Mediterranean Journal of Emergency Medicine & Acute Care最新文献

{"title":"Reforming Healthcare Practice in View of the Economic Crisis in Lebanon: The Case of Cardiovascular Care","authors":"H. Isma'eel, N. Jamal, E. Al‐Chaer, Wissam Haj-Ali, G. Hamadeh","doi":"10.52544/2642-7184(1)4003","DOIUrl":"https://doi.org/10.52544/2642-7184(1)4003","url":null,"abstract":"Since the fall of 2019, Lebanon has been facing an economic crisis that has imposed many challenges on its healthcare system in its entirety. In this review, we propose a methodology to inform healthcare policy and apply it on cardiovascular disease (CVD) healthcare with emphasis on ischemic heart disease (IHD). The main goal of this methodology is reducing unnecessary expenditure while maintaining quality and access. CVD, and particularly IHD, is the most common reason for hospitalizations in Lebanon. Lebanon also has a high density of catheterization labs, higher than countries with higher prevalence of disease. Additionally, we found coronary to be are more expensive in comparison to other countries. To reduce healthcare costs without compromising quality and access we propose solutions targeting healthcare financing, payment for services, healthcare organizations, behaviors of providers, payers, and patients, and above all government regulation.","PeriodicalId":364543,"journal":{"name":"Mediterranean Journal of Emergency Medicine & Acute Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127499123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Volunteer-Operated Field Medical Tents During Civilian Protests in Beirut, Lebanon: Challenges and Lessons","authors":"S. Kiblawi, Sarah S Abdul-Nabi, Z. Dimassi","doi":"10.52544/2642-7184(2)1002","DOIUrl":"https://doi.org/10.52544/2642-7184(2)1002","url":null,"abstract":"In October 2019, the worsening political, economic, and perceived corruption in Lebanon led to civil unrest. In anticipation of injuries, a group of healthcare professionals and social activists summoned paramedics, nurses, and physicians through social media, to provide medical assistance in the protest area. These volunteers established a physician-led advanced first-aid tent, whose aim was to reduce the patient load on Emergency Departments in local hospitals. We present the experience of volunteers, lessons learned, and challenges faced during the establishment of the physician-led first aid tent. In this manuscript, we discuss the following aspects of our efforts that can serve as relevant lessons we learned about medical volunteerism: spontaneity in volunteerism, operations, location and storage, supplies, roaming team, coordination with emergency services, safety, documentation, communication, special situations, and transition from acute to primary care.","PeriodicalId":364543,"journal":{"name":"Mediterranean Journal of Emergency Medicine & Acute Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131084490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Together for Emergency Medicine in the United Arab Emirates!","authors":"S. Fares","doi":"10.52544/2642-7184(1)1004","DOIUrl":"https://doi.org/10.52544/2642-7184(1)1004","url":null,"abstract":"Author(s): Fares, Saleh | Abstract: As I began writing this article, I was stunned realizing that September 2019 marks the anniversary of a ten-year journey for the specialty of emergency medicine (EM) in the United Arab Emirates (UAE). I had returned home to the UAE after 17 years’ acquiring and refining knowledge and skills as well as building experience and expertise abroad. This included medical school studies in Ireland,1 an Emergency Medicine (EM) Residency training in Montreal, Quebec2, a Prehospital Care fellowship in Toronto, Ontario,3 a Disaster Medicine fellowship in Boston, Massachusetts4, and finally a public health graduate degree in Baltimore, Maryland5. Throughout that time spent in nations where EM was well-developed, I was persistently asking myself, “What can I learn from here to allow me to develop EM back home?”. This challenging journey was certainly exciting and beneficial and exposed me to so many different “systems”, to their strengths and weaknesses, to the different approaches used to address problems, needs and day-to-day operations, and reinforced my belief that there is room and a need for flexibility, variability and diversity in the EM models one could build.","PeriodicalId":364543,"journal":{"name":"Mediterranean Journal of Emergency Medicine & Acute Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115279466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psoriasis and Heart Failure: Literature Review and a Case Challenge","authors":"Maruli Tua Sianipar, B. Siswanto","doi":"10.52544/2642-7184(1)1002","DOIUrl":"https://doi.org/10.52544/2642-7184(1)1002","url":null,"abstract":"Psoriasis is a disease characterized by chronic inflammation with a global prevalence of 1-2%. It has a strong genetic component with a systemic immunological response mainly driven by T helper (Th) 1 and 17 lymphocytes. The relationship between HF and psoriasis is not well-described. In this paper we describe 2 cases of concomitant psoriasis and heart failure. Furthermore, we revisit the pathogenesis of those entities and discuss the available