Proceedings (Baylor University. Medical Center)
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Proc (Bayl Univ Med Cent) · Apr 2017
Pre and post hoc analysis of electronic health record implementation on emergency department metrics.
Longitudinal time-based emergency department (ED) performance measures were quantified 12 months before and 12 months after (March 2012-February 2014) implementation of a Meditech 6.0® electronic health record (EHR) at a single urban academic ED. Data assessed were length of stay from door to door, door to admission, door to bed, bed to provider, provider to disposition, and disposition to admission, as well as number of patients leaving against medical advice and number of patients leaving without being seen. Analysis of variance was used to compare levels before and after EHR implementation for each variable, with adjustments made for the number of admissions, transfers, and month. ⋯ Thus, EHR implementation was associated with an increase in time with most performance metrics. Although general times trended back to near preimplementation baselines, most ED time metrics remained elevated beyond the study length of 12 months. Understanding the impact of EHR system implementation on the overall performance of an ED can help departments prepare for potential adverse effects of such systems on overall efficiency.
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Proc (Bayl Univ Med Cent) · Jan 2017
Factors associated with performance in an internal medicine clerkship.
The purpose of this retrospective study was to examine the relationship between demographic and educational variables and student performance on an internal medicine (IM) clerkship in order to target areas for educational intervention and potential early remediation. This study examined data associated with third-year medical student performance (N = 505) during the IM clerkship at Baylor Scott & White, Temple/Texas A&M Health Science Center College of Medicine from 2005 to 2011. Multiple regression analysis (N = 341) showed that a model containing the following variables was significantly associated with scores on the National Board of Medical Examiners (NBME) subject exam, accounting for 46.5% of the variance: Objective Structured Clinical Exam (OSCE), Medical College Admissions Test (MCAT), US Medical Licensing Exam (USMLE) Step 1, second-year grade point average (GPA), and clinical evaluation. ⋯ In conclusion, in contrast to previous studies in the field, we did not find a significant association between undergraduate GPA and NBME score. Our findings supply further evidence that the OSCE, typically believed to be a clinical performance exam, actually assesses a broader set of domains. Interest group membership did not confer any academic benefit to medical students in IM clerkships in our study.
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Proc (Bayl Univ Med Cent) · Jan 2017
Case ReportsB-cell lymphoma, thiamine deficiency, and lactic acidosis.
Type B lactic acidosis is found in the absence of tissue hypoperfusion, can be associated with malignancies, and can be caused by thiamine deficiency. We present a patient who presented with an abdominal mass that biopsy disclosed to be a diffuse large B-cell lymphoma. ⋯ The level prior to treatment was low. The case emphasizes a rare cause of lactic acidosis.
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Proc (Bayl Univ Med Cent) · Jan 2017
Case ReportsAn approach for safe conversion of an oral endotracheal tube to a nasal endotracheal tube.
We present an approach for safe management of a patient with an oral endotracheal tube who required conversion to a nasal endotracheal tube. A 35-year-old man presented for mandibular fracture repair after multiple injuries sustained in a motor vehicle accident. The patient already had an oral endotracheal tube, and the surgical team requested a nasal endotracheal tube to facilitate surgical exposure and postoperative airway management in anticipation of a wired jaw. ⋯ A tracheal tube introducer was inserted through the oral endotracheal tube, and the oral endotracheal tube was then withdrawn approximately 5 cm. The nasal endotracheal tube was advanced through the vocal cords alongside the tracheal tube introducer. The nasal endotracheal tube cuff was then inflated and the tracheal tube introducer was withdrawn.
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Proc (Bayl Univ Med Cent) · Oct 2016
Case ReportsEpipericardial fat necrosis as a cause of acute chest pain.
Acute chest pain is one of the most common reasons for presentation to the emergency department. Although most etiologies of chest pain are easy to clinically ascertain with routine history, physical, and laboratory examinations, we present an important benign cause of acute chest pain that may mimic acute coronary syndrome.