Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Short, subjective measures of numeracy and general health literacy in an adult emergency department.
The objective was to evaluate the reliability and validity of brief subjective measures of numeracy and general health literacy in the adult emergency department (ED) setting. ⋯ The SNS and SLS are reliable, valid tests that can be used to rapidly estimate general health literacy and numeracy skill levels in adult ED patients. Continuing work is needed to establish their ability to predict clinical outcomes.
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Facebook and social media networking applications use is ubiquitous across all ages and cultures. Facebook has finally begun to appear in the medical-scientific press. Today's medical literature is focused on concerns of professionalism in young health care practitioners vis-à-vis the lay public as they continuously expose themselves through this online social medium. ⋯ Nobody so far has considered the opposite issue: that of physician invasion of privacy by "looking-up" a patient on Facebook during clinical practice for purposes of history-taking or diagnostic clues in situations where patients are too ill to provide needed information. We need to consider the ethical implications of privacy invasion in the current era of information technology. We need to acquire and maintain a certain level of "social media competency" to better debate the issues around Facebook and how we integrate on-line content with our patients' histories of present illness (HPI) or past medical histories (if at all).
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The emergency department (ED) is a valuable setting to initiate intervention to prevent future complications following traumatic injury. Posttraumatic stress disorder (PTSD) occurs in 10% to 40% of patients after single-incident civilian trauma. Prior research suggests that young age is associated with increased risk. We hypothesized that other factors correlated with age may be responsible. The aim of this study was to determine if factors identifiable in the ED can better explain the relationship between younger age and PTSD, therefore more specifically identifying those at risk for long-term distress. ⋯ Although young age is associated with increased PTSD symptom severity scores, characteristics associated with young age, specifically assaultive trauma and low SES, account for this risk. Young age is not an independent risk factor for PTSD. Psychological assessment in the ED can be targeted toward assaultive trauma patients, especially those of low SES, to establish early intervention and hopefully prevent the development of PTSD.
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Levamisole is an antihelminthic agent found in nearly 70% of seized U.S. cocaine. Sporadic case literature describes a life-threatening agranulocytosis associated with levamisole exposure secondary to cocaine use. The authors compared the distribution of hematologic indices in a population of cocaine users with and without a confirmed exposure to levamisole. ⋯ The overall incidence of neutropenia was 4.2% in all cocaine users and 2.1% in the levamisole-positive group. A striking number of the reported patients with levamisole-associated neutropenia have presented to care with oropharyngeal complaints, vasculitis, or fever. A clinical algorithm for identifying levamisole toxicity in the emergency department setting is provided. Further research is necessary to determine the circumstances required for levamisole-associated neutropenia.
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Comparative Study
Association of direct helicopter versus ground transport and in-hospital mortality in trauma patients: a propensity score analysis.
Helicopter emergency medical services (HEMS) transport of trauma patients has been used for decades. Its use, however, is still a subject of debate, including issues such as high costs, increasing numbers of crashes, and conflicting results regarding effectiveness in reducing mortality. The aim of this study was to examine whether mode of transport (HEMS vs. ground EMS) is independently associated with mortality among trauma patients transported directly from the scene of injury to definitive care. ⋯ Helicopter EMS transport was associated with a decreased hazard of mortality among certain patients transported from the scene of injury directly to definitive care. Refinements in scene triage and transport guidelines are needed to more effectively select patients that may benefit from HEMS transport from those unlikely to benefit.