Rebecca A.H. Anwar

The role of the emergency physician in the prevention of domestic violence

In the United States, every 7.4 seconds a woman is battered by her husband. Of women who present to emergency departments with traumatic injuries, 16% to 30% report that their injuries were secondary to domestic violence. Not infrequently, battered womens medical and surgical problems are treated by ED staff and the women are released without any intervention directed toward the prevention of future battering and/or injury. Protocols are presented that require only minimal reorganization of staffing in EDs to provide essential services directed toward battered womens most serious health problem, chronic victimization.

A longitudinal study of residency-trained emergency physicians

An annual survey of emergency medicine (EM) graduate physicians from 31 programs was conducted from 1977 through 1979. Results of the 1979 data are presented. Practice patterns show that 96% of the EM graduates are providing patient care, and almost half are working in the states in which they trained. Of those caring for patients, 38.8% practice in an urban location and only 7% work in rural hospitals. Learning new skills and procedures and retaining skills are major problems faced by physicians in rural locations. Other activities of EM graduates include teaching medical students and residents, administration, research, and community emergency medical services. Data are analyzed with attention to long-term commitment to emergency medicine. Implications for manpower needs are suggested.

Management of ankle sprains

One hundred fifty-seven patients between the ages of 15 and 65 were evaluated for ankle injury. Patients without fractures were assigned to one of two treatment groups. Patients in the plaster splint group were non-weight-bearing. Patients in the early mobilization group used an elastic bandage and were permitted to begin partial weight bearing as soon as tolerated while using crutches. The talar tilt (stress) test was not found to be a useful routine radiographic study. Of the patients with follow-up, no significant benefit was obtained from the plaster splint. Aside from a previous ankle injury adversely affecting long-term ankle function, no historical or physical factor was useful in predicting either short- or long-term disability.

The continuing emergency care clinic: Improving patient compliance with follow-up care

Traditionally, emergency patients have been noted for high rates of noncompliance with appointments in outpatient clinics for follow-up care. S study of cases referred for follow-up care at the outpatient clinic of The Medical College of Pennsylvania showed that less than 20% of the patients kept their appointments. To cope with this problem, a Continuing Emergency Care (CEC) clinic was established on the assumption that a change in structural environment could change noncompliance behavior patterns. The clinic is a small unit near the emergency department, separate from the larger hospital outpatient clinic area. Patient compliance data were collected on each case referred to the CEC clinic during a three-month period. Findings showed a threefold increase in appointment compliance over the previous study in which referrals were made to the hospital clinics.

The Research Component in the Development of Emergency Medicine as a Specialty.

The development of emergency medicine as a separate medical specialty involves several major processes, including professional identification, delineation of the dimensions of the specialty, development of a body of knowledge, and creative investigative activities. Residents in emergency medicine offer a potential source of expertise that could be utilized in the development of such research activities. However, for a variety of reasons routine research has not been part of current resident education. One example of a methodology for programmatic research development in emergency medicine is identified in this paper through the establishment of a nonclinical health services research position. The effect of having staff to assist in the development and analysis of research projects has contributed to building a body of knowledge specific to emergency medicine and creating a sense of professional identity among graduate trainees.

Tension headache in emergency department patients

Abstract The authors report the results of a retrospective study of the charts of 181 emergency department patients with a complaint of tension headache. Although more than half the patients appeared to be suffering from anxiety and/or depression, only 14 were seen by a psychiatrist. Anxiety was reported considerably more often than depression. Additional psychiatric training of emergency room staff and active involvement of consultation-liaison psychiatrists are suggested as means of obtaining early psychiatric intervention for headache patients with associated psychiatric problems.

A time efficient EMT-A course for first year medical students

The purpose of the study was to design an EMT-A course for freshman medical students that maximized practical work and minimized lecture hours. A 48-hour required course was given up to 101 members of the first-year class at The Medical College of Pennsylvania. Ten hours of lecture-demonstration time were included. Test scores were comparable to scores of regular EMT-A candidates and medical students who had a full lecture series included in their course. Means of further decreasing the number of hours of the course are discussed. By decreasing the number of curricular hours, it is hoped that medical schools not having EMT-A certification programs in their preclinical years will be encouraged to do so.

Trends in training: Focus on emergency medicine

A research project was developed to study the process of professional socialization in graduate medical education by describing and analyzing the development of emergency medicine residencies in comparison to those of surgery and internal medicine. Based on the assumption that residency programs have a profound impact on the quality, distribution, and career patterns of physicians, researchers surveyed residents and residency directors in the three specialty groups to determine the following: characteristics of founders of the programs, factors influencing physicians to enter a specialty, variations in residency program organization and structure, and career patterns of physicians entering the specialty. Implications are drawn from the data and applied to the development of residency training. Anwar RAH: Trends in training: focus on emergency medicine.

Orientation program for emergency medicine residents

An orientation curriculum was developed for incoming residents in emergency medicine at the University of Cincinnati (UC) in July, 1976. The major objectives of the orientation were 1) to identify and delineate the subject matter of emergency medicine, and 2) to review the basic elements of emergency medicine. Results of a pre- and posttest using the residency program at the Medical College of Pennsylvania (MCP) as a control group are presented. The pretest scores of the study groups showed no significant difference at a .05 level. The posttest, however, resulted in a significant improvement of the UC scores (p less than 0.05), while little change occurred in the MCP scores. An inter-group evaluation shows the UC group to have out-performed the MCP group significantly (p less than 0.05). Results of a one-year posttest showed the UC residents scoring an overall average of six points higher on the test. However, the general difference between the two groups of residents was not significant at the 0.05 level.

Skills and procedures in emergency medicine: Room for controversy

To examine patterns of consensus and divergence of opinion about whether, and under what conditions, residency-trained emergency physicians use certain skills and perform procedures, directors of 35 emergency medicine, 28 surgery and 30 internal medicine residency programs were surveyed. The directors reacted to a list of 30 skills modified from the condition/skills list compiled by the Certification Task Force of the American College of Emergency Physicians representing a consensus on the core-knowledge for emergency medicine, as determined by both practicing and university-based emergency physicians. The responses indicate a wide variation of opinion about which skills are within the realm of residency-trained emergency physicians, and under what circumstances a procedure should be performed. The skills of greatest concern among emergency medicine directors include axillary and intravenous lidocaine blocks, bronchoscopy, burr holes, closed reduction of dislocated hips, Swan-Ganz catheterization, and cardiopulmonary by-pass. In contrast, slightly more than one third of the procedures on the modified list were clearly agreed upon by over 80% of the directors as procedures performed by trained emergency physicians.