evidence on their association, and the proper evaluation of psoriasis in the management of heart failure in patients present with both diseases","PeriodicalId":364543,"journal":{"name":"Mediterranean Journal of Emergency Medicine & Acute Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116736241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing Emergency Medicine in Iran: a Post-implementation Perspective","authors":"K. Golshani","doi":"10.52544/2642-7184(1)1003","DOIUrl":"https://doi.org/10.52544/2642-7184(1)1003","url":null,"abstract":"Author(s): Golshani, Keihan | Abstract: In the 1990s, a comprehensive evaluation of national emergency care (EC) system was performed by the Iranian Ministry of Health and Medical Education (I-MOHME) to identify gaps in timely and proper EC delivery. It was then concluded that a refurbished patient-centered specialty, namely emergency medicine (EM), could reduce or close these gaps.","PeriodicalId":364543,"journal":{"name":"Mediterranean Journal of Emergency Medicine & Acute Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130045946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of a Bedside Pocket-Sized Ultrasound Device to Promptly Manage Abdominal Pain in the Emergency Department","authors":"Bongiovanni Cristina, G. Chiara, D. Benedetta, Marino Rossella, Laghi Andrea, D. Salvatore","doi":"10.52544/2642-7184(1)1001","DOIUrl":"https://doi.org/10.52544/2642-7184(1)1001","url":null,"abstract":"Introduction: Abdominal pain is a frequent reason for Emergency Department (ED) admission; it amounts for around 5–10% of all ED visits. Early assessment should focus on immediately distinguishing cases of acute abdomen that require urgent surgical intervention. The clinical localization of pain is crucial, suggesting an initial evaluation of the origin of the abdominal pain; however, imaging is often required for final diagnosis. Ultrasound (US) represents a rapid imaging modality that is readily available in the ED and does not involve radiation or contrast agent administration. A new generation of portable, battery-powered, low-cost, hand-carried ultrasound devices have become available recently; these devices can provide immediate diagnostic information in patients presenting with abdominal pain in ED.The aim of the study was to demonstrate the diagnostic usefulness of a bedside pocket-sized ultrasound (BPU) device (Vscan from General Electrics) in non-traumatic patients complaining of acute abdominal pain in a tertiary care university hospital in Italy.\u0000\u0000Methods: Patients with acute non-traumatic abdominal pain presenting in ED were prospectively enrolled and underwent physical examination, traditional imaging and BPU.\u0000\u0000Results: A total number of 230 patients with acute non-traumatic abdominal pain were enrolled. Overall agreement between routine standard imaging and BPU turned out to be equal for computed tomography (K=0.3) and traditional ultrasound (K=0.29). Receiver operating characteristics curve (ROC) analysis for diagnostic power of the BPU in comparison with traditional US showed an area under the curve of 0.65, sensitivity and specificity of 87.2% and 42.31% respectively.\u0000\u0000Conclusions: Emergency use of BPU in patients with non-traumatic abdominal pain demonstrated good diagnostic performance when compared to traditional imaging, with the potential advantage of reducing costs and delay in patient final disposition.","PeriodicalId":364543,"journal":{"name":"Mediterranean Journal of Emergency Medicine & Acute Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115932282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The International Medical Graduate","authors":"M. Cheaito, B. Kazzi, E. Hitti, K. Badr, S. Zeineldine, Z. Kazzi, Amin N Kazzi","doi":"10.52544/2642-7184(1)2002","DOIUrl":"https://doi.org/10.52544/2642-7184(1)2002","url":null,"abstract":"International medical graduates (IMGs) are graduates of medical schools located outside the United States (U.S.) and Canada. IMGs face various challenges on the road to U.S. residency training. These challenges include sitting for the United States Medical Licensing Examinations (USMLEs) to obtain certification from the Educational Commission for Foreign Medical Graduates (ECFMG). After that, IMGs are faced with a foreign application process whereby they must apply for and secure a position in a residency program through the Electronic Residency Application System (ERAS) and the National Resident Matching Program (NRMP). Once accepted into a residency program, IMGs who are not US citizens or legal permanent residents are challenged with securing a visa to be able to practice in the U.S. In this article, we elaborate on these processes and highlight the challenges IMGs may face along the way.","PeriodicalId":364543,"journal":{"name":"Mediterranean Journal of Emergency Medicine & Acute Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128632320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mass Casualty Management in the Emergency Department – Lessons Learned in Beirut, Lebanon - Part II","authors":"E. Hitti, M. E. Sayed, M. Cheaito, A. Kellermann, A. Kazzi","doi":"10.52544/2642-7184(1)3003","DOIUrl":"https://doi.org/10.52544/2642-7184(1)3003","url":null,"abstract":"The