Acute Flaccid Paralysis Accompanying West Nile Meningitis Ahmed ...

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Self-Perceived Opioid Prescription Habits in Residents Vachon, C, D.O., Manyan, J, D.O. Kent Hospital, Family Medicine Residency Program, Warwick, RI Introduction: The objective of this study is to assess residents’ current prescribing habits and confidence in prescribing opioids in the emergency department, inpatient, and outpatient setting. In 2012 a community warning was issued by Kent Hospital in response to a dramatic increase in drug overdoses, specifically after seven cardiac arrests over an eight-week span due to drug overdoses from narcotics, heroin, and/or synthetic marijuana, five of which resulted in deaths. According to the CDC, in 2009 more than 15,500 overdose deaths in the US were from prescription pain killers. Misuse and abuse of these medications accounted for more than 475,000 emergency department visits in that same year, nearly double the amount of visits from five years prior. Studies have shown that there are gaps in residents’ confidence and knowledge in managing chronic nonmalignant pain. Previous studies have been done to assess the differences between prescription practices of residents versus attendings and also how different interventions affect residents’ beliefs and concerns, as well as their knowledge about using opioids. Interventions have included workshops as well as web-based training versus reviewing the current guidelines from the Veterans Affairs/Department of Defense. Methods: A voluntary survey questionnaire was administered to emergency medicine, internal medicine, and family medicine residents. A total of 28 residents (17 emergency medicine, 6 internal medicine, and 5 family medicine) completed the survey. Results: A minority (N=7, 25 percent) of residents stated that they were aware of their department having a written policy on opioid medications, 5 of which were family medicine residents, and 6 of the total residents surveyed (21 percent) stated that they had received training regarding this policy. 14 respondents stated that they felt very comfortable or comfortable managing patients’ non-cancer chronic pain with opiate medication. 50 percent of these respondents correctly knew that there are different cutoff levels for abuse versus therapeutic use on lab screenings and 50% knew the appropriate urine opiate level cutoff the therapeutic use of opiates. 14 residents stated that they felt uncomfortable managing a patients’ non-cancer chronic pain with opiate medication, 43 percent of which stated that they always communicate with an attending prior to prescribing opiates to a chronic pain patient. When asked about whether opioids were appropriate for specific diagnoses; metastatic bone cancer (100 percent), closed metacarpal fracture (75 percent), and shingles (50 percent) were most common whereas chronic low back pain (29 percent), abdominal pain (25 percent), and migraine (4 percent) were less common. Discussion: Our survey showed that half of residents surveyed (50 percent) did not feel comfortable managing chronic nonmalignant pain. The habits that residents develop in training are maintained as they move into private practice. These results show that, with this cohort, curricular interventions need to be made and reinforced to improve residents’ preparedness to manage pain in both the inpatient and outpatient setting. This should include reviewing safer opioid prescribing practices and alternatives to opioids. A randomized trial showed that an interactive web-based training that was focused on shared decision-making and communication skills was more effective than simply reviewing compatible guidelines for both knowledge and self-reported competence in the management of chronic nonmalignant pain 1 . While the majority of residents in our study reported that they mostly or always (79 percent) communicated with their attendings prior to prescribing opioids to a chronic pain patient, supervision should continue to be stressed in order to provide effective and safe care for patients. 1. Sulivan MD, et al. Randomized trial of web-based training about opioid therapy for chronic pain. Clin J Pain. 2010 Jul-Aug;26(6):512-7.
A Comparison of Temporal Thermometry to Rectal Thermometry in the Adult Emergency Department Population. Volkova, L. DO; Lienhop, T.E. DO; Colyer, E. DO; Campbell, K.A. DO; Graves, P.F. MD; Schuenke, M. Ph. D Kent Hospital, Department of Emergency Medicine, Warwick, RI INTRODUCTION: Temporal artery thermometry has become a popular, convenient, and non-invasive way of obtaining critical vital signs in the emergency department (ED). However, speculation still exists regarding its accuracy in comparison to a more invasive, “gold standard” measurement: the rectal temperature. The aim of this study is to determine the accuracy of temporal artery thermometry compared with rectal thermometry in an adult ED population, and to evaluate a number of variables that may affect temperature differences, should they exist. METHODS: This prospective randomized study enrolled 200 adult ED patients presenting to a community teaching hospital in a four month period. Temperature recording was obtained from a patient population that met our inclusion criteria. Temperatures from the temporal artery and rectum were measured no more than five minutes apart. We tested the correlation between multiple variables and their effect on both methods of measurement using Bland- Altman plots and Spearman Rho correlations. T-test was utilized for direct comparison of the two methods of thermometry in the entire sample size. RESULTS: The mean temporal artery temperature across the entire sample size was 36.66°C±0.56°C, and the mean rectal temperature statistically higher, at 37.31°C±0.92°C, p-value=0.001. We found that rectal temperatures were consistently higher than temporal wand temperatures, especially in febrile patients. In the febrile group, every single rectal reading was higher than its temporal wand counterpart and over 50% were at least 1.5ºC higher. Spearman- Rho analysis did not exhibit any statistical correlation between temporal artery measurement and age, sex, BMI, or time of measurement. There was poor correlation between rectal temperature and temporal artery temperature. CONCLUSIONS: We have demonstrated that temporal artery thermometry has poor accuracy for detecting fever and is a poor measurement of core temperature in an adult emergency department population.
Page 1 and 2: Acute Flaccid Paralysis Accompanyin
Page 3 and 4: Adult Typhilitis Associated With Ly
Page 5 and 6: Acute Interstitial Nephritis Second
Page 7 and 8: Atypical Presentation for Complex R
Page 9 and 10: Ptosis As A Variant Presentation of
Page 11 and 12: Isolated Gastric Varices as an Etio
Page 13 and 14: A Case of Idiopathic Pulmonary Arte
Page 15 and 16: Diagnosis and Management of Meningi
Page 17 and 18: Surveillance for an Indeterminate H
Page 19 and 20: contralateral trunk/extremities sho
Page 21 and 22: An Unexpected Course of Rhabdomyoly
Page 23 and 24: Severe Autoimmune Hemolytic Anemia
Page 25 and 26: An Uncommon Cause of a Common Sympt
Page 27 and 28: Implications of Epidemiology in Bre
Page 29 and 30: Methicillin-Resistant Staphylococcu
Page 31 and 32: An Unusual Electrocardiogram Presen
Page 33 and 34: Using NSQIP and Zynxhealth to Build
Page 35 and 36: Resident-Run OMM Skills Clinic: Doe
Page 37: Waves of Health Evaluation of Diabe
Page 41 and 42: Lactation Assessment Standardized T
Page 43 and 44: Use of Opioids in Management of Chr
Page 45 and 46: Not All Anterior Wall ST Segment El
Page 47 and 48: A Case of Sudden Monocular Blindnes
Page 49 and 50: Can Name Recognition Allow for More
Page 51 and 52: Developing a Treatment Plan for a C
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Page 55 and 56: A Classical Misnomer To Consider: G
Page 57 and 58: A Case of Mycoplasma Pneumoniae Rel
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Page 83 and 84: in Haiti. Future research can focus
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The Patient Simulator for Training
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In Vivo Micron Scale Arthroscopic I
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Breast Cancer-Induced Bone Remodeli
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Acute Flaccid Paralysis Accompanying West Nile Meningitis Ahmed ...

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