Xavier Muschart

Does offering pricing information to resident physicians in the emergency department potentially reduce laboratory and radiology costs

Objectives The aim of this study was to establish whether price list information could reduce laboratory and radiological examination costs in emergency departments (EDs). Materials and methods A prospective survey of adult (>16 years old) admissions was conducted at the ED of a university hospital in Belgium. Nine resident emergency physicians were followed for a span of 6 months, which was divided into 2-month periods: control (October and November 2011), intervention (December 2011 to January 2012), and washout (February and March 2012). Laboratory and radiological costs for each of the daily admissions were calculated during the respective periods and compared. Results A total of 3758 patients were registered: 1093 in period 1 (control), 1329 in period 2 (intervention), and 1336 in period 3 (washout). We observed significant reductions in examination costs: 10.73% (P=0.015) for laboratory and 33.66% (P<0.001) for radiological costs in period 2 versus period 1; 5.02% (P=0.014) for laboratory and 40.00% (P<0.001) for radiological costs in period 3 versus period 1. In addition, we found that laboratory examination costs increased slightly between periods 2 and 3 (+6.4%), whereas costs related to radiologic examinations continued to decrease (−10.16%); however, these differences were not statistically significant. Conclusion We conclude that the distribution of price lists at EDs promotes cost awareness, which can result in significant decreases in examination costs.

Assessing clinical reasoning using a script concordance test with electrocardiogram in an emergency medicine clerkship rotation

Objectives Script concordance tests (SCTs) can be used to assess clinical reasoning, especially in situations of uncertainty, by comparing the responses of examinees with those of emergency physicians. The examinees answers are scored based on the level of agreement with responses provided by a panel of experts. Emergency physicians are frequently uncertain in the interpretation of ECGs. Thus, the aim of this study was to validate an SCT combined with an ECG. Methods An SCT-ECG was developed. The test was administered to medical students, residents and emergency physicians. Scoring was based on data from a panel of 12 emergency physicians. The statistical analyses assessed the internal reliability of the SCT (Cronbachs α) and its ability to discriminate between the different groups (ANOVA followed by Tukeys post hoc test). Results The SCT-ECG was administered to 21 medical students, 19 residents and 12 emergency physicians. The internal reliability was satisfactory (Cronbachs α=0.80). Statistically significant differences were found between the groups (F0.271=21.07; p<0.0001). Moreover, significant differences (post hoc test) were detected between students and residents (p<0.001), students and experts (p<0.001), and residents and experts (p=0.017). Conclusions This SCT-ECG is a valid tool to assess clinical reasoning in a context of uncertainty due to its high internal reliability and its ability to discriminate between different levels of expertise.

A case report with Fitz-Hugh-Curtis syndrome, what does it mean?

Fitz–Hugh–Curtis (FHC) syndrome, also known as acute perihepatitis, was discovered in 1930 and is a rare disorder characterised by inflammation of the peritoneum and the tissues surrounding the liver. This syndrome can arise as a potential complication from a pelvic inflammatory disease caused by Neisseria gonorrhoeae or Chlamydia trachomatis. This syndrome is not well known in the medical community and is often underdiagnosed. In this case report, we revisit FHC syndrome, particularly its noninvasive diagnosis and complications.

A non-classical cannabinoid syndrome

Abstract Hyperemesis cannabinoid syndrome (HCS) is characterized by cyclic vomiting and compulsive bathing behaviors in chronic cannabis users. This syndrome is not well known in the medical world and is underdiagnosed, despite the increasing use of cannabis. In this case report, physicians should keep in mind the criteria that characterize HCS syndrome. However, non-classical forms of HCS can exist with bradycardia, and pain can be relieved by cold temperature.

Preventability of serious thromboembolic and bleeding events related to the use of oral anticoagulants: a prospective study

To determine the preventability of serious adverse drug reactions (ADRs) related to the use of direct oral anticoagulants (DOACs), and to explore contributing factors to preventable ADRs. Results were compared with vitamin K antagonists (VKAs).

Seeks, finds, threats: Lyme disease!

Lyme borreliosis is a disease commonly found in humans. Here we report the case of a young, healthy girl presenting with symptomatic first- and second-degree atrioventricular blocks secondary to cardiac myocarditis. The disappearance of the conduction anomaly after antibiotic treatment confirmed Lyme disease before the results from the serology. Therefore, when a healthy, young person suddenly presents with an atrioventricular conduction block, physicians should consider a diagnosis of Lyme disease.