Do Emergency Medicine Residents Prefer Resident-initiated or Attending-initiated Feedback?

Background: Real-time feedback is crucial to improving physician performance. Emerging theory suggests that learner-initiated feedback may be more effective in changing performance than attending-initiated feedback, but little is known about how residents perceive resident- versus attending-initiated feedback.

Objectives: The primary aim was to determine whether residents' satisfaction varied by learner-versus attending-initiated feedback encounters.

Comparison of severity of illness scoring systems in the prediction of hospital mortality in severe sepsis and septic shock.

Background: New scoring systems, including the Rapid Emergency Medicine Score (REMS), the Mortality in Emergency Department Sepsis (MEDS) score, and the confusion, urea nitrogen, respiratory rate, blood pressure, 65 years and older (CURB-65) score, have been developed for emergency department (ED) use in various patient populations. Increasing use of early goal directed therapy (EGDT) for the emergent treatment of sepsis introduces a growing population of patients in which the accuracy of these scoring systems has not been widely examined.

Objectives: To evaluate the ability of the REMS, MEDS score, and CURB-65 score to predict mortality in septic patients treated with modified EGDT.

Evaluation of a modified early goal-directed therapy protocol.

Objectives: The study aimed to determine mortality in septic patients 2 years after introduction of a modified early goal-directed therapy (EGDT) protocol and to measure compliance with the protocol.

Design: This was an observational study of prospectively identified patients treated with EGDT in our emergency department (ED) from May 2007 through May 2008 and compared with retrospectively obtained data on patients treated before protocol implementation, from May 2004 to May 2005.

Setting: This study was conducted at a large tertiary-care suburban community hospital with more than 85 000 ED visits annually and 700 inpatient beds.

Hyperkalemic distal renal tubular acidosis associated with Rett syndrome.

Renal function was studied in a 7-year-old girl with Rett syndrome (RS) complicated by persistent hyperchloremic hyperkalemic metabolic acidosis. The acidosis was associated with a urine pH above 5.5, positive urinary anion gap and decreased potassium excretion.

Emergence of multidrug-resistant Salmonella enterica serotype Newport infections resistant to expanded-spectrum cephalosporins in the United States.

We describe a field investigation in New England that identified the emergence and epidemiology of new strains of multidrug-resistant Salmonella, Newport-MDRAmpC, and summarize the Center for Disease Control and Prevention's surveillance data for these infections. In Massachusetts, the prevalence of Newport-MDRAmpC among Salmonella serotype Newport isolates obtained from humans increased from 0% (0/14) in 1998 to 53% (32/60) in 2001 (P<.001).

An outbreak of foodborne botulism associated with food sold at a salvage store in Texas.

Foodborne botulism is caused by potent neurotoxins of Clostridium botulinum. We investigated a large outbreak of foodborne botulism among church supper attendees in Texas. We conducted a cohort study of attendees and investigated the salvage store that sold the implicated foods.