Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To determine whether the absence of a gestational sac on transvaginal ultrasonography in patients with a quantitative beta-human chorionic gonadotropin (beta-hCG) > 3,000 mIU/mL and/or menstrual days > 38 excludes the diagnosis of a normal intrauterine pregnancy (IUP). ⋯ In patients with either a beta-hCG > 3,000 mIU/mL or menstrual days > 38 and no gestational sac by transvaginal ultrasonography, the likelihood of a normal IUP is low.
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Clinical Trial Controlled Clinical Trial
Rotating shiftwork schedules: can we enhance physician adaptation to night shifts?
To evaluate the effectiveness of a broad, literature-based night shiftwork intervention for enhancement of emergency physicians' (EPs') adaptation to night rotations. ⋯ Although the experimental intervention was successfully implemented, it failed to significantly improve attending physicians' sleep, performance, or mood on night shifts. A decrease in speed of intubation, vigilance reaction times, and subjective alertness was evident each time the physicians rotated through the night shift. These findings plus the limited sleep across all conditions and shifts suggest that circadian-mediated disruptions of waking neurobehavioral functions and sleep deprivation are problems in EPs.
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There is a rapidly growing interest in emergency medicine (EM) and emergency out-of-hospital care throughout the world. In most countries, the specialty of EM is either nonexistent or in an early stage of development. Many countries have recognized the need for, and value of, establishing a quality emergency health care system and are striving to create the specialty. ⋯ Since the United States has an advanced emergency health care system and the longest history of recognizing EM as a distinct medical specialty, lessons learned in the United States may benefit other countries. In order to provide appropriate advice to countries in the early phase of emergency health care development, careful assessment of national resources, governmental structure, population demographics, culture, and health care needs is necessary. This paper lists specific recommendations for EM organizations and physicians seeking to assist the development of the specialty of EM internationally.