Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Mentoring is an important aspect of career development for medical students, residents, and junior faculty. It is vital to the professional growth and maturation of individuals early in each phase of their careers. Additionally, mentoring has a critical role throughout all career stages, because the mentor-mentee relationship provides mutual benefit to both participants. ⋯ In contrast to role models, mentors play an active part in the development of a young physician's career. This difference will be discussed. Finally, this article will describe the responsibilities of career guidance and recommendation letter authorship that mentors assume for medical students.
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Review Case Reports
Profiles in patient safety: authority gradients in medical error.
The term "authority gradient" was first defined in aviation when it was noted that pilots and copilots may not communicate effectively in stressful situations if there is a significant difference in their experience, perceived expertise, or authority. A number of unintentional aviation, aerospace, and industrial incidents have been attributed, in part, to authority gradients. ⋯ The concept that authority gradients might contribute to medical error is largely unrecognized. This article presents one case and a series of examples to detail how authority gradients can contribute to medical error, and describes methods used in other disciplines to avoid their potentially negative impact.
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Comparative Study
Nonurgent emergency department patient characteristics and barriers to primary care.
Nonurgent (NU) emergency department (ED) use is at the forefront of medico-political agendas, and diversion of NU patients has been entertained as a management strategy. Before policy changes are implemented, this population should be better understood with respect to their characteristics and reasons for not presenting to primary care providers (PCPs) instead of EDs. This study compares NU with urgent and semiurgent (USU) patients and describes the NU patients' reasons for not seeking care with a PCP before presenting to the ED. ⋯ NU ED patients are different from USU patients and have multiple reasons for not seeking primary care before going to the ED. This may help explain why various diversion strategies have been unsuccessful and indicate that a multifaceted approach may be better suited to this group of patients. The design of new interventions, however, will benefit from further research that clarifies the impact of NU patients on the health care system.
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The ideal diagnostic test for the diagnosis of epiglottitis would be simple, rapid, noninvasive, and highly accurate, performed at the bedside, and would not use ionizing radiation. The purpose of this study was to assess the utility of ultrasound to image the epiglottis and to determine the range of normal epiglottis diameter for men and women. ⋯ Bedside ultrasonography is easy to perform and can accurately evaluate the epiglottis. Further analysis should include patients with known epiglottic disease to assess the utility of this technique to detect pathologic enlargement.
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In relying on the peripheral blood white blood cell (WBC) count to identify infants at high risk for acute bacterial meningitis and bacteremia, to the best of the authors' knowledge, it has not been reported previously whether high and low values of the test have similar implications for predicting these separate infections. ⋯ In young infants, the peripheral blood WBC count is useful for estimating the odds of acute bacterial meningitis relative to isolated bacteremia. A low peripheral blood WBC count should be considered a much more worrisome laboratory finding because it is associated with a relatively high risk for acute bacterial meningitis relative to the potential for bacteremia.