Using a rule-based system to define error in the emergency department.

Introduction: The evaluation of peer-reviewed cases for error is key to quality assurance (QA) in emergency medicine, but defining error to ensure reviewer agreement and reproducibility remains elusive. The objective of this study was to create a consensus-based set of rules to systematically identify medical errors.

Methods: This is a prospective, observational study of all cases presented for peer review at an urban, tertiary care, academic medical center emergency department (ED) quality assurance (QA) committee between October 13, 2015, and September 14, 2016.

Errors in Decisionmaking in Emergency Medicine: The Case of the Landscaper's Back and Root Cause Analysis.

Root cause analysis is often suggested as a means of conducting quality assurance, but few physicians are familiar with the actual process. We describe a detailed approach to conducting root cause analysis, with an illustrative case to explain the technique. By studying how root cause analysis is applied to the case of a missed epidural abscess, the reader will see how the process reveals systems improvements that reduce the risk that such a miss will happen again.

Management pathway for emergency department patients in the setting of the opioid epidemic and emergency department overcrowding.

Objective: The United States is currently in the midst of a major opioid addiction epidemic, of which the primary drivers are a sharp increase in prescription opioid pain medications, their misuse, and the inordinate illicit use of opioids. Declared a national health emergency, the opioid crisis puts enormous pressure on various systems, including increasing overcrowding in emergency departments (EDs) and forced changes in prescribing practices. We are piloting a newlydeveloped ED opiate pathway to streamline ED care for patients who frequently present at the ED for chronic pain management or other recurrent pain-causing medical problems.

Disaster Medicine: A Comprehensive Review of the Literature From 2016.

Objective: The Society of Academic Emergency Medicine Disaster Medicine Interest Group, the Office of the Assistant Secretary for Preparedness and Response - Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE) team, and the National Institutes of Health Library searched disaster medicine peer-reviewed and gray literature to identify, review, and disseminate the most important new research in this field for academics and practitioners.

Methods: MEDLINE/PubMed and Scopus databases were searched with key words. Additional gray literature and focused hand search were performed.

Utility-Value Score: A Case Study in System Generalization for Writing Analytics.

Collection and analysis of students' writing samples on a large scale is a part of the research agenda of the emerging writing analytics community that promises to deliver an unprecedented insight into characteristics of student writing. Yet with a large scale often comes variability of contexts in which the samples were produced-different institutions, different purposes of writing, different author demographics, to name just a few possible dimensions of variation. What are the implications of such variation for the ability of automated methods to create indices/features based on the writing samples that would be valid and meaningful? This paper presents a case study in system generalization.

Use of Physician Concerns and Patient Complaints as Quality Assurance Markers in Emergency Medicine.

Introduction: The value of using patient- and physician-identified quality assurance (QA) issues in emergency medicine remains poorly characterized as a marker for emergency department (ED) QA. The objective of this study was to determine whether evaluation of patient and physician concerns is useful for identifying medical errors resulting in either an adverse event or a near-miss event.

Methods: We conducted a retrospective, observational cohort study of consecutive patients presenting between January 2008 and December 2014 to an urban, tertiary care academic medical center ED with an electronic error reporting system that allows physicians to identify QA issues for review.

Utility of Procedural Sedation as a Marker for Quality Assurance in Emergency Medicine.

Background: The Joint Commission requires health care organizations to monitor and evaluate procedural sedation. However, the utility of mandatory review of procedural sedation in evaluating health care quality is unknown.

Objective: To determine whether procedural sedation is a useful marker for evaluating error in the emergency department (ED).

Health care system hazard vulnerability analysis: an assessment of all public hospitals in Abu Dhabi.

Hazard vulnerability analysis (HVA) is used to risk-stratify potential threats, measure the probability of those threats, and guide disaster preparedness. The primary objective of this project was to analyse the level of disaster preparedness in public hospitals in the Emirate of Abu Dhabi, utilising the HVA tool in collaboration with the Disaster Medicine Section at Harvard Medical School. The secondary objective was to review each facility's disaster plan and make recommendations based on the HVA findings.

Angiographic and clinical outcomes after implantation of drug eluting stents in bifurcation lesions with crush or kissing stent technique.

Background: Long-term outcome after bifurcation stenting with drug-eluting stents (DES) for obstructive coronary artery disease is poorly understood. In this study, we report 6-9-month angiographic follow-up and long-term clinical outcomes after implantation of drug-eluting stents by crush and kissing stent technique for coronary bifurcation lesions.

Methods: Consecutive patients undergoing bifurcation stenting with DES by crush or kissing stent technique were enrolled in a prospective registry.

Paraperitoneal inguinal hernia of ureter.

