An Epidemiologic Study of Bacterial Culture and Antibiotic Susceptibility Analyses in Captive Macaques and Marmosets at the Wisconsin National Primate Research Center.

Antimicrobial resistance (AMR) represents a growing public health threat that arises at the interface between animal, human, and environmental health. Although the pathways promoting the development of AMR are well characterized in human health settings, data within the veterinary medical world are less abundant, particularly from fields focusing on nontraditional species, such as nonhuman primates (NHPs). The purpose of this study was to describe trends in sample submission for bacterial culture, characterize patterns of microbial growth and any changes in AMR and susceptibility over time, and inform best practices for veterinary antimicrobial stewardship in a captively-housed, indoor NHP colony.

Emergency Services Capacity of a Rural Community in Guatemala.

Introduction: Access to emergency care is an essential part of the health system. Improving access to emergency services in low- and middle-income countries (LMIC) decreases mortality and reduces global disparities; however, few studies have assessed emergency services resources in LMICs. To guide future improvements in care, we performed a comprehensive assessment of the emergency services capacity of a rural community in Guatemala serving a mostly indigenous population.

Training for Pediatric Cardiac and Pulmonary Point of Care Ultrasound in Eastern Uganda.

Caring for children with acute illness is a challenge in limited-resource settings, especially when diagnostic imaging is limited or unavailable. We developed a training program in cardiac and lung point-of-care ultrasound (POCUS) for pediatric patients in eastern Uganda. Fourteen trainees including physicians, resident physicians and midlevels received training in cardiac and lung POCUS.

Utility of bedside assessment to evaluate for cervical-spine fracture post ground-level fall for patients 65 years and older.

Objectives: The effectiveness of current assessment tools for cervical fracture are mixed with respect to elderly patients. We aim to examine utility of history and physical exam to assess for cervical fracture for elderly patients suffering a ground-level fall.

Methods: Retrospective cohort from a tertiary-care ED for patients ≥65 years, including dementia, after ground-level fall.

A One Health Approach to Compare Self-Prescribed Antibiotic Use across Rural and Semi-urban Populations in San Lucas Tolimán, Guatemala.

Antimicrobial resistance resulting from antibiotic overuse represents an increasing public health challenge. The purpose of this study was to investigate antibiotic self-medication practices in a rural, indigenous Guatemalan population, and to compare self-prescribing patterns in rural and semi-urban populations using a One Health integrated approach, a framework acknowledging that health arises at the interface of humans, animals, and the environment. We conducted a mixed methods study using semi-structured interviews in and around San Lucas Tolimán, Guatemala.

The Use of Traditional and Complementary Medicine for Diabetes in Rural Guatemala.

Objectives: The global burden of type 2 diabetes mellitus is increasing, especially in Central America. In resource-limited settings, such as Guatemala, there are significant barriers to diabetes care and many Guatemalans use medicinal plants as treatment. The purpose of this study is to understand the use of medicinal plants in an indigenous population with diabetes in rural Guatemala.

Using the Hendrich II Inpatient Fall Risk Screen to Predict Outpatient Falls After Emergency Department Visits.

Objectives: To evaluate the utility of routinely collected Hendrich II fall scores in predicting returns to the emergency department (ED) for falls within 6 months.

Design: Retrospective electronic record review.

Setting: Academic medical center ED.

Improved cookstoves and their effect on carbon monoxide levels in San Lucas Tolimán, Guatemala.

Introduction: Installation of ventilated cookstoves has been shown to improve 24-h carbon monoxide (CO) and particulate exposure in the Guatemalan highlands. However, a survey of villagers around San Lucas Tolimán found much higher than expected CO levels. Our purpose is to evaluate the effects of improved cookstoves on CO levels in these villagers.

The Impact of an Emergency Department Front-End Redesign on Patient-Reported Satisfaction Survey Results.

Introduction: For emergency department (ED) patients, delays in care are associated with decreased satisfaction. Our department focused on implementing a front-end vertical patient flow model aimed to decrease delays in care, especially care initiation. The physical space for this new model was termed the Flexible Care Area (FCA).

Using Chief Complaint in Addition to Diagnosis Codes to Identify Falls in the Emergency Department.

Objectives: To compare incidence of falls in an emergency department (ED) cohort using a traditional International Classification of Diseases, Ninth Revision (ICD-9) code-based scheme and an expanded definition that included chief complaint information and to examine the clinical characteristics of visits "missed" in the ICD-9-based scheme.

Design: Retrospective electronic record review.

Setting: Academic medical center ED.

Negative D-dimer testing excludes pulmonary embolism in non-high risk patients in the emergency department.

Purpose: The purpose of this study was to assess the ability of d-dimer testing to obviate the need for cross-sectional imaging for patients at "non-high risk" for pulmonary embolism (PE).

Methods: This is a retrospective study of emergency department patients at an academic medical center who underwent cross-sectional imaging (MRA or CTA) to evaluate for PE from 2008 to 2013. The primary outcome was the NPV of d-dimer testing when used in conjunction with clinical decision instruments (CDIs = Wells', Revised Geneva, and Simplified Revised Geneva Scores).

