Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 41
Filtrar
Más filtros










Base de datos
Intervalo de año de publicación
1.
J Speech Lang Hear Res ; : 1-18, 2019 Dec 13.
Artículo en Inglés | MEDLINE | ID: mdl-31841365

RESUMEN

Objective The aim of the study was to conduct a meta-analysis of research examining the early speech and language functioning of young children, birth to age 8;11 (years;months), with nonsyndromic cleft lip and/or palate (NSCL/P) compared to their peers without NSCL/P. Method We conducted a random-effects metaregression using 241 effect sizes from 31 studies comparing 955 young children with NSCL/P to 938 typically developing peers on measures of speech and language functioning. Moderators were sample characteristics (i.e., age, cleft type, publication year, and study location) and measurement characteristics (i.e., speech sample material, language modality and domain, and assessment type). Results Young children with NSCL/P scored significantly lower on measures of speech and language compared to children without NSCL/P. Children with NSCL/P had smaller consonant inventories (standardized mean difference effect size [ESg] = -1.24), less accurate articulation (ESg = -1.13), and more speech errors (ESg = 0.93) than their peers. Additionally, children with NSCL/P had poorer expressive (ESg = -0.57) and receptive (ESg = -0.59) language skills than their peers. Age and assessment type moderated effect sizes for expressive language. As children with NSCL/P aged, their expressive language performance became more similar to their peers. Expressive language effect sizes from parent reports and observational language measures (estimated effect size = -0.74) were significantly lower than those from standardized norm-referenced tests (estimated effect size = -0.45). Conclusions These findings suggest that young children with NSCL/P experience delays relative to their peers across multiple speech and language constructs. Differences between children with NSCL/P and their typically developing peers appear to decrease with age. Supplemental Material https://doi.org/10.23641/asha.11356904.

2.
Prehosp Disaster Med ; 34(4): 401-406, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31389327

RESUMEN

INTRODUCTION: The aim of this study was to determine if school personnel can understand and apply the Sort, Assess, Life-saving interventions, Treat/Transport (SALT) triage methods after a brief training. The investigators predicted that subjects can learn to triage with accuracy similar to that of medically trained personnel, and that subjects can pass an objective-structured clinical exam (OSCE) evaluating hemorrhage control. METHODS: School personnel were eligible to participate in this prospective observational study. Investigators recorded subject demographic information and prior medical experience. Participants received a 30-minute lecture on SALT triage and a brief lecture and demonstration of hemorrhage control and tourniquet application. A test with brief descriptions of mass-casualty victims was administered immediately after training. Participants independently categorized the victims as dead, expectant, immediate, delayed, or minimal. They also completed an OSCE to evaluate hemorrhage control and tourniquet application using a mannequin arm. RESULTS: Subjects from two schools completed the study. Fifty-nine were from a private school that enrolls early childhood through grade eight, and 45 from a public school that enrolls grades seven and eight (n = 104). The average subject age was 45 years and 68% were female. Approximately 81% were teachers and 87% had prior cardiopulmonary resuscitation (CPR) training. Overall triage accuracy was 79.2% (SD = 10.7%). Ninety-six (92.3%) of the subjects passed the hemorrhage control OSCE. CONCLUSIONS: After two brief lectures and a short demonstration, school personnel were able to triage descriptions of mass-casualty victims with an overall accuracy similar to medically trained personnel, and most were able to apply a tourniquet correctly. Opportunities for future study include integrating high-fidelity simulation and mock disasters, evaluating for knowledge retention, and exploring the study population's baseline knowledge of medical care, among others.

