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The “July Effect” in the intensive care units revisited:A bi-institutional 6-year experience of 57,160 patients

World Journal of Emergency Medicine 2022年第3期13卷 215-218页

作者： Leon Naar Ander D.Gallastegi Raghu R.Seethala B.Christian Renne Michael E.Billington Jasmine Kannikal Haytham M.A.Kaafarani jarone lee Division of Trauma Emergency Surgery&Surgical Critical CareDepartment of SurgeryMassachusetts General HospitalHarvard Medical SchoolBoston 02114-2696USA Division of Emergency Critical Care Medicine Department of Emergency MedicineBrigham and Women's HospitalHarvard Medical SchoolBoston 02115-6195USA Department of Emergency Medicine Massachusetts General HospitalHarvard Medical SchoolBoston 02115-6195USA

July coincides with the beginning of the academic year in teaching hospitals across the United States of America (USA).The increased responsibility assumed by trainees transitioning to a higher role in the healthcare team is hypothesized to lead to poorer patient outcomes,termed the“July Effect”.The consequence of a“July Effect”might be more severe in critical care settings,where the complexity of patients requires a higher level of experience and *** only studies evaluating the“July Effect”in the ICU were published in the early 2000’s.;Since that time,several resident work-hour regulations have been implemented by the Accreditation Council for Graduate Medical Education (ACGME).;These regulations have resulted in more frequent sign-outs,reduced continuity of care,and less clinical time for trainees,which in theory could increase the risk of errors among young trainees at the time they are most vulnerable.

关键词： sized academic assumed

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Emergency department rectal temperatures in over 10 years:A retrospective observational study

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World Journal of Emergency Medicine 2013年第2期4卷 107-112页

作者： Graham A.Walker Daniel Runde Daniel M.Rolston Dan Wiener jarone lee Department of Emergency Medicine Kaiser PermanenteSan FranciscoUSA Department of Emergency Medicine University of CaliforniaLos AngelesUSA Department of Emergency Medicine St.Luke's-Roosevelt Hospital CenterColumbia University College of Physicians and SurgeonsNew YorkUSA Massachusetts General Hospital Harvard Medical SchoolSouth BostonMA 02127USA

BACKGROUND:Fever in patients can provide an important clue to the etiology of a patient's ***-invasive temperature sites(oral,axillary,temporal) may be insensitive due to a variety of *** has not been well studied in adult emergency department *** determine whether emergency department triage temperatures detected fever adequately when compared to a rectal ***:A retrospective chart review was made of 27 130 adult patients in a high volume,urban emergency department over an eight-year period who received first a non-rectal triage temperature and then a subsequent rectal ***:The mean difference in temperatures between the initial temperature and the rectal temperature was 1.3 °F(P2°F,and 5.0%having higher rectal temperatures >4 °*** mean difference among the patients who received oral,axillary,and temporal temperatures was 1.2 °F(PO.001),1.8 °F(PO.001),and 1.2 °F(P<0.001) *** 18.1%of the patients were initially afebrile and found to be febrile by rectal temperature,with an average difference of 2.5 °F(P<0.001).These patients had a higher rate of admission(61.4%,P<0.005),and were more likely to be admitted to the hospital for a higher level of care,such as an intensive care unit,when compared with the full cohort(12.5%vs.5.8%,P<0.005).CONCLUSIONS:There are significant differences between rectal temperatures and noninvasive triage temperatures in this emergency department *** almost one in five patients,fever was missed by triage temperature.

关键词： Rectal temperatures Oral temperatures Axillary temperatures Emergency department

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Traumatic brain injury:A case-based review

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World Journal of Emergency Medicine 2013年第4期4卷 252-259页

作者： Liza Victoria S Escobedo Joseph Habboushe Haytham Kaafarani George Velmahos Kaushal Shah jarone lee Department of Emergency Medicine Beth Israel Medical CenterNew YorkNYUSA Trauma Emergency SurgerySurgical Critical CareMassachusetts General HospitalBostonMAUSA Department of Emergency Medicine Mount Sinai School of MedicineNew YorkNYUSA

BACKGROUND:Traumatic brain injuries are common and costly to hospital *** of the guidelines on management of traumatic brain injuries are taken from the Brain Trauma Foundation *** is a review of the current literature discussing the evolving practice of traumatic brain *** SOURCES:A literature search using multiple databases was performed for articles published through September 2012 with concentration on meta-analyses,systematic reviews,and randomized controlled ***:The focus of care should be to minimize secondary brain injury by surgically decompressing certain hematomas,maintain systolic blood pressure above 90 mmHg,oxygen saturations above 93%,euthermia,intracranial pressures below 20 mmHg,and cerebral perfusion pressure between 60-80 ***:Much is still unknown about the management of traumatic brain *** current practice guidelines have not yet been sufficiently validated,however equipoise is a major issue when conducting randomized control trials among patients with traumatic brain injury.

关键词： Traumatic brain injury Emergency departments Glascow Coma Scale

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