Lowering the threshold for discussions of domestic violence: a randomized controlled trial of computer screening.

Background: Women experiencing domestic violence (DV) frequent health care settings, but DV is rarely identified.

Methods: We conducted a randomized controlled trial to determine the effect of computer screening on health care provider-patient DV communication at 2 socioeconomically diverse emergency departments (EDs). Consenting nonemergent female patients, aged 18 to 65 years, were randomized to self-administered computer-based health risk assessment, with a prompt for the health care provider, or to "usual care"; all visits were audiotaped.

Pediatric hypocalcemic seizures: a case of rickets.

Although cases of Vitamin D-deficient Rickets have declined since the Industrial Revolution, certain populations remain at risk. Risk factors for developing vitamin D-deficient Rickets include breast-feeding without formula or vitamin supplementation, very dark skin and inadequate exposure to sunlight. We describe a case of Rickets in a breastfed infant with dark skin who presented with hypocalcemic seizures.

Resuscitating the physician-patient relationship: emergency department communication in an academic medical center.

Study Objective: We characterize communication in an urban, academic medical center emergency department (ED) with regard to the timing and nature of the medical history survey and physical examination and discharge instructions.

Methods: Audiotaping and coding of 93 ED encounters (62 medical history surveys and physical examinations, 31 discharges) with a convenience sample of 24 emergency medicine residents, 8 nurses, and 93 nonemergency adult patients.

Results: Patients were 68% women and 84% black, with a mean age of 45 years.

Acquired factor VIII inhibitor presenting as a tongue hematoma.

Acquired hemophilia is a rare disorder that has potentially disastrous consequences if not recognized and treated in the setting of acute hemorrhage. We report a case of undiagnosed acquired hemophilia due to factor VIII inhibitor in which a tongue hematoma was the chief manifestation. Diagnosis, acute management, and long-term therapeutic options are reviewed.

Efficient communication: assessment-oriented oral case presentation.

Objective: To introduce and assess the time savings from and effectiveness of assessment-oriented (AO) oral case presentation as a model of interphysician communication.

Methods: This was a prospective, interventional study of all 10 on-site faculty and 36 residents in a postgraduate year 1 to 3 format emergency medicine residency training program. Residents were requested to perform all oral case presentations in either the traditional or AO formats.

Atraumatic Clostridial myonecrosis: case report and literature review.

Clostridial myonecrosis (CM) is a rare, life-threatening infection that is most often associated with recent surgery or skeletal muscle trauma. It usually affects patients with some degree of underlying immunocompromise or vascular insufficiency. Occasionally, CM can occur at remote sites, with seeding from a gastrointestinal source in the setting of malignancy.

"Between me and the computer": increased detection of intimate partner violence using a computer questionnaire.

Study Objective: The emergency department is a problem-focused environment in which routine screening for intimate partner violence (IPV) is difficult. We hypothesized that screening for IPV during computer-based health-risk assessment would be acceptable to patients and improve detection.

Methods: We performed a descriptive study of IPV data collected during a controlled trial of computer-based health promotion in an urban hospital ED.