Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties sought to define milestones for skill and knowledge acquisition during residency training. Milestones are significant objective observable events. The milestones are listed within a structure that is derived from the ACGME general competencies. Major groups of milestones are called "subcompetencies." The original 24 subcompetencies containing 255 milestones for emergency medicine (EM) were developed through a multiorganizational group representing most EM stakeholder groups. To assure that the milestones reflected EM resident progress throughout training, the EM Milestones Working Group (EM MWG) sought to validate the individual milestones. ⋯ The EM milestones were validated through a milestone assignment process using a computer-based survey completed by program directors and key faculty. Milestones were revised in accordance with the results to better align assignment within each performance level.
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In 2012, the Accreditation Council for Graduate Medical Education (ACGME) designated ultrasound (US) as one of 23 milestone competencies for emergency medicine (EM) residency graduates. With increasing scrutiny of medical educational programs and their effect on patient safety and health care delivery, it is imperative to ensure that US training and competency assessment is standardized. ⋯ A survey summary of focused EUS education in EM residencies is described, as well as a suggestion for structuring education in residency. Finally, adjuncts to a quantitative measurement of resident competency for EUS are offered.
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Dizziness and vertigo account for roughly 4% of chief symptoms in the emergency department (ED). Little is known about the aggregate costs of ED evaluations for these patients. The authors sought to estimate the annual national costs associated with ED visits for dizziness. ⋯ Total U.S. national costs for patients presenting with dizziness to the ED are substantial and are estimated to now exceed $4 billion per year (about 4% of total ED costs). Rising costs over time appear to reflect the rising prevalence of ED visits for dizziness and increased rates of imaging use. Future economic studies should focus on the specific breakdown of total costs, emphasizing areas of high cost and use that might be safely reduced.
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Comparative Study
The diagnostic value of serum ischemia-modified albumin levels in experimentally induced carbon monoxide poisoning and their correlation with poisoning severity.
The objectives were to determine the diagnostic value of blood ischemia-modified albumin (IMA) levels in experimentally induced carbon monoxide (CO) poisoning and to analyze their correlation with poisoning severity. ⋯ Ischemia-modified albumin levels are higher in rats exposed to CO. This indicates that IMA levels can potentially be important in the diagnosis of exposure to CO or of CO poisoning. However, IMA levels are not a good biochemical marker in terms of determining the severity of poisoning.
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Emergency physicians often encounter females presenting with symptoms suggestive of urinary tract infections (UTIs). The diagnostic accuracy of history, physical examination, and bedside laboratory tests for female UTIs in emergency departments (EDs) have not been quantitatively described. ⋯ No single H&P finding can accurately rule in or rule out UTI in symptomatic women. Urinalysis with a positive nitrite or moderate pyuria and/or bacteruria are accurate predictors of a UTI. If the pretest probability of UTI is sufficiently low, a negative urinalysis can accurately rule out the diagnosis.