3.
AEM Educ Train ; 3(2): 188-192, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31008431

RESUMEN

Background: Traditional medical education strategies teach learners how to correctly perform procedures while neglecting to provide formal training on iatrogenic error management. Error management training (EMT) requires active exploration as well as explicit encouragement for learners to make and learn from errors during training. Simulation provides an excellent methodology to execute a curriculum on iatrogenic procedural complication management. We hypothesize that a standardized simulation-based EMT curriculum will improve learner's confidence, cognitive knowledge, and performance in iatrogenic injury management. Methods: This was a pilot, prospective, observational study performed in a simulation center using a curriculum developed to educate resident physicians on iatrogenic procedural complication management. Pre- and postintervention assessments included confidence surveys, cognitive questionnaires, and critical action checklists for six simulated procedure complications. Assessment data were analyzed using medians and interquartile ranges (IQRs), and the paired change scores were tested for median equality to zero via Wilcoxon signed rank tests with p < 0.05 considered statistically significant. Results: Eighteen residents participated in the study curriculum. The median (IQR) confidence increased significantly by a summed score of 12.5 (8.75-17.25; p < 0.001). Similarly, the median (IQR) knowledge significantly increased by 6 (3-8) points from the pre- to postintervention assessment (p < 0.001). For each of the simulation cases, the number of critical actions performed increased significantly (p < 0.001 to p = 0.002). Conclusion: We demonstrated significant improvement in the confidence, clinical knowledge, and performance of critical actions after the completion of this curriculum. This pilot study provides evidence that a structured EMT curriculum is an effective method to teach management of iatrogenic injuries.

4.
Am J Emerg Med ; 2019 Apr 13.
Artículo en Inglés | MEDLINE | ID: mdl-31023586

RESUMEN

BACKGROUND: Emergency department (ED) frequent users have high resource utilization and associated costs. Many interventions have been designed to reduce utilization, but few have proved effective. This may be because this group is more heterogeneous than initially assumed, limiting the effectiveness of targeted interventions. The purpose of this study was to identify and describe distinct subgroups of ED frequent users and to estimate costs to provide hospital-based care to each group. METHODS: Latent class analysis was used to identify homogeneous subgroups of ED frequent users. ED frequent users (n = 5731) from a single urban tertiary hospital-based ED and level 1 trauma center in 2014 were included. Descriptive statistics (counts and percentages) are described to characterize subgroups. A cost analysis was performed to examine differences in direct medical costs between subgroups from the healthcare provider perspective. RESULTS: Four subgroups were identified and characterized: Short-term ED Frequent Users, Heart-related ED Frequent Users, Long-term ED Frequent Users, and Minor Care ED Frequent Users. The Heart-related group had the largest per person costs and the Long-term group had the largest total group costs. CONCLUSION: Distinct subgroups of ED frequent users were identified and described using a statistically objective method. This taxonomy of ED frequent users allows healthcare organizations to tailor interventions to specific subgroups of ED frequent users who can be targeted with tailored interventions. Cost data suggest intervention for long-term ED frequent users offers the greatest cost-avoidance benefit from a hospital perspective.

5.
J Cyst Fibros ; 18(1): 127-134, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-29937318

RESUMEN

BACKGROUND: Pulmonary disease remains the primary cause of morbidity and mortality for individuals with cystic fibrosis (CF). Variants at a locus on the X-chromosome containing the type 2 angiotensin II receptor gene (AGTR2) were identified by a large GWAS as significantly associating with lung function in CF patients. We hypothesized that manipulating the angiotensin-signaling pathway may yield clinical benefit in CF. METHODS: Genetic subset analysis was conducted on a local CF cohort to extend the GWAS findings. Next, we evaluated pulmonary function in CF mice with a deleted AGTR2 gene, and in those who were given subcutaneous injections of PD123,319, a selective AGTR2 antagonist for 12 weeks beginning at weaning. RESULTS: The genetic subset analysis replicated the initial GWAS identified association, and confirmed the association of this locus with additional lung function parameters. Studies in genetically modified mice established that absence of the AGTR2 gene normalized pulmonary function indices in two independent CF mouse models. Further, we determined that pharmacologic antagonism of AGTR2 improved overall pulmonary function in CF mice to near wild-type levels. CONCLUSIONS: These results identify that reduced AGTR2 signaling is beneficial to CF lung function, and suggest the potential of manipulating the angiotensin-signaling pathway for treatment and/or prevention of CF pulmonary disease. Importantly, the beneficial effects were not CF gene mutation dependent, and were able to be reproduced with pharmacologic antagonism. As there are clinically approved drugs available to target the renin-angiotensin signaling system, these findings may be quickly translated to human clinical trials.

