Journal of Acute Medicine RSS feed: Current Issue. The Journal of Acute Medicine (JACME) is the official peer-reviewed publication of the Taiwan Society of Emergency Medicine. It is published quarterly by Elsevier. The Journal aims to publish high quality scientific and clinical research in the field of emergency medicine, critical care and trauma, with the goal of promoting and disseminating medical science knowledge to improve global health. Articles on laboratory, clinical, and social research in emergency medicine and other related fields that are of interest to the medical profession are eligible for consideration. Review articles, original articles, case reports, short communications, and letters to the editor are accepted. The journal is published quarterly, with a total of 4 issues a year. http://www.e-jacme.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. Journal of Acute Medicine2211-558721March 2012 © 2012 Published by Elsevier Inc. healthpermissions@elsevier.comhttp://www.e-jacme.com/article/PIIS2211558712000039/abstract?rss=yesAbstract: Background/Introduction: Mini-clinical evaluation exercises (mini-CEXs) have been successfully adapted as a formative and summative assessment tool for various different postgraduate medical programs. However, only a few studies have evaluated its use in the setting of an emergency department (ED).Purpose(s)/Aim(s): The purpose of this study was to examine the quality of feedback given by preceptors to postgraduate Year 