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The relative value of education of emergency physicians in patient outcome: A retrospective analysis at a single center in developing India

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World Journal of Emergency Medicine 2018年第2期9卷 130-135页

作者： Shastri Vandana Singh Shubnum kole tamorish Department of Emergency Medicine and Max Institute of Medical Excellence Max Super Specialty Hospital

BACKGROUND: There is a considerable paucity with regards to the research available on the quality and quantity of clinical teaching in the national emergency department(ED) setups. With the onset of the age of modern medicine, the outlook towards to the time worn tradition of triage and detailed medical evaluation must be revoked. Despite the variety of programs being conducted in the country, a comparable entity common to all is patients' clinical outcomes which can be measured using simple parameters which can be easily acquired compiling hospital registry ***: A retrospective observational study was conducted in the emergency department of Max Hospital, Saket, New Delhi. A period of 22 months prior to the start of the program and like-wise 22 months after initiation of the program was collected from the hospital registry. The Emergency Medicine program in consideration was the Masters in emergency Medicine(MEM) Program affiliated with George Washington University, NY, USA. Patients of all age groups and gender registering in the Emergency Department and so were all the doctors working in the ED before and after initiation of the ***: An improvement was noted in terms of total admissions through the ED per month, average length of stay of admitted as well as discharged patients; return to ED within 24 hours; leave against medical advice and patient complaints. A reduction was noted in number of discharges from the ED. Despite a numerical worsening on the patient's death in ED a graphical improvement can be noted considering the month wise representation of ***: We can make a coherent conclusion that there is an improvement in the outcome of the entire patient related aspects in the Emergency Department considering the all two time frames included in the study. The difference can be very well attributed to the integration of the structural Academic Program in the development of the Emergency Physicians. This leads us to make a co

关键词： Education Emergency physicians

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A correlation analysis of BroselowTM Pediatric Emergency Tape-determined pediatric weight with actual pediatric weight in India

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World Journal of Emergency Medicine 2016年第1期7卷 40-43页

作者： Deepak Geetaprasad mishra tamorish kole Rahul Nagpal Jeffery Paul Smith Department of Emergency Medicine Max Health Care New Delhi 110017 India Department of Pediatrics Max Health Care New Delhi 110017 India International Program Ronald Reagan Institute of Emergency Medicine GWU USA

BACKGROUND:The Broselow?Pediatric Emergency Tape indicates standardized,precalculated medication doses,dose delivery volumes,and equipment sizes using color-coded zones based on height-weight *** present study attempted to provide more evidence on the effectiveness of the Broselow?Pediatric Emergency Tape by comparing the tape-estimated weights with actual *** hypothesized that the Broselow?Pediatric Emergency Tape would overestimate weights in Indian children aged18 *** calculated the percentage difference between the Broselow-predicted weight and the measured weight as a measure of tape *** results were those with a mean percent difference within 3%.Standard deviation was measured to determine *** was determined as color-coded zone prediction and measured weight concordance,including the percentage overestimation by 1–2 ***:The male-to-female ratio of the patients was 1.3:*** agreement between colorcoding was 63.18%(κ=0.582).The Broselow?color-coded zone agreement was 74.8%in the18 kg ***:The Broselow?Pediatric Emergency Tape showed good evidence for being more reliable in children of the18 kg.

关键词： Body weights and measures India Child Emergencies Developing countries

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International normalized ratio as a predictor of mortality in trauma patients in India

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World Journal of Emergency Medicine 2014年第3期5卷 192-195页

作者： Ankur Verma tamorish kole Department of Emergency Medicine King Hamad University HospitalBusaiteenKingdom of BahrainIndia Department of Emergency Medicine Max Hospital

BACKGROUND:Hemorrhage is the second leading cause of death in trauma patients preceded only by traumatic brain injury. But hemorrhagic shock is the most common cause of preventable death within 6 hours of admission. Traumatic coagulopathy is a hypocoagulable state that occurs in the most severely injured. International normalized ratio(INR) and its relationship with trauma mortality have not been studied specifi cally. This study aimed to establish a predictive value of INR for trauma-related ***:A total of 99 trauma patients aged 18–70 years were included in the study. Their INR was determined and patient progression was followed up till death/discharge. According to previous retrospective studies,the cutoff value for INR in our study was kept at ***:The total mortality rate of the patients was 16.16%(16/99). The mean INR was 1.45 with a SD of 1.35. INR was deranged in a total of 14 patients(14.14%). Of these patients,11 died(78.57%) and 3 survived. INR was deranged in 11(68.75%) of the 16 patients who died,but 5 deaths(31.25%) had normal INR values. The sensitivity of INR was 69%(95%CI 41%–88%) and the specificity 96%(95%CI 90%–99%). The diagnostic accuracy of INR was 92%(95%CI 85%–96%). Positive predictive value and negative predictive value were 79%(95%CI 49%–95%) and 94%(95%CI 87%–98%),***:Our results showed that INR is a good predictor of mortality in trauma patients.