6.
Pediatrics ; 142(2)2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-30026243

RESUMEN

CONTEXT: A large number of studies have shown a relationship between language disorders and problem behaviors; however, methodological differences have made it difficult to draw conclusions from this literature. OBJECTIVE: To determine the overall impact of language disorders on problem behaviors in children and adolescents between the ages of birth and 18 years and to investigate the role of informant type, age, and type of problem behavior on this relationship. DATA SOURCES: We searched PubMed, EBSCO, and ProQuest. STUDY SELECTION: Studies were included when a group of children with language disorders was compared with a group of typically developing children by using at least 1 measure of problem behavior. DATA EXTRACTION: Effect sizes were derived from all included measures of problem behaviors from each study. RESULTS: We included 47 articles (63 153 participants). Meta-analysis of these studies revealed a difference in ratings of problem behaviors between children with language disorders and typically developing children of moderate size (g = 0.43; 95% confidence interval 0.34 to 0.53; P < .001). Age was entered as a moderator variable, and results showed that the difference in problem behavior ratings increases with child age (increase in g for each additional year in age = 0.06; 95% confidence interval 0.02 to 0.11; P = .004). LIMITATIONS: There was considerable heterogeneity in the measures of problem behaviors used across studies. CONCLUSIONS: Children with language disorders display greater rates of problem behaviors compared with their typically developing peers, and this difference is more pronounced in older children.


Asunto(s)
Trastornos de la Conducta Infantil/epidemiología , Trastornos de la Conducta Infantil/psicología , Trastornos del Lenguaje/epidemiología , Trastornos del Lenguaje/psicología , Problema de Conducta/psicología , Niño , Trastornos de la Conducta Infantil/diagnóstico , Desarrollo Infantil/fisiología , Humanos , Trastornos del Lenguaje/diagnóstico
7.
J Ultrasound Med ; 37(8): 1985-1992, 2018 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-29388234

RESUMEN

OBJECTIVES: Telepresent education is becoming an important modality in medical education, as it provides a means for instructors to lead education sessions via videoconferencing technologies. This study aimed to compare the effectiveness of telepresent ultrasound training versus traditional in-person ultrasound training. METHODS: Medical student cohorts were educated by either traditional in-person instruction or telementoring on how to perform a focused assessment with sonography for trauma (FAST) examination. Effectiveness was evaluated by pre- and post-multiple-choice tests (knowledge), confidence surveys, and summative simulation scenarios (hands-on FAST simulation). Formative simulation scenario debriefings were evaluated by each student using the Debriefing Assessment for Simulation in Healthcare student version (DASH-SV). RESULTS: Each method of instruction had significant increases in knowledge, confidence, and hands-on FAST simulation performance (P < .05). The collective increase in knowledge was greater for the in-person group, whereas the improvement in FAST examination performance during simulations was greater for the telementored group. Confidence gains were comparable between the groups. The DASH-SV scores were significantly higher for the in-person group for each criterion; however, both methods were deemed effective via median scoring. CONCLUSIONS: Telepresent education is a viable option for teaching the FAST examination to medical students.


Asunto(s)
Competencia Clínica/estadística & datos numéricos , Entrenamiento Simulado/métodos , Estudiantes de Medicina , Ultrasonido/educación , Videoconferencia , Adulto , Curriculum , Femenino , Humanos , Masculino , Proyectos Piloto , Adulto Joven
8.
Cleft Palate Craniofac J ; 55(2): 276-286, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29351026

RESUMEN

OBJECTIVE: The purpose of this study was to investigate the influences of child speech intelligibility and rate on caregivers' linguistic responses. DESIGN: This study compared the language use of children with cleft palate with or without cleft lip (CP±L) and their caregivers' responses. Descriptive analyses of children's language and caregivers' responses and a multilevel analysis of caregiver responsivity were conducted to determine whether there were differences in children's productive language and caregivers' responses to different types of child utterances. SETTING: Play-based caregiver-child interactions were video recorded in a clinic setting. PARTICIPANTS: Thirty-eight children (19 toddlers with nonsyndromic repaired CP±L and 19 toddlers with typical language development) between 17 and 37 months old and their primary caregivers participated. MAIN OUTCOME MEASURES: Child and caregiver measures were obtained from transcribed and coded video recordings and included the rate, total number of words, and number of different words spoken by children and their caregivers, intelligibility of child utterances, and form of caregiver responses. RESULTS: Findings from this study suggest caregivers are highly responsive to toddlers' communication attempts, regardless of the intelligibility of those utterances. However, opportunities to respond were fewer for children with CP±L. Significant differences were observed in children's intelligibility and productive language and in caregivers' use of questions in response to unintelligible utterances of children with and without CP±L. CONCLUSIONS: This study provides information about differences in children with CP±L's language use and caregivers' responses to spoken language of toddlers with and without CP±L.


