to 3.53). Sixty-five percent of PDs had served previously as an associate PD. Most PDs (92%) have an associate or assistant PD, with 54% reporting one; 25%, two; and 9%, three associate or assistant PDs. A 1995 study noted that 62% had an associate PD. Ninety-two percent have a program coordinator, and 35% stated that they have both a residency secretary and a program coordinator. Program directors worked a median of 195 hours per month: clinical, 75 hours; scholarly activity, 20 hours; administrative, 80 hours; and teaching and residency conferences, 20 hours; compared with a median total hours of 220 previously reported. Lack of adequate time to do the job required, career needs interfering with family needs, and lack of adequate faculty help with residency matters were identified as the most important problems (means of 3.5 [95% CI = 3.2 to 3.7], 3.4 [95% CI = 3.2 to 3.6], and 3.1 [95% CI = 2.9 to 3.3], respectively, on a scale of 1 to 5, with 5 as maximum). This study identified multiple resources that were found to be useful by \textgreater50% of PDs, including national meetings, lectures, advice from others, and self-study. CONCLUSIONS: Emergency medicine PDs generally are very satisfied with the position of PD, perhaps because of increased support and resources. Although PD turnover remains an issue, PDs intend to remain in the position for a longer period of time than noted before this study. This may reflect the overall satisfaction with the position as well as the increased resources and support now available to the PD. PDs have greater satisfaction if they have been mentored for the position.
Beeson Michael S; Gerson Lowell W; Weigand John V; Jwayyed Sharhabeel; Kuhn Gloria J
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2006
2006-02
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.2005.08.010" target="_blank" rel="noreferrer noopener">10.1197/j.aem.2005.08.010</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>
Temporal artery temperature measurements in healthy infants, children, and adolescents.
Adolescent; Body Temperature/*physiology; Child; Cohort Studies; Confidence Intervals; Female; Humans; Infant; Male; Newborn; Preschool; Reference Values; Sensitivity and Specificity; Skin Temperature/physiology; Temporal Arteries; Thermometers/*standards
A noninvasive temporal artery thermometer that uses arterial heat balance technology has been compared to rectal and ear thermometry and is available in the marketplace. This study was undertaken to establish mean temperatures and temperatures 2 standard deviations above the mean for healthy infants, children, and adolescents. Temperatures were measured in healthy patients 0 to 18 years of age using a noninvasive temporal artery thermometer. Temperatures were measured in 2,346 patients. Mean temperatures and temperatures 2 standard deviations above the mean were: 37.1 degrees C (38.1 degrees C) for 383 infants 0 to 2 months; 36.9 degrees C (37.9 degrees C) for 860 children 3 to 47 months; 36.8 degrees C (37.8 degrees C) for 680 children 4 to 9 years; and 36.7 degrees C (37.8 degrees C) for 423 adolescents 10 to 18 years. There were no significant differences in temperatures in white compared to African-American children, children with or without perspiration on their forehead, or between measurements taken on the left compared to the right side of the forehead. This study provides information about temporal artery temperatures in healthy infants and children that can serve as a basis for interpreting temperature measurements in ill children when the same instrument is used.
Roy Sumita; Powell Keith; Gerson Lowell W
Clinical pediatrics
2003
2003-06
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/10.1177/000992280304200508" target="_blank" rel="noreferrer noopener">10.1177/000992280304200508</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>
In reply:.
Gerson Lowell W; Cone David C; Bono Michael J
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2010
2010-02
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.1553-2712.2009.00654.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2009.00654.x</a>
A research agenda for geriatric emergency medicine.