first article in this series (Part I) discussed the abundant exposure of our emergency department (ED) to mass casualty incidents (MCIs), particularly over the past 14 years. This experience led us to define practical strategies that emergency departments can use to develop their own MCI response plans. In the first part, our main focus was to highlight the abrupt nature of MCIs and the subsequent need to use disaster drills. Additionally, we discussed the importance of having a tiered response and activation as well as other lessons learned from our experience to maximize the preparedness of the emergency department to receive mass casualty.In this article, we discuss the optimal way to triage patients. In addition, we will tackle the best methods for documentation and communication, which are vital yet overlooked during mass casualty incidents. We will also elaborate on what we learned from dealing with outbursts of anger and violence in the ED during MCIs and how to ensure the safety of the ED staff.","PeriodicalId":364543,"journal":{"name":"Mediterranean Journal of Emergency Medicine & Acute Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115734958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of Attempted Suicide in the Middle East and North Africa Region: The Mediating Role of Arab Culture and Religion","authors":"S. Halabi, R. Hayek, Karine Kahil, Marwa Nofal, S. Hayek","doi":"10.52544/2642-7184(1)3002","DOIUrl":"https://doi.org/10.52544/2642-7184(1)3002","url":null,"abstract":"The general lack of awareness of mental health in the Middle East and North Africa (MENA) region, particularly within its Arab countries, accounts for limited mental health services and stigmatization of psychiatric conditions in the region. Suicide is a drastic consequence of mental health neglect. Suicidal attempts are one form of presentation to emergency departments (ED) in healthcare centers across the Arab countries in the MENA region. We collected data from various research studies in the region to narrate such presentations. This epidemiological country-by-country summary includes the characteristics of suicidal attempts in the Arab region, with a focus on methods, causes, and management of cases. The summary demonstrates that suicidal attempts in this part of the world share sociocultural and logistic grounds. The prominent archetypes of suicidal attempts are middle-aged Arab women ingesting poisonous substances secondary to familial or interpersonal stressors. We also link these presentations to the Arab culture and its associated beliefs, which at times can dictate privacy and stigmatization of mental health and suicide. Even though religion plays a role in mollifying suicidal attempts, it might exacerbate stigma regarding suicide among Arab societies. Lastly, we recommend management measures that enhance suicide risk detection in the ED and provide an ameliorated understanding of suicidal ideations and behaviors of patients in the Arab countries of the MENA region.","PeriodicalId":364543,"journal":{"name":"Mediterranean Journal of Emergency Medicine & Acute Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133013551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"USMLE Scores Do Not Predict the Clinical Performance of Emergency Medicine Residents","authors":"K. Sajadi-Ernazarova, E. Ramoska, M. Saks","doi":"10.52544/2642-7184(1)2001","DOIUrl":"https://doi.org/10.52544/2642-7184(1)2001","url":null,"abstract":"Background: Scores on “high-stakes” multiple choice exams such as the United States Medical Licensing Examination® (USMLE) are important screening and applicant ranking criteria used by residencies.Objective: We tested the hypothesis that USMLE scores do not predict overall clinical performance of emergency medicine (EM) residents.Methods: All graduates from our University-based EM residency between the years 2008 and 2015 were included. Residents who had incomplete USMLE records were terminated, transferred out of the program, or did not graduate within this timeframe were excluded from the analysis. Clinical performance was defined as a gestalt of the residency program’s leadership and was classified into three sets: top, average, and lowest clinical performer. Dissimilarities of the initial blind rankings were adjudicated during a consensus conference.Results: During the eight years of the study period, there were a total of 115 graduating residents: 73 men (63%) and 42 women. Nearly all of them (109; 95%) had allopathic medical degrees; the remainder had osteopathic degrees. There was not a statistically significant correlation between our ranking of clinical performance and the Step 2 Clinical Knowledge score. There was a non-significant correlation between clinical performance and the Step 1 score.Conclusion: Neither USMLE Step 1 nor Step 2 Clinical Knowledge were good predictors of the actual clinical performance of residents during their training. We feel that their scores are overemphasized in the resident selec­tion process.","PeriodicalId":364543,"journal":{"name":"Mediterranean Journal of Emergency Medicine & Acute Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114811121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}