Asunto(s)
Cuidadores/psicología , Fisura del Paladar/fisiopatología , Inteligibilidad del Habla , Preescolar , Femenino , Humanos , Lactante , Masculino , Grabación en Video
9.
Cleft Palate Craniofac J ; 55(7): 941-953, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-27723377

RESUMEN

OBJECTIVE: This study compares the early speech and language development of children with cleft palate with or without cleft lip who were adopted internationally with children born in the United States. DESIGN: Prospective longitudinal description of early speech and language development between 18 and 36 months of age. PARTICIPANTS: This study compares four children (age range = 19 to 38 months) with cleft palate with or without cleft lip who were adopted internationally with four children (age range = 19 to 38 months) with cleft palate with or without cleft lip who were born in the United States, matched for age, gender, and cleft type across three time points over 10 to 12 months. MAIN OUTCOME MEASURES: Children's speech-language skills were analyzed using standardized tests, parent surveys, language samples, and single-word phonological assessments to determine differences between the groups. RESULTS: The mean scores for the children in the internationally adopted group were lower than the group born in the United States at all three time points for expressive language and speech sound production measures. Examination of matched pairs demonstrated observable differences for two of the four pairs. No differences were observed in cognitive performance and receptive language measures. CONCLUSIONS: The results suggest a cumulative effect of later palate repair and/or a variety of health and environmental factors associated with their early circumstances that persist to age 3 years. Early intervention to address the trajectory of speech and language is warranted. Given the findings from this small pilot study, a larger study of the long-term speech and language development of children who are internationally adopted and have cleft palate with or without cleft lip is recommended.


Asunto(s)
Niño Adoptado , Labio Leporino/fisiopatología , Fisura del Paladar/fisiopatología , Desarrollo del Lenguaje , Trastornos del Habla/fisiopatología , Preescolar , China , Femenino , Humanos , Lactante , Estudios Longitudinales , Masculino , Proyectos Piloto , Estudios Prospectivos , Medición de la Producción del Habla , Estados Unidos
11.
Am J Speech Lang Pathol ; 26(3): 806-818, 2017 Aug 15.
Artículo en Inglés | MEDLINE | ID: mdl-28586828

RESUMEN

Purpose: The purpose of this pilot study was to investigate the extent to which a naturalistic communication intervention, enhanced milieu teaching with phonological emphasis (EMT+ PE), improved the language and speech outcomes of toddlers with cleft lip and/or palate (CL/P). Method: Nineteen children between 15 and 36 months (M = 25 months) with nonsyndromic CL/P and typical cognitive development were randomly assigned to a treatment (EMT+PE) or nontreatment, business-as-usual (BAU), experimental condition. Participants in the treatment group received forty-eight 30-min sessions, biweekly during a 6-month period. Treatment was delivered in a university clinic by trained speech language pathologists; fidelity of treatment was high across participants. Results: Children in the treatment group had significantly better receptive language scores and a larger percentage of consonants correct than children in the BAU group at the end of intervention. Children in the treatment group made greater gains than children in the BAU group on most language measures; however, only receptive language, expressive vocabulary (per parent report), and consonants correct were significant. Conclusions: The results of this preliminary study indicate that EMT+PE is a promising early intervention for young children with CL/P. Replication with a larger sample and long-term follow-up measures are needed.


Asunto(s)
Lenguaje Infantil , Fisura del Paladar/rehabilitación , Trastornos del Desarrollo del Lenguaje/rehabilitación , Fonética , Trastornos del Habla/rehabilitación , Patología del Habla y Lenguaje/métodos , Habla , Enseñanza , Factores de Edad , Conducta Infantil , Preescolar , Fisura del Paladar/diagnóstico , Fisura del Paladar/fisiopatología , Fisura del Paladar/psicología , Cognición , Femenino , Humanos , Lactante , Trastornos del Desarrollo del Lenguaje/diagnóstico , Trastornos del Desarrollo del Lenguaje/fisiopatología , Trastornos del Desarrollo del Lenguaje/psicología , Pruebas del Lenguaje , Masculino , Proyectos Piloto , Trastornos del Habla/diagnóstico , Trastornos del Habla/fisiopatología , Trastornos del Habla/psicología , Medición de la Producción del Habla , Factores de Tiempo , Vocabulario
12.
BMC Emerg Med ; 17(1): 16, 2017 05 10.
Artículo en Inglés | MEDLINE | ID: mdl-28486935

