Evaluation of the Early Administration of Tranexamic Acid in Geriatric Hip Fractures in the Emergency Department: A Retrospective Study.

Introduction Tranexamic acid (TXA) administration perioperatively has demonstrated efficacy in reducing postoperative drops in hemoglobin levels and the need for transfusions among patients with peritrochanteric hip fractures. This study aims to perform a retrospective analysis to assess the impact on hemoglobin levels by comparing patients with fragility hip fractures who received TXA in the ED, in addition to the standard perioperative TXA dose, with those who did not receive TXA in the ED. Methods This study retrospectively reviewed 64 patient records from May 2020 to May 2021 at a Level II trauma center that were classified into two groups: patients who received one gram (g) of TXA in the ED, within five hours of injury (new protocol), or patients who received no TXA in the ED (old protocol).

Improved Cardiac Rehabilitation Referral Rate Utilizing a Multidisciplinary Quality Improvement Team.

Introduction Cardiac rehabilitation (CR) is an underutilized resource in patients with ischemic heart disease, despite being a Class IA recommendation. In this study, a multidisciplinary quality improvement (QI) team aimed to improve CR referrals by standardizing the ordering process at our hospital system. Method By using a collaborative approach involving the electronic medical record (EMR), medical provider education, and hospital protocols, our two-hospital healthcare system was able to successfully identify barriers to CR referral rates and implement interventions for these barriers.

The Effect of Tranexamic Acid With or Without Tourniquet on Blood Loss in Total Knee Arthroplasty at a Community Hospital.

Tourniquets have long been used in total knee arthroplasty due to the theoretical improvement of bleeding control, integration of cement-bone interface, visibility, and efficiency of the overall surgery. However, this has become increasingly disputed. Comparative studies in total knee arthroplasty employing chemical prophylaxis, i.

Characterizing Social Insecurity in a Rural North Carolina Emergency Department.

Introduction: Social insecurity, a form of deprivation of social amenities, if present among patients presenting in a rural emergency department (ED) can be a source of medical burden and poor health outcomes. Although knowledge and understanding of the insecurity profile of such patients is necessary for targeted care that improves their health outcomes, the concept has not been comprehensively quantified. In this study we explored, characterized, and quantified the social insecurity profile of ED patients at a rural teaching hospital in southeastern North Carolina with a large Native American population.

COVID-19 and Cardiomyopathy in African Americans: An Early Single-Center Experience.

Introduction The 2019 coronavirus pandemic has taken a toll on our society. Although most patients report minimal symptoms, a small proportion of patients have reported significant respiratory symptoms that led to admission to the inpatient medical ward or even the intensive care unit. Complications and long-term sequela of COVID-19 are still being reported and studied.

Evaluation of a Community Hospital-Based Residencies' Intimate Partner Violence Education by a Domestic Violence Shelter Expert.

Intimate partner violence, or IPV, is estimated to affect an estimated 10 million Americans. From 2015-2017 our community hospital-based residencies trained first-year residents to improve education in recognizing and screening for IPV. This retrospective cohort study's goal was to analyze the longitudinal effectiveness of the educational program.

Impact of the COVID-19 Pandemic on the Rate of Influenza Vaccination in a Predominately African American Pregnant Population.

Background The data is sparse on the uptake of preventative vaccinations during the COVID-19 pandemic in the pregnant population. Our goal was to determine if the COVID-19 pandemic affected the rate of influenza and tetanus, diphtheria, and acellular pertussis (TDAP) vaccination in a predominantly African American pregnant population.  Methods  This retrospective descriptive cross-sectional study compared the influenza vaccination rates of pregnant women 18 years and older between the pre-COVID influenza season (September 1, 2019 to March 1, 2020) and the COVID influenza season (September 1, 2020 to March 1, 2021).

Arthroscopic Latarjet procedure does not lead to loss of clinically significant external rotation at 0° and 90° of shoulder abduction.

Background: Several reports have shown that shoulder stabilizing procedures lead to postoperative external rotation (ER) deficits. However, no study on arthroscopic Latarjet procedures has investigated the effect on ER when the arm is abducted at 0° (ER) and 90° (ER). This study examined the relationship between the arthroscopic Latarjet procedure and the subsequent effect on ER and ER.

Assessing Root Causes of First Case On-time Start (FCOTS) Delay in the Orthopedic Department at a Busy Level II Community Teaching Hospital.

Introduction: Due to the high cost of operating room time, hospitals have been under increasing pressure to optimize operating room (OR) efficiency. One parameter that has been used to predict OR efficiency is First Case On-Time Start (FCOTS). In this brief report, the authors describe results from a quality improvement project designed to identify the rates and primary causes of first case delay for elective procedures within the orthopedic department at their suburban community hospital.

Multisite assessment of emergency medicine resident knowledge of evidence-based medicine as measured by the Fresno Test of Evidence-Based Medicine.

Context: Evidence-based medicine (EBM) is the application of scientific evidence while treating a patient. To date, however, there is very little evidence describing how residents in emergency medicine understand and incorporate EBM into practice.

Objectives: The aim of this study was to determine EBM theoretical and quantitative knowledge in emergency medicine residents in community hospital-based training programs.

Comment on Suresh et al. The Short-Term Effects and Tolerability of Low-Viscosity Soluble Fibre on Gastroparesis Patients: A Pilot Clinical Intervention Study. 2021, , 4298.

Zhou and colleagues are commended for their innovative research on the tolerability of "low-viscosity" fibre supplements in symptomatic diabetic gastroparesis patients [...

Time Sequence of Measurement Affects Blood Pressure Level in an African American Cohort.

Introduction: Uncontrolled hypertension can result in severe clinical conditions such as stroke, chronic kidney disease and congestive heart failure, especially in African American populations. To the knowledge of the authors, the effect of time sequence on blood pressure (BP) using an Automated Office Blood Pressure (AOBP) device has not been documented in an African American cohort. The objective of this study was to investigate the possible influence of time sequence of measurement (pre- and post-physician visit) on BP readings in an African American cohort, in the presence or absence of a Medical Assistant (MA) via AOBP monitoring.

A Low Cost, Novel Treatment of Severe Diabetic Gastroparesis Based on Burkitt's Dietary Fiber Hypothesis.

We report a seven-year follow-up of a 43-year-old Hispanic female with severe diabetic gastroparesis (GP) and a 42.5 kg weight loss (45% of body mass), who required feeding jejunostomy tube placement. The patient had an excellent response to a treatment regime directed at increasing stool bulk, enhancing gut transit, and mobilizing intestinal gas by using dietary fiber supplements and osmotic laxatives with as needed tap water enemas.

Controlled Substance Use Among Psychiatric Patients in a Rural North Carolina Emergency Department.

Introduction: Emergency department (ED) visits for mental health and substance use disorders have been on the rise, with substance use disorders frequently coexisting with mental health disorders. This study evaluated substances commonly used/abused by patients presenting to the ED of a rural, regional medical center with subsequent admission for mental health treatment in Robeson County, North Carolina.

Methods: This retrospective, single-center study was approved by the Southeastern Health Institutional Review Board.

Management of gastroesophageal reflux disease: Patient and physician communication challenges and shared decision making.

Gastroesophageal reflux disease (GERD) is a common upper esophageal condition and typical symptoms can include heartburn and sensation of regurgitation while atypical symptoms include chronic cough, asthma, hoarseness, dyspepsia and nausea. Typically, diagnosis is presumptive given the presence of typical and atypical symptoms and is an indication for empiric therapy. Treatment management can include lifestyle modifications and/or medication therapy with proton pump inhibitor (PPI) class being the preferred and most effective.