The West Virginia medical journal
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Case Reports
Prolonged mechanical ventilation: are your ventilator patients ready to be cared for outside ICU?
A significant number of patients in the ICU require prolonged periods of ventilator support. We present here, four such patients and incorporate the recent recommendations of a consensus conference on prolonged mechanical ventilation. We hope our case studies will enable physicians to better manage and care for this challenging group of patients.
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Staffing of rural emergency departments (ED) with residency-trained, board certified emergency physicians has been an ongoing challenge in the field of Emergency Medicine. ⋯ Just over half of all physicians staffing WV's EDs are residency trained or board certified in EM, a number that lags well behind the national average. Rural EDs report even lower numbers, although the proportion has increased since the 1996 WV study. WV EM practitioners, particularly in more rural locations, continue to provide emergency care with less formal training, certification credentials, and specialty back-up.
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Report cards based on publicly disclosed data abound. Consumers can use the internet to review grades on physicians, hospitals, nursing homes, home health agencies, and insurance plans. The reports differ in their combinations of mortality data, process measures, access scores, and satisfaction surveys. ⋯ Public disclosure of quality data has had little impact on the behavior of consumers, larger purchasers of health care, and physicians. However, health care provider organizations have responded to the public reports of quality. Analysis of the impact of public report cards is lagging as web-available reports rapidly grow and pay for performance programs emerge.
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Twelve cases of pyomyositis treated at a rural tertiary care referral center are reported and compared to other published cases of this disorder in the United States. About 350 cases have been reported nationally and over a quarter of them are in patients infected with human immunodeficiency virus (HIV). ⋯ Imaging studies are conclusive in most cases by the time of presentation. Our series has a predominance of older females, no HIV positive patients and is unique in comparison to previously reported trends and cases.