RESUMEN

BACKGROUND: There is no common understanding of how needs of emergency department (ED) frequent users differ from other patients. This study sought to examine how to best serve this population. Examinations of why ED frequent users present to the ED, what barriers to care exist, and what service offerings may help these patients achieve an optimal level of health were conducted. METHODS: We performed a prospective study of frequent ED users in an adult only, level 1 trauma center with approximately 90,000 visits per year. Frequent ED users were defined as those who make four or more ED visits in a 12 month period. Participants were administered a piloted structured interview by a trained researcher querying demographics, ED usage, perceived barriers to care, and potential aids to maintaining health. RESULTS: Of 1,523 screened patients, 297 were identified as frequent ED users. One hundred frequent ED users were enrolled. The mean age was 48 years (95% CI 45-51). The majority of subjects were female (64%, 64/100, 95% CI 55-73%), white (61%, 60/98, 95% CI 52-71%) and insured by Medicaid (55%, 47/86, 95% CI 44-65%) or Medicare (23%, 20/86, 95% CI 14-32%). Subjects had a median of 6 ED visits, and 2 inpatient admissions in the past 12 months at this hospital. Most frequent ED users (61%, 59/96, 95% CI 52-71%) stated the primary reason for their visit was that they felt that their health problem could only be treated in an ED. Transportation presented as a major barrier to few patients (7%, 7/95, 95% CI 3-14%). Subjects stated that "after-hours options, besides the ED for minor health issues" (63%, 60/95, 95% CI 53-73%) and having "a nurse to work with you one-on-one to help manage health care needs" (53%, 50/95, 95% CI 43-63%) would be most helpful in achieving optimal health. CONCLUSION: This study characterized ED frequent users and identified several opportunities to better serve this population. By understanding barriers to care from the patient perspective, health systems can potentially address unmet needs that prevent wellness in this population.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Encuestas y Cuestionarios , Centros Traumatológicos/estadística & datos numéricos
13.
Am J Emerg Med ; 35(7): 983-985, 2017 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-28209392

RESUMEN

PURPOSE/OBJECTIVE: With an elderly and chronically ill patient population visiting the emergency department, it is important to know patients' wishes regarding care preferences and advanced directives. Ohio law states DNR orders must be transported with the patient when they leave an extended care facility (ECF). We reviewed the charts of ECF patients to evaluate which patients presenting to the ED had their DNR status recognized by the physician and DNR orders that were made during their hospital stay. METHODS: We prospectively enrolled patients presenting from ECFs to the ED, blinding the treating team to the purpose. We did a chart review for the presence of a DNR form, demographic data and acknowledgement of the DNR forms. RESULTS: Fifty patients were enrolled in this study. The mean age was 77.6years and 56% were female. Twenty-eight percent had a DNR order transported to the ED, but 68% had a DNR preference noted in their ECF notes. Registration only noted an advanced directive on 32% of patients (p=0.09). Eighteen percent had a DNR noted by the ED physician (p=0.42). Sixteen percent of patients had a DNR order written by an ED physician while 28% had a DNR order written by a non-ED physician during their inpatient evaluation. Thirty percent had a palliative care consult while in the hospital, but there was no significant association between DNR from the ECF and these consults. CONCLUSIONS: Hospital staff did a poor job of noting DNR preferences and ECFs were inconsistent with sending Ohio DNR forms.