关键词： Hemorrhage Trauma International normalized ratio Mortality

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Acute care needs in an Indian emergency department： A retrospective analysis

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World Journal of Emergency Medicine 2016年第3期7卷 191-195页

作者： Elizabeth G. Clark Jessica Watson Allison Leemann Alan H. Breaud Frank G. Feeley III James Wolff tamorish kole Gabrielle A. Jacquet Kerala Institute of Medical Sciences Trivandrum Kerala India Boston University School of Public Health Boston Massachusetts USA Department of Emergency Medicine Boston Medical Center Boston Massachusetts USA Boston University Center for Global Health and Development Boston Massachusetts USA Max Hospital New Delhi India Boston University School of Medicine Boston Massachusetts USA

BACKGROUND: Emergencies such as road traffic accidents(RTAs), acute myocardial infarction(AMI) and cerebrovascular accident(CVA) are the most common causes of death and disability in India. Robust emergency medicine(EM) services and proper education on acute care are necessary. In order to inform curriculum design for training programs, and to improve the quality of EM care in India, a better understanding of patient epidemiology and case burden presenting to the emergency department(ED) is ***: This study is a retrospective chart review of cases presenting to the ED at Kerala Institute of Medical Sciences(KIMS), a private hospital in Trivandrum, Kerala, India, from November 1, 2011 to April 21, 2012 and from July 1, 2013 to December 21, 2013. De-identified charts were systematically sampled and ***: A total of 1 196 ED patient charts were analyzed. Of these patients, 55.35%(n=662) were male and 44.7%(n=534) were female. The majority(67.14%, n=803) were adults, while only 3.85%(n=46) were infants. The most common chief complaints were fever(21.5%, n=257), renal colic(7.3%, n=87), and dyspnea(6.9%, n=82). The most common ED diagnoses were gastrointestinal(15.5%, n=185), pulmonary(12.3%, n=147), tropical(11.1%, n=133), infectious disease and sepsis(9.9%, n=118), and trauma(8.4%, n=101).CONCLUSION: The patient demographics, diagnoses, and distribution of resources identifi ed by this study can help guide and shape Indian EM training programs and faculty development to more accurately refl ect the burden of acute disease in India.

关键词： Emergency care systems Emergency department Education Acute care Emergency department utilization

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Bombings specific triage(Bost Tool) tool and its application by healthcare professionals

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World Journal of Emergency Medicine 2015年第4期6卷 289-292页

作者： Jaiswal Sanjay Verma Ankur kole tamorish Department of Emergency Medicine Paras Hospitals

BACKGROUND: Bombing is a unique incident which produces unique patterns, multiple and occult injuries. Death often is a result of combined blast, ballistic and thermal effect injuries. Various natures of injury, self referrals and arrival by private transportation may lead to "wrong triage" in the emergency department. In India there has been an increase in incidence of bombing in the last 15 years. There is no documented triage tool from the National Disaster Management Authority of India for Bombings. We have tried to develop an ideal bombing specific triage tool which will guide the right patients to the right place at the right time and save more ***: There are three methods of studying the triage tool: 1) real disaster; 2) mock drill; 3) table top exercise. In this study, a table top exercise method was selected. There are two groups, each consisting of an emergency physician, a nurse and a ***: By using the proportion test, we found that correct triaging was significantly different(P=0.005) in proportion between the two groups: group B(80%) with triage tool performed better in triaging the bomb blast victims than group A(50%) without the bombing specific triage tool ***: Development of bombing specific triage tool can reduce under triaging.

关键词： Bombing Blast Injuries Terrorist Bombings Triage

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Acute ischemic stroke in a child with cyanotic congenital heart disease due to non-compliance of anticoagulation

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World Journal of Emergency Medicine 2012年第2期3卷 154-156页

作者： Misbahuddin Mohammad Anish F.James Raheel S.Qureshi Sapan Saraf Tina Ahluwalia Joy Dev Mukherji tamorish kole Department of Emergency Medicine Max Super Speciality Hospital Department of Radiology Max Super Speciality Hospital Department of Neurology Max Super Speciality Hospital

BACKGROUND:Stroke is a common presentation in geriatric patients in emergency department but rarely seen in pediatric *** case of acute ischemic stroke in pediatric age group,management is different from that of adult ischemic stroke where thrombolysis is a good ***:We report a case of a 17-year-old male child presenting in emergency with an episode of acute ischemic stroke causing left hemiparesis with left facial weakness and *** patient suffered from cyanotic congenital heart disease for which he had undergone Fontan operation *** had a history of missing his daily dose of warfarin for last 3 days prior to the ***:The patient recovered from acute ischemic stroke without being ***:In pediatric patients,acute ischemic stroke usually is evolving and may not require thrombolysis.

关键词： Acute ischemic stroke Congenital heart disease Single ventricle Fontan operation Warfarin Thrombolytic

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