Inguinal herniation of ureter is an uncommon finding that can potentially lead to obstructive uropathy. We report a case of inguinal herniation of ureter discovered incidentally during workup for acute renal failure and ultrasound finding of hydronephrosis.

Hebephilia and the construction of a fictitious diagnosis.

As mass media and the advertising industry sexualize children at earlier ages, DSM-5 is considering a proposal for a new mental disorder involving sexual attraction to adolescents. Despite the fact that most men are sexually aroused by pubescent teens, some clinicians and researchers believe they have identified a new subgroup of chronically impaired men who are compulsively drawn to older children. We discuss the proposal and conclude that it is insufficiently documented and that with such potentially serious medicolegal consequences, inclusion in the new manual is not advised.

DIORAMA: dynamic information collection and resource tracking architecture.

DIORAMA is a real-time scalable decision support framework built on rapid information collection and accurate resource tracking functionalities. Using RFID technology the proposed system tracks emergency responders and victims at the disaster scene. DIORAMA improves the accuracy and decreases the time it takes rescuers to triage, treat and evacuate victims from a disaster scene, as compared to the traditional methods and process that involves using paper triage tags.

"Operation Helping Hands": Massachusetts health and medical response to Hurricane Katrina.

Introduction: As Hurricane Katrina bore down on New Orleans in August 2005, the city's mandatory evacuation prompted the exodus of an estimated 80% of its 485,000 residents. According to estimates from the US Centers for Disease Control and Prevention (CDC), at least 18 states subsequently hosted more than 200,000 evacuees.

Hypothesis/problem: In this case study, "Operation Helping Hands" (OHH), the Massachusetts health and medical response in assisting Hurricane Katrina evacuees is described.

Inter-agency communication and operations capabilities during a hospital functional exercise: reliability and validity of a measurement tool.

Introduction: As proxies for actual emergencies, drills and exercises can raise awareness, stimulate improvements in planning and training, and provide an opportunity to examine how different components of the public health system would combine to respond to a challenge. Despite these benefits, there remains a substantial need for widely accepted and prospectively validated tools to evaluate agencies' and hospitals' performance during such events. Unfortunately, to date, few studies have focused on addressing this need.

Esthetic grafting for small volume hard and soft tissue contour defects for implant site development.

Ridge contour defects around dental implants are caused by underlying bony defects. Although adequate bone may exist to obtain stability of the implant, irregular bony anatomy can result in an unnatural appearance of the final crown. Particulate onlay grafting to support the peri-implant soft tissue along with tension-free closure while using pedicle papilla regeneration techniques can convert unaesthetic gingival contours into favorable sites.

Dental implant reconstruction in a patient with ectodermal dysplasia using multiple bone grafting techniques.

Ectodermal dysplasia is a syndrome in which 2 ectodermally derived structures fail to develop. Patients have a reduced number of teeth, and dental implant reconstruction is the preferred method of replacing teeth. We report the use of the tent pole technique in the severely resorbed mandible with sinus lifts and block grafting in the maxilla to restore the maxillofacial complex of a female patient with ectodermal dysplasia.

B-type natriuretic peptide and serum unbound free fatty acid levels after contemporary percutaneous coronary intervention.

Objectives: To determine the frequency and timing of B-type natriuretic peptide (BNP) and unbound free fatty acid (FFAu) elevation after percutaneous coronary intervention (PCI).

Design And Methods: Blood samples were collected from 55 patients undergoing PCI within 1 hour prior to PCI, immediately after PCI, 6 hours and 18-24 hours after PCI, and were analyzed for BNP and FFAu.

Results: There was a trend toward a rise in BNP levels at 18-24 hours post-PCI (65 vs.

Avoiding injury to the inferior alveolar nerve by routine use of intraoperative radiographs during implant placement.

Injury to the inferior alveolar nerve during implant placement in the posterior atrophic mandible is a rare but serious complication. Although a preoperative computerized tomography scan can help determine the distance from the alveolar ridge to the nerve canal, variables such as magnification errors, ridge anatomy, and operator technique can increase the chance for complications. The routine use of intraoperative periapical radiographs during the drilling sequence is an inexpensive and reliable tool, allowing the operator to confidently adjust the direction and depth of the implant during placement.

Cortical tenting grafting technique in the severely atrophic alveolar ridge for implant site preparation.

Objectives: Alveolar ridge augmentation using intraoral autogenous block grafts to augment localized alveolar ridge defects before implant placement is a predictable method. However, large severely atrophic edentulous segments may require extraoral donor sites. The purpose of this study was to evaluate the effectiveness of using intraoral cortical block grafts in combination with particulate human mineralized allograft, in a "tenting" fashion, to augment large atrophic alveolar ridge defects for implant placement.