Asunto(s)
Directivas Anticipadas , Enfermedad Crítica , Servicios Médicos de Urgencia/organización & administración , Control de Formularios y Registros/organización & administración , Servicios de Salud para Ancianos , Registros Médicos/estadística & datos numéricos , Instituciones de Cuidados Especializados de Enfermería , Anciano , Anciano de 80 o más Años , Servicio de Urgencia en Hospital , Femenino , Control de Formularios y Registros/normas , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Ohio , Defensa del Paciente , Médicos , Estudios Prospectivos , Órdenes de Resucitación
14.
Prehosp Emerg Care ; 21(3): 390-394, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28103119

RESUMEN

BACKGROUND: The recommended practice for over 30 years has been to routinely immobilize patients with unstable cervical spinal injuries using cervical spinal collars. It is shown that patients with Ankylosing spondylitis (AS) are four times more likely to suffer a spinal fracture compared to the general population and have an eleven-fold greater risk of spinal cord injury. Current protocols of spinal immobilization were responsible for secondary neurologic deterioration in some of these patients. OBJECTIVE: To describe an iatrogenic injury resulting from the use of a rigid spinal board and advocate for the use of alternative immobilization methods or no immobilization at all. CASE: We present our case here of a 68-year-old male with a history of AS. The patient was ambulatory on scene after a low speed car accident, but immobilized with a rigid backboard by paramedics. He developed back pain and paraplegia suddenly when the backboard was lifted for transport to the hospital. A CT scan revealed an extension fraction of T10 to T11 with involvement of the posterior column. Emergency spinal fusion was performed. Patient died of complications in the hospital. CONCLUSION: This case shows that spinal immobilization should be avoided in cases of ambulatory patients without a clear indication. Alternative transport methods such as vacuum mattresses should be considered when spinal immobilization is indicated, especially for patients with predispositions to spinal injury, particularly AS, to maintain the natural alignment of the spinal curvature.


Asunto(s)
Inmovilización/efectos adversos , Traumatismos de la Médula Espinal/etiología , Fracturas de la Columna Vertebral/etiología , Férulas (Fijadores)/efectos adversos , Espondilitis Anquilosante/complicaciones , Heridas y Traumatismos/terapia , Anciano , Servicios Médicos de Urgencia , Resultado Fatal , Humanos , Enfermedad Iatrogénica , Inmovilización/instrumentación , Masculino , Traumatismos de la Médula Espinal/diagnóstico por imagen , Fracturas de la Columna Vertebral/diagnóstico por imagen , Tomografía Computarizada por Rayos X
17.
Am J Emerg Med ; 34(7): 1281-5, 2016 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-27162112

RESUMEN

OBJECTIVES: Both sexual assault (SA) survivors and domestic violence (DV) survivors are populations at risk of strangulation injury. Our goal was to identify the prevalence of strangulation in patients who are survivors of SA and DV, identify presence of lethality risk factors in intimate partner violence, and assess differences in strangulation between SA and DV populations. METHODS: We reviewed all patient encounters from our health system's SA/DV forensic nurse examiner program from 2004 to 2008. Medical records were reviewed for documented physical signs of strangulation or documentation of strangulation. Risk factors for lethality included presence of firearm, threats of suicide/homicide by the perpetrator, significant bodily injury, loss of consciousness, loss of bladder or bowel control, voice changes, or difficulty swallowing. Data were analyzed with Pearson χ(2) and 95% confidence intervals (CIs). RESULTS: A total of 1542 encounters were reviewed. The mean patient age was 30 (range, 13-98) years and 97% were female. Six hundred forty-nine encounters were for DV assaults and 893 were SA. An intimate partner was the assailant 46% of the time; 84% DV vs 16% SA (P<.001). Patients reported strangulation in 23% (351/1542; 95% CI, 21%-25%) of their assaults. The prevalence of strangulation was 38% with DV and 12% with SA (P<.001). Most of the intimate partner encounters with strangulation had significant risk for lethality (97%, 261/269; 95% CI, 94%-99%). CONCLUSIONS: Patients presenting to our forensic nurse examiner program who were survivors of DV were more likely than SA patients to sustain strangulation. Lethality risk factors were common.


Asunto(s)
Asfixia/epidemiología , Violencia Doméstica/estadística & datos numéricos , Delitos Sexuales/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
18.
J Grad Med Educ ; 8(2): 252-5, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-27168898

RESUMEN

Background In the past few years, there has been rapid growth in the number of simulation fellowships for physicians in the United States and Canada, with the objective of producing faculty with expertise and leadership training in medical simulation. Relatively little is known about the collective content and structure of these new fellowship opportunities. Objective We sought to identify a common set of core curricular elements among existing simulation fellowships and to obtain demographic background information on participants and leadership. Methods We designed a web-based survey and circulated it to simulation fellowship directors in the United States and Canada. The questions explored aspects of the fellowship curriculum. A grounded theory approach was used to qualitatively analyze fellowship goals and objectives. Results Of the 29 program directors surveyed, 23 responded (79%). The most commonly listed goals and objectives were to increase skills in simulation curriculum development, simulation operations and training environment setup, research, educational theory, administration, and debriefing. The majority of the responding fellowship directors (17 of 22, 77%) indicated that a set of consensus national guidelines would benefit their fellowship program. Conclusions Simulation fellowships are experiencing a period of rapid growth. Development of a common set of program guidelines is a widely shared objective among fellowship directors.


Asunto(s)
Curriculum/estadística & datos numéricos , Becas/estadística & datos numéricos , Entrenamiento Simulado , Canadá , Humanos , Encuestas y Cuestionarios , Estados Unidos
19.
Cureus ; 8(3): e534, 2016 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-27096134

RESUMEN

UNLABELLED: OBJECTIVE : The purpose of this study was to elicit feedback from simulation technicians prior to developing the first simulation technician-specific simulation laboratory in Akron, OH. BACKGROUND: Simulation technicians serve a vital role in simulation centers within hospitals/health centers around the world. The first simulation technician degree program in the US has been approved in Akron, OH. To satisfy the requirements of this program and to meet the needs of this special audience of learners, a customized simulation lab is essential. METHOD: A web-based survey was circulated to simulation technicians prior to completion of the lab for the new program. The survey consisted of questions aimed at identifying structural and functional design elements of a novel simulation center for the training of simulation technicians. Quantitative methods were utilized to analyze data. RESULTS: Over 90% of technicians (n=65) think that a lab designed explicitly for the training of technicians is novel and beneficial. Approximately 75% of respondents think that the space provided appropriate audiovisual (AV) infrastructure and space to evaluate the ability of technicians to be independent. The respondents think that the lab needed more storage space, visualization space for a large number of students, and more space in the technical/repair area. CONCLUSIONS : A space designed for the training of simulation technicians was considered to be beneficial. This laboratory requires distinct space for technical repair, adequate bench space for the maintenance and repair of simulators, an appropriate AV infrastructure, and space to evaluate the ability of technicians to be independent.

20.
Am J Emerg Med ; 34(3): 531-5, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26809927

RESUMEN

BACKGROUND: Non-ST-segment elevation myocardial infarctions (NSTEMIs) are more common but less studied than ST-segment elevation myocardial infarctions (STEMIs) treated by emergency medical services (EMS). OBJECTIVE: The purpose of this study was to evaluate the differences in baseline characteristics and outcomes of NSTEMI patients when arriving by EMS vs self-transport. METHODS: We performed a retrospective medical record review of 96 EMS patients and 96 self-transport patients with the diagnosis of NSTEMI based on billing code. RESULTS: The mean age of patients arriving by EMS was 75 vs 65 years for self-transport patients (P≤ .000). Patients arriving by self-transport received cardiac catheterization more often than patients arriving by EMS (84% vs 49%, P≤ .001). Emergency medical services patients had significantly longer average hospital length of stay and intensive care unit length of stay than did patients arriving by self-transport (6.5 vs 4 days [P≤ .001] and 4.1 vs 2.7 days [P= .019]). Significantly more EMS patients were discharged to a new extended care facility (25% vs 3.1%, P≤ .001). Finally, more EMS patients died in the hospital (18.8 vs 4.2%, P= .002). CONCLUSIONS: Patients with NSTEMI who arrived by EMS are older, are more ill, and have worse outcomes compared with patients who arrived by self-transport. Further research into patient reasoning for mode of transportation to the ED may influence public health interventions, public policy development, and EMS and hospital protocols for management of NSTEMIs. The high mortality in prehospital cohort should prompt further investigation to develop evidence-based protocols.


Asunto(s)
Electrocardiografía , Servicios Médicos de Urgencia/estadística & datos numéricos , Infarto del Miocardio/mortalidad , Transporte de Pacientes/métodos , Transporte de Pacientes/estadística & datos numéricos , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Servicios Médicos de Urgencia/métodos , Femenino , Mortalidad Hospitalaria , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Registros Médicos/estadística & datos numéricos , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/terapia , Ohio/epidemiología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Factores de Tiempo , Centros Traumatológicos/estadística & datos numéricos
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA