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Open Access Publications from the University of California

Volume 1, Issue 1, 2019

Mediterranean Journal of Emergency Medicine & Acute Care Volume 1 Issue 1

Articles

The Mediterranean Journal of Emergency Medicine & Acute Care: Why

Certainly, we cannot launch a new open access journal such as MedJEM without justifying why we aredoing so and what will be different about it.

First, we believe the specialty of emergency medicine (EM) as well as emergency, urgent and acutecare around the Mediterranean basin have reached over the last three decades a level of development,complexity and needs that require the establishment of a regional internationally-driven medical journal.The publication of such a journal constitutes a major milestone in the development of any specialty ingeneral - and of EM and emergency medical services in particular.

Impact of Internally Developed Electronic Prescription on Prescribing Errors at Discharge from the Emergency Department

Introduction: Medication errors are common, with studies reporting at least one error per patient encounter. At hospital discharge, medication errors vary from 15%-38%. However, studies assessing the effect of an internally developed electronic (E)-prescription system at discharge from an emergency department (ED) are comparatively minimal. Additionally, commercially available electronic solutions are cost-prohibitive in many resource-limited settings. We assessed the impact of introducing an internally developed, low-cost E-prescription system, with a list of commonly prescribed medications, on prescription error rates at discharge from the ED, compared to handwritten prescriptions.

Methods: We conducted a pre- and post-intervention study comparing error rates in a randomly selected sample of discharge prescriptions (handwritten versus electronic) five months pre and four months post the introduction of the E-prescription. The internally developed, E-prescription system included a list of 166 commonly prescribed medications with the generic name, strength, dose, frequency and duration. We included a total of 2,883 prescriptions in this study: 1,475 in the pre-intervention phase were handwritten (HW) and 1,408 in the post-intervention phase were electronic. We calculated rates of 14 different errors and compared them between the pre- and post-intervention period.

Results: Overall, E-prescriptions included fewer prescription errors as compared to HW- prescriptions. Specifically, E-prescriptions reduced missing dose (11.3% to 4.3%, p <0.0001), missing frequency (3.5% to 2.2%, p=0.04), missing strength errors (32.4% to 10.2%, p <0.0001) and legibility (0.7% to 0.2%, p=0.005). E-prescriptions, however, were associated with a significant increase in duplication errors, specifically with home medication (1.7% to 3%, p=0.02).

Conclusion: A basic, internally developed E-prescription system, featuring commonly used medications, effectively reduced medication errors in a low-resource setting where the costs of sophisticated commercial electronic solutions are prohibitive.

Utility of a Bedside Pocket-Sized Ultrasound Device to Promptly Manage Abdominal Pain in the Emergency Department

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.

Methods: Patients with acute non-traumatic abdominal pain presenting in ED were prospectively enrolled and underwent physical examination, traditional imaging and BPU.

Results: 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.

Conclusions: 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.

Psoriasis and Heart Failure: Literature Review and a Case Challenge

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.

Establishing Emergency Medicine in Iran: a Post-implementation Perspective

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.

Together for Emergency Medicine in the United Arab Emirates!

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.