J Emerg Med
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In 2004, a hepatitis A outbreak occurred in Boston, Massachusetts with an incident rate of 14.8 per 100,000, compared to 4.2 in 2003. The majority of cases had risk factors of homelessness, injection drug use, or incarceration. In September 2004, the Boston Public Health Commission began an immunization campaign partnering with health centers, detoxification centers, homeless shelters, and our Emergency Department (ED) to increase the number of hepatitis A vaccinations and stem the epidemic. ⋯ There was a 51% decrease in the number of cases of Hepatitis A in Boston in the first 4 months of 2005. As a partner, the ED helped stem the epidemic by rapidly providing vaccinations to those most vulnerable. This project provides a model for future collaborations between EDs and local, state, and federal organizations to address epidemics.
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The purpose of this study was to identify the variables that acutely influence reporting practices in female sexual assault victims presenting to an urban clinic or Emergency Department. We conducted a cross-sectional survey of consecutive female victims during an 18-month study period. Patient demographics, assault characteristics, and injury patterns were recorded in all eligible patients using a standardized classification system. ⋯ Thirty-six percent (152/424) of the eligible population agreed to complete the questionnaire. Only three of the 20 psychosocial variables examined were found to be significantly different in women not reporting sexual assault compared to reporters. The reasons for not reporting were primarily environmental factors (prior relationship with assailant) rather than internal psychological barriers (shame, anxiety, fear).
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Definitive methods for treatment of a Bartholin cyst and abscess include placement of a Word catheter, marsupialization, application of silver nitrate, and surgical excision. Placement of a Word catheter is the most frequently employed technique for office and emergency department (ED) management. However, many institutions do not have the Word catheter available; in addition, the catheter has a tendency to dislodge before epithelialization, leading to recurrence of the cyst. ⋯ This technique may be used as an alternative to placement of a Word catheter for management of Bartholin gland abscess or cyst.
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The Royal Flying Doctor Service (RFDS) has been providing emergency aeromedical retrieval services in Queensland, Australia since 1928. ⋯ The RFDS in Queensland is an effective provider of fixed-wing aeromedical retrieval services, operating in an unusual environment with vast distances, low population density, and a high number of Indigenous people.
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Randomized Controlled Trial Multicenter Study
Bedside ultrasound for the detection of soft tissue foreign bodies: a cadaveric study.
The objective of this study was to evaluate the sensitivity and specificity of bedside ultrasound, as performed by emergency physicians with typical equipment, in detecting small, soft tissue foreign bodies, using a cadaveric model. This was a prospective study, using 6 unembalmed human cadavers and 6 ultrasound-credentialed, emergency medicine residency-trained physicians as sonographers. Incisions were made in 150 total sites of the extremities and each site was randomly assigned one of five groups: wood, metal, plastic, glass, or no foreign body. ⋯ Sensitivity for individual sonographers ranged from 40.8% to 72.3% (average 52.6% +/- 13.3%), and specificity ranged from 30% to 66.7% (average 47.2% +/- 15.1%). Inter-observer reliability was poor. In our model, bedside ultrasound performed by emergency physicians was neither sensitive nor specific for the presence of small soft tissue foreign bodies.