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1.
Intern Emerg Med ; 15(2): 351-353, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32034672
2.
J Emerg Med ; 57(6): e205-e208, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31495518

RESUMO

Emergency medicine (EM) has its challenges, downsides, advantages, and accompanying lifestyle. Additionally, graduates of EM residency programs have abundant job opportunities. Accordingly, there is an increased interest in residency training in EM, even among residents with prior training. Transitioning from another specialty to EM can be complicated yet achievable, especially if EM is the transitioning physician's passion and career goal. Therefore, in this article, we elaborate on the transition process from another discipline to EM in light of changes in residency funding. We also explore the advantages and disadvantages of transitioning to EM with previous training in another specialty. Moreover, we expand on credit equivalencies for months already completed in another training programs, as well as the difficulties to be anticipated by transitioning physicians.

3.
Emerg Med J ; 30(3): e15, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22492125

RESUMO

STUDY OBJECTIVE: The Meyer Pediatric Hospital in Florence, Italy recently implemented the single provider model of emergency medicine. Prior to these changes, patients were triaged to a paediatric surgeon or paediatrician based on the complaint. The authors assess the outcomes of patients evaluated by surgeons prior to this change and compare them with those of patients seen by emergency physicians. METHODS: A retrospective, cohort study was performed reviewing patients seen in the emergency department between 2005 and 2008 for the three most common surgical complaints encountered before the systems change: head trauma, testicular pain and abdominal pain. Outcomes include misdiagnoses, consultation rates, dispositions, imaging, interventions and surgeries. RESULTS: A total of 2415 patient visits were included. Emergency physicians saw more patients (1388 vs 1027) and obtained more consultations (25.6% vs 8.1%) than surgeons. Patients triaged directly to surgeons were more likely to be admitted to the hospital (10.3% vs 7.6%), undergo urgent interventions (9.5% vs 6.7%), undergo surgery (8.0% vs 4.8%), have more radiographic images to evaluate head trauma (12.1% vs 5.3%), be misdiagnosed (1.0% vs 0.3%) and have more plain films for abdominal pain (3.1% vs 1.3%). There is an overall trend towards fewer missed diagnoses by emergency physicians (0.3% vs 0.9%), but this difference is only statistically significant in the abdominal pain subset analysis (p=0.032, combined data p=0.052). CONCLUSIONS: The single provider model of emergency medicine where emergency physicians manage all patients presenting to the emergency department appears to be a safe and efficient model of emergency medical care.


Assuntos
Serviço Hospitalar de Emergência , Hospitais Pediátricos , Modelos Organizacionais , Dor Abdominal/diagnóstico , Dor Abdominal/terapia , Distribuição de Qui-Quadrado , Criança , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/terapia , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Humanos , Itália , Masculino , Padrões de Prática Médica/estatística & dados numéricos , Estudos Retrospectivos , Doenças Testiculares/diagnóstico , Doenças Testiculares/terapia , Triagem , Recursos Humanos
4.
J Trauma ; 71(5): 1442-6, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21460744

RESUMO

BACKGROUND: Trauma is the leading cause of death and disability in Italy among patients aged between 1 year and 19 years. To transform its fragmented regional pediatric trauma system to a more organized and efficient spoke and hub model, Tuscany has developed a partnership with physicians from the United States to facilitate the process and to implement a series of strategic system changes to create the first pediatric trauma center in Italy. METHODS: After establishing a multidisciplinary and institutional task force, a rigorous needs assessment was conducted to evaluate resources and develop a strategic timeline with specific project goals. Once an intensive educational program was completed, a series of system changes were made in Tuscany to create a full-service pediatric trauma center. Once accomplished, regional changes were enacted to divert the most severely injured children to the new center. RESULTS: In <3 years, a full-service pediatric trauma center was developed and ingratiated into the adult trauma system. All these changes were achieved through relentless administrative support, creation of a strong sense of urgency, and empowerment of innovators and early adopters to effect change. CONCLUSION: Through a comprehensive process including early extensive system analysis leading to educational interventions and organizational changes, the Anna Meyer Children's Hospital has developed the first Italian pediatric trauma center.


Assuntos
Inovação Organizacional , Pediatria/organização & administração , Centros de Traumatologia/organização & administração , Medicina de Emergência/educação , Humanos , Capacitação em Serviço , Cooperação Internacional , Itália , Determinação de Necessidades de Cuidados de Saúde , Equipe de Assistência ao Paciente/organização & administração , Pediatria/educação , Técnicas de Planejamento , Estados Unidos
5.
Am J Infect Control ; 39(1): 14-8, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20965610

RESUMO

BACKGROUND: Health care-associated infection is one of the most important patient safety problems in the world. While many methods exist to prevent health care-associated infection, most experts believe that improving hand hygiene is paramount. We previously published the results of a successful before-and-after hand hygiene interventional study performed in the pediatric emergency department of the Meyer Hospital in Florence, Italy. The goal of the current study is to assess the longer term sustainability of the previously described intervention. METHODS: Direct observation was used to assess hand hygiene compliance for both doctors and nurses in the emergency department using the same methods and observers as previously employed. RESULTS: In addition to the 420 preintervention and 463 immediately postintervention observations previously reported, we observed another 456 clinician-patient interactions approximately 1 year after the intervention. Among all health care workers, there was no significant difference between hand hygiene compliance immediately postintervention (44.9%) compared with 1 year after the intervention (45.2%). Adherence among nurses, however, increased from 40.7% to 49.8% (P = .03), whereas adherence among doctors decreased from 50.5% to 36.5% (P = .008). CONCLUSION: The overall effects of the intervention were sustained over a 1-year period, although a marked difference was observed between nurses and doctors.


Assuntos
Infecção Hospitalar/prevenção & controle , Serviço Hospitalar de Emergência , Fidelidade a Diretrizes/estatística & dados numéricos , Desinfecção das Mãos/métodos , Atitude do Pessoal de Saúde , Humanos , Itália
6.
Int J Emerg Med ; 3(1): 21-6, 2010 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-20414377

RESUMO

BACKGROUND: There are an increasing number of training programs in emergency medicine involving different countries or cultures. Many examination types, both oral and written, have been validated as useful assessment tools around the world; but learner perception of their use in the setting of cross-cultural training programs has not been described. AIMS: The goal of this study was to evaluate learner perception of four common examination methods in an international educational curriculum in emergency medicine. METHODS: Twenty-four physicians in a cross-cultural training program were surveyed to determine learner perception of four different examination methods: structured oral case simulations, multiple-choice tests, semi-structured oral examinations, and essay tests. We also describe techniques used and barriers faced. RESULTS: There was a 100% response rate. Learners reported that all testing methods were useful in measuring knowledge and clinical ability and should be used for accreditation and future training programs. They rated oral examinations as significantly more useful than written in measuring clinical abilities (p < 0.01). Compared to the other three types of examinations, learners ranked oral case simulations as the most useful examination method for assessing learners' fund of knowledge and clinical ability (p < 0.01). CONCLUSIONS: Physician learners in a cross-cultural, international training program perceive all four written and oral examination methods as useful, but rate structured oral case simulations as the most useful method for assessing fund of knowledge and clinical ability.

7.
J Emerg Med ; 39(2): 234-9, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19703741

RESUMO

BACKGROUND: The Tuscan Emergency Medicine Initiative is a comprehensive training program for physicians designed to create a lasting infrastructure for training in emergency medicine (EM) in a region of Italy. A "Train-the-Trainers" model was utilized to prepare physicians who were working in the emergency department (ED) to become the teachers of EM, and a master's program was created to train the next generation of emergency physicians as well as to put in place a structure into which residency training in EM will be placed. This model has been used in other projects as well; however, the dilemma of what to do with physicians who are already in practice remained an unsolved problem. OBJECTIVES: We wished to create a qualification course in EM for this important group of physicians. METHODS: Didactic lectures, workshops, simulations, and clinical rotations were utilized to standardize current emergency care delivery in the region's EDs. RESULTS: Between 2005 and 2008, 488 physicians completed the program. CONCLUSIONS: We propose this model as a way of training and including the physicians caught in the transition to specialty training in any area developing the specialty of EM.


Assuntos
Currículo , Educação Médica Continuada/métodos , Medicina de Emergência/educação , Medicina de Emergência/normas , Humanos , Itália
8.
Acad Emerg Med ; 15(7): 678-82, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19086325

RESUMO

The Tuscan Emergency Medicine Initiative (TEMI) is a comprehensive emergency medicine (EM) training program designed to build an EM training infrastructure in Tuscany, Italy. The program has successfully trained a team of instructors using a train-the-trainers model, certified 350 physicians who are already practicing in emergency departments (EDs), and established a master's program as a bridge to specialty training at the region's three universities. Using lessons learned from this program, the authors identify eight factors (The Eight Cs) that can serve as a guide to implementing a collaborative EM program in other environments: collaboration, context, culture, credibility, consulting, consistency, critique, and conclusion. Each of these topics is described in detail and may be useful to other international interventions.


Assuntos
Medicina de Emergência/educação , Intercâmbio Educacional Internacional , Humanos , Itália
10.
Eur J Emerg Med ; 15(2): 75-9, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18446068

RESUMO

OBJECTIVE: To measure the effectiveness of a 9-month emergency medicine 'train the trainers' program in Tuscany, Italy. METHODS: A total of 81 physicians with emergency department experience completed a training course in Italy. The course included 120 h of didactic lectures, 700 h of clinical rotations and 30 h of practical workshops. The effect of the training course was measured by written multiple-choice and oral case-simulation examinations, and a precourse and postcourse self-assessment instrument using a four-point Likert scale, to describe the ability to care for different types of emergency medicine patients. RESULTS: Twenty-four physicians completed the course in 2003-2004 and 57 physicians completed the course in 2004-2005. A comparison of an identical examination given as a posttest to the first group and a pretest to the second group demonstrated significant improvement on a 75-question multiple-choice examination (38.7 vs. 46.2 points, P<0.001). Improvement was also seen in oral case examinations, in pediatrics (17.8 vs. 37.3 points, P<0.001) and neurology (24.8 vs. 34.5, P<0.001). In the self-assessment survey, when asked to describe the ability to diagnose and provide initial treatment for several types of patients before and after the course, significant improvement was reported by 13 of 20 participants (65%). When asked to describe the ability to perform a variety of procedures, significant improvement was seen in seven of sixteen (44%). CONCLUSIONS: When measured by written examinations, oral examinations and physician self-assessment, a train the trainers program, designed as part of an international emergency medicine collaboration, was efficacious.


Assuntos
Educação Médica Continuada , Educação de Pós-Graduação em Medicina , Medicina de Emergência/educação , Docentes de Medicina , Intercâmbio Educacional Internacional , Competência Clínica , Educação Médica Continuada/normas , Educação de Pós-Graduação em Medicina/normas , Avaliação Educacional , Medicina de Emergência/normas , Europa (Continente) , Humanos , Itália , Avaliação de Programas e Projetos de Saúde , Padrões de Referência , Estados Unidos
12.
Int J Emerg Med ; 1(2): 127-9, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19384664

RESUMO

INTRODUCTION: Intubation is one of the most important life-saving procedures performed by emergency physicians (EPs). There is variation in practice when different countries are compared. METHODS: A written questionnaire on intubation practices was administered to a group of Italian doctors practicing in Tuscany during the examination period of a year-long course in emergency medicine. RESULTS: The survey was administered to 153 participants. Of these, 143 (93.4%) returned a complete survey. In the sub-group of physicians who work in the emergency department (ED), 73.6% report intubating patients. Of those that intubate patients, 92.3% use some sort of sedation, and 49.3% use paralytics. While direct visualization of the cords for intubation and auscultation of breath sounds after intubation are almost universal (97% and 100%, respectively), only 11.9% use colorimetric CO2 detectors for confirmation of intubation. After intubation 58.2% commonly place a nasogastric tube and 50.7% obtain a post intubation chest radiograph. CONCLUSIONS: Practice patterns in the USA and Tuscany are different. RSI and post-intubation radiographs are the standard of care in EDs in the USA. This is not the case in Tuscany.

13.
Ann Emerg Med ; 50(6): 726-32, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17766008

RESUMO

Italy lacks standardized specialty training in emergency medicine. There is no system of national or regional accreditation of the knowledge base or skill set of physicians working in regional emergency departments (ED), which results in variability of emergency medical care delivery not only between hospital EDs but also within individual EDs. To address this need, the Tuscan Minister of Health chose to develop a partnership with emergency medicine specialists from the United States to help expedite the growth of the specialty in Tuscany. The collaboration called the Tuscan Emergency Medicine Initiative consists of the regional health care service, the Tuscan university system, Harvard Medical International, and the Beth Israel Deaconess Medical Center Department of Emergency Medicine. We describe that effort and process, with an expectation of more than 625 physicians completing the program by June 2008.


Assuntos
Educação Médica/organização & administração , Medicina de Emergência/educação , Desenvolvimento de Programas/métodos , Currículo , Serviços Médicos de Emergência/organização & administração , Docentes de Medicina , Humanos , Cooperação Internacional , Internato e Residência/organização & administração , Itália , Estados Unidos
15.
Intern Emerg Med ; 1(2): 139-47, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-17111789

RESUMO

Airway management is unequivocally the most important responsibility of the emergency physician. No matter how prepared for the task, no matter what technologies are utilized, there will be cases that are difficult. The most important part of success in the management of a difficult airway is preparation. When the patient is encountered, it is too late to check whether appropriate equipment is available, whether a rescue plan has been in place, and what alternative strategies are available for an immediate response. The following article will review the principles of airway management with an emphasis upon preparation, strategies for preventing or avoiding difficulties, and recommended technical details that hopefully will encourage the reader to be more prepared and technically skillful in practice.


Assuntos
Obstrução das Vias Respiratórias , Cartilagem Cricoide/cirurgia , Emergências , Tratamento de Emergência , Intubação Intratraqueal/métodos , Cartilagem Tireóidea/cirurgia , Adulto , Auscultação , Criança , Traumatismos Craniocerebrais , Medicina de Emergência , Serviço Hospitalar de Emergência , Traumatismos Faciais , Escala de Coma de Glasgow , Humanos , Laringoscopia , Masculino , Traumatismo Múltiplo , Lesões do Pescoço , Fatores de Risco , Toracotomia , Fatores de Tempo , Ferimentos por Arma de Fogo , Ferimentos não Penetrantes , Ferimentos Perfurantes
17.
20.
Intern Emerg Med ; 1(1): 67-71, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16941817

RESUMO

OBJECTIVE: The Tuscan Emergency Medicine Initiative is an international collaboration designed to create a sustainable emergency medicine training and qualification process in Tuscany, Italy. Part of the program involves training all emergency physicians currently practicing in the region. This qualification process includes didactic lectures, clinical rotations and practical workshops for those with significant emergency department experience. Lectures in the didactic portion were given by both emergency medicine (EM) and non-EM faculty. We hypothesized that faculty who worked clinically in EM would give more effective lectures than non-EM faculty. METHODS: Fifty-one emergency physicians from the hospitals surrounding Florence completed the course, which included 48 one-hour lectures. Twenty lectures were given by practicing emergency physicians and 28 were given by non-EM faculty. Participants completed an evaluation at the end of each session using a 5-point Likert scale describing the pertinence of the lecture to EM, the efficacy and clarity of the presentation, the accuracy of the information and the didactic ability of the lecturer. RESULTS: A mean of 38.5 evaluations was completed for each lecture. Every factor was significantly higher for lectures given by EM faculty: the pertinence of the lecture to EM (4.46 vs. 4.16, p < 0.001), the efficacy of the faculty (4.10 vs. 3.91, p < 0.001), the accuracy of the lecture content (4.16 vs 3.96, p < 0.001), and the didactic ability of the instructors (4.02 vs. 3.85, p = 0.001). CONCLUSIONS: When teaching EM, evaluations of lectures in this training intervention were higher for lectures given by EM faculty than by non-EM faculty.


Assuntos
Medicina de Emergência/educação , Intercâmbio Educacional Internacional , Ensino , Humanos , Itália , Fatores de Tempo
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