Anemia is not a risk factor for developing pulmonary embolism.

Objective: Our aim was to validate the previously published claim of a positive relationship between low blood hemoglobin level (anemia) and pulmonary embolism (PE).

Methods: This was a retrospective study of patients undergoing cross-sectional imaging to evaluate for PE at an academic medical center. Patients were identified using billing records for charges attributed to either magnetic resonance angiography or computed tomography angiography of the chest from 2008 to 2013.

Emergency Department Patients' Perceptions of Radiation From Medical Imaging.

Objective: To evaluate emergency department patients' knowledge of radiation exposure and subsequent risks from computed tomography (CT) and magnetic resonance imaging (MRI) scans.

Methods: This is a cross-sectional survey study of adult, English-speaking patients from June to August 2011 at 2 emergency departments--1 academic and 1 community-based--in the upper Midwest. The survey consisted of 2 sets of 3 questions evaluating patients' knowledge of radiation exposure from medical imaging and subsequent radiation-induced malignancies and was based on a previously published survey.

Trends in the Use of Medical Imaging to Diagnose Appendicitis at an Academic Medical Center.

Objective: To quantify the trends in imaging use for the diagnosis of appendicitis.

Methods: A retrospective study covering a 22-year period was conducted at an academic medical center. Patients were identified by International Classification of Diseases-9 diagnosis code for appendicitis.

Prospective evaluation of the ability of clinical scoring systems and physician-determined likelihood of appendicitis to obviate the need for CT.

Objective: To determine whether clinical scoring systems or physician gestalt can obviate the need for computed tomography (CT) in patients with possible appendicitis.

Methods: Prospective, observational study of patients with abdominal pain at an academic emergency department (ED) from February 2012 to February 2014. Patients over 11 years old who had a CT ordered for possible appendicitis were eligible.

Systematic review and meta-analysis of the accuracy of MRI to diagnose appendicitis in the general population.

Purpose: To perform a systematic review and meta-analysis of all published studies since 2005 that evaluate the accuracy of magnetic resonance imaging (MRI) for the diagnosis of acute appendicitis in the general population presenting to emergency departments.

Materials And Methods: All retrospective and prospective studies evaluating the accuracy of MRI to diagnose appendicitis published in English and listed in PubMed, Web of Science, Cinahl Plus, and the Cochrane Library since 2005 were included. Excluded studies were those without an explicitly stated reference standard, with insufficient data to calculate the study outcomes, or if the population enrolled was limited to pregnant women or children.

Safety of a rapid diagnostic protocol with accelerated stress testing.

Background: Most patients at low to intermediate risk for an acute coronary syndrome (ACS) receive a 12- to 24-hour "rule out." Recently, trials have found that a coronary computed tomographic angiography-based strategy is more efficient. If stress testing were performed within the same time frame as coronary computed tomographic angiography, the 2 strategies would be more similar.

Emergency department discharge prescription interventions by emergency medicine pharmacists.

Study Objective: We determine the rate and details of interventions associated with emergency medicine pharmacist review of discharge prescriptions for patients discharged from the emergency department (ED). Additionally, we evaluate care providers' satisfaction with such services provided by emergency medicine pharmacists.

Methods: This was a prospective observational study in the ED of an academic medical center that serves both adult and pediatric patients.

Rhythm disturbances.

Patients with cardiac rhythm disturbances may present in a variety of conditions. Patients may be unstable, requiring immediate interventions, or stable, allowing for a more deliberate approach. Rapid assessment of patient stability, underlying rhythm, and determination of appropriate interventions guides timely therapy.

Hypertension in the ED: still an unrecognized problem.

Introduction: Hypertension is prevalent in the general population. Emergency Department (ED) follow-up studies show persistence of blood pressure elevations in up to 50% of patients, and ED screening for hypertension has been recommended. Blood pressure elevations are often ignored or attributed to pain or anxiety.

Trauma systems and timing of patient transfer: are we improving?

Introduction: The regionalization of trauma services is based on the premise that injured persons presenting to nontertiary facilities will be stabilized and rapidly transported to a more definitive center. Although trauma systems seem to improve outcomes for urban patients, this same benefit has not been shown for rural patients. There are many factors associated with the decision to transfer injured patients to a regional trauma center, including referral hospital and patient age, for example.

Ketamine for prehospital use: new look at an old drug.

Introduction: Ketamine has been used extensively for analgesia and anesthesia in many situations, including disaster surgery where extra personnel and advanced monitoring are not available. There are many features of ketamine that seem to make it an ideal drug for prehospital use. The reported use of ketamine in the prehospital environment is limited, however.

Effectiveness of nonnarcotic protocol for the treatment of acute exacerbations of chronic nonmalignant pain.

Introduction: Emergency department (ED) overcrowding is a growing problem. Frequent visits for chronic pain are a significant subset of patients. The use of narcotics in these patients is controversial.