J Emerg Med
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The study evaluated the impact of rotational assignment of emergency department (ED) patients to residents on patient's length of stay (LOS) and resident satisfaction. The study was conducted in a university, inner-city, adult ED. Prior to the intervention, residents saw patients at their own rate as patient charts were placed into a common rack waiting to be seen. ⋯ During the same periods, the average total LOS increased significantly for the surgical patients. Residents reported that the new system was more fair and did not affect teaching quality. The rotational assignment of patients to resident physicians led to significantly less ED LOS while improving resident satisfaction without affecting education.
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Cutaneous myiasis (myia: Greek word for fly) is an infestation of fly maggots in the skin. A case of human botfly (Dermatobia hominis) myiasis presenting to a Canadian emergency department is described. ⋯ However, the rapidity of international air travel permits this exotic tropical infestation to present in any region. Obtaining a history of recent travel to an endemic area is the key to making the diagnosis and instituting appropriate treatment.
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We present a case of a 98-yr-old woman with acute urinary retention secondary to a large urethral calculus. This is a unique cause of obstructive uropathy for several reasons. ⋯ Second, urethral stones in females are nearly always associated with underlying genitourinary pathology; however, subsequent work up failed to reveal any strictures, diverticula, or related processes that may have predisposed this patient to urethral calculus formation. The epidemiology, pathogenesis, clinical presentation, and emergency management of large urethral calculi are reviewed.