*Emergency Service; *Geriatric Assessment; *Health Services Research; Aged; Cardiopulmonary Resuscitation; Emergency Medicine/education; Geriatrics/education; Hospital; Humans; Outcome Assessment (Health Care); Wounds and Injuries/therapy
OBJECTIVES: The Research Agenda Setting Process (RASP), part of the American Geriatric Society's (AGS's) project "Increasing Geriatric Expertise in Surgical and Related Medical Specialties," was designed to define a research agenda for the geriatrics aspects of participating specialties. This paper presents a summary of the research agenda for emergency medicine. METHODS: The RASP was developed by the AGS in conjunction with experts from the participating specialty organizations. A "content expert" (CE) for each specialty developed a Medline search strategy in conjunction with RAND Health librarians. The CE reviewed the search to identify papers that were germane to research in the emergency care of older patients. The CE and a senior writing group member drafted a paper that synthesized the current literature and suggested areas for further research. A panel consisting of AGS members and emergency physicians with geriatrics expertise reviewed this paper. The research agenda was further refined at a two-day retreat. Two senior geriatricians reviewed the resulting paper. RESULTS: The Medline search for emergency medicine resulted in a list of 3,348 articles; 299 articles were pertinent and reviewed. The search for trauma resulted in a list of 1,838 articles; 133 were reviewed. Research agenda items were defined for multiple topics within geriatric emergency medicine and trauma. CONCLUSION: A research agenda for geriatric emergency medicine has been developed, using a combination of review of current literature and expert opinion.
Wilber Scott T; Gerson Lowell W
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
2003
2003-03
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.1553-2712.2003.tb01999.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2003.tb01999.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>
US emergency department visits for hip fracture, 1992-2000.
80 and over; Age Factors; Aged; Analgesia/statistics & numerical data; Emergency Medical Services/*statistics & numerical data; Female; Hip Fractures/diagnosis/*epidemiology/therapy; Humans; Male; Middle Aged; Sex Factors; United States/epidemiology
BACKGROUND: Hip fracture is a significant injury for older persons. Little has been reported about emergency department (ED) care of these patients. OBJECTIVE: To characterize the management of older patients treated in the ED for hip fracture with specific attention to the use of analgesia. METHODS: This study analysed data from the National Hospital Ambulatory Medical Care Survey ( approximately 400 hospitals report each year) for the years 1992-2000. We included records of patients who were at least 50 years old and had a diagnosis of hip fracture (International Classification of Disease, 9th revision, clinical modification 820-820.9) in any of the three fields allowed for recording diagnosis. RESULTS: There were 1,935,000 ED visits ( approximately 215,000 a year), predominantly among older white women. The rate in those over 80 years old was 25 times that of the youngest group. Fifty-six per cent of patients received analgesia (44% narcotics). There were no ethnic or racial distinctions in the use of analgesia. CONCLUSIONS: The ED visit presents a largely untapped opportunity for focused efforts in fall and hip fracture prevention, especially in countries with comprehensive geriatric services and well integrated healthcare delivery systems. Despite the high likelihood of pain, the administration of analgesics appears to be low and may be a worthy focus for practice improvement.
Gerson Lowell W; Emond Jennifer A; Camargo Carlos A Jr
European journal of emergency medicine : official journal of the European Society for Emergency Medicine
2004
2004-12
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/10.1097/00063110-200412000-00005" target="_blank" rel="noreferrer noopener">10.1097/00063110-200412000-00005</a>
Health promotion and disease prevention in the emergency department.
*Emergency Medical Services; Cause of Death/trends; Emergency Service; Health Behavior; Health Promotion/*methods; Hospital/*organization & administration/statistics & numerical data; Humans; Preventive Health Services/*organization & administration
This article provides an overview of health promotion and disease and injury prevention concepts. It provides an emergency medicine perspective and reviews approaches that can be used in the emergency department. It discusses examples of innovative emergency medicine-based preventive activities including prevention in the prehospital setting. This article ends with a discussion of the importance of a system approach to prevention and suggests a role for a preventionist as a new member of the emergency medicine team.
Stiffler Kirk A; Gerson Lowell W
Emergency medicine clinics of North America
2006
2006-11
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.emc.2006.06.010" target="_blank" rel="noreferrer noopener">10.1016/j.emc.2006.06.010</a>
Optimal older adult emergency care: Introducing multidisciplinary geriatric emergency department guidelines from the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine.
*Practice Guidelines as Topic; Aged; AMERICAN College of Emergency Physicians; AMERICAN Geriatrics Society; ELDER care; EMERGENCY medical services; EMERGENCY medical services – Standards; EMERGENCY medicine; Emergency Medicine – Standards; Emergency Medicine/*standards; EMERGENCY Nurses Association; Emergency Service; Emergency Service – Standards; GERIATRICS; Geriatrics – Standards; Geriatrics/*standards; HEALTH care teams; Hospital/standards; Humans; Interdisciplinary Communication; Interprofessional Relations; Medical; Medical Organizations; MEDICAL protocols; OLD age; PATIENTS; Practice Guidelines; QUALITY assurance; Societies; SOCIETY for Academic Emergency Medicine (U.S.); United States
Carpenter Christopher R; Bromley Marilyn; Caterino Jeffrey M; Chun Audrey; Gerson Lowell W; Greenspan Jason; Hwang Ula; John David P; Lyons William L; Platts-Mills Timothy F; Mortensen Betty; Ragsdale Luna; Rosenberg Mark; Wilber Scott T
Annals of emergency medicine
2014
2014-05
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.annemergmed.2014.03.002" target="_blank" rel="noreferrer noopener">10.1016/j.annemergmed.2014.03.002</a>
Weakness and fatigue in older ED patients in the United States.
80 and over; 80 and Over; Aged; Cross Sectional Studies; Cross-Sectional Studies; Demography; Fatigue – Diagnosis; Fatigue – Epidemiology; Fatigue/diagnosis/*epidemiology; Female; Health Care Surveys; Human; Humans; Male; Muscle Weakness – Diagnosis; Muscle Weakness – Epidemiology; Muscle Weakness/diagnosis/*epidemiology; Prevalence; Surveys; United States; United States/epidemiology
BACKGROUND: The objectives of this study are to estimate the prevalence of weakness and fatigue visits in older emergency department (ED) patients, to compare demographics and resource use in these patients with those without these complaints, and to determine their ED diagnoses and disposition. METHODS: We performed a cross-sectional cohort analysis of ED visits in patients aged older than 65 years from the 2003 to 2007 National Hospital Ambulatory Medical Care Surveys. Weakness and fatigue visits had a reason for visit code of generalized weakness (1020.0) or tiredness and exhaustion (1015.0); the comparison cohort lacked these codes. Descriptive data are presented as totals, means, and proportions with 95% confidence intervals (CIs). Comparisons between cohorts used chi(2) for proportions and the adjusted Wald test for means. RESULTS: There were an estimated 575 million ED visits, those aged 65 years and older made 14.7% (95% CI, 14.2-15.3) of visits. Overall, 6.0% (95% CI, 5.6-6.4) of these visits had weakness and fatigue; this was the fifth most common primary reason for visit. Weakness and fatigue visits increased with age. Weakness and fatigue visits had longer ED lengths of stay (300 vs 249 minutes, P \textless .001), more diagnostic tests (7.7 vs 5.0, P \textless .001), procedures (5.7 vs 4.7, P \textless .001), and hospital admissions (55% vs 35%, P \textless .001). The most common primary diagnoses for the weakness and fatigue cohort were "other malaise and fatigue," pneumonia, and urinary tract infection. CONCLUSION: Weakness and fatigue are common in older ED patients. These patients undergo more tests and procedures, and most are admitted.
Bhalla Mary Colleen; Wilber Scott T; Stiffler Kirk A; Ondrejka Jason E; Gerson Lowell W
The American journal of emergency medicine
2014
2014-11
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.2014.08.027" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2014.08.027</a>
Home modification to prevent falls by older ED patients.
Accidental Falls/*prevention & control; Accidents; Aged; Female; Home/*prevention & control; Humans; Male; Prospective Studies; Safety
This trial was conducted at 11 EDs to test the effectiveness of distributing fall prevention information to patients 65 years or older. Intervention patients were given 2 brochures and received a reminder call 2 weeks later. All patients were called at 1 month and asked if they made home safety modifications. Three hundred ninety-seven patients were enrolled (118 control, 279 intervention). Seventy-six percent had complete follow up interviews. Nine percent of control and 8% of intervention patients reported a home modification (95% confidence interval on difference, -8.1% to 5.5%). Patients who fell in the prior year had a 2.0 increased odds (95% confidence interval, 0.8-4.6) of making a home modification. The similar home modification rates in the 2 study groups suggest that even minimum discussion (eg, the informed consent procedure) may increase patients' fall prevention activities. The stronger association in patients who fell suggests that a targeted program may have added benefit.
Gerson Lowell W; Camargo Carlos A Jr; Wilber Scott T
The American journal of emergency medicine
2005
2005-05
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.2005.02.035" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2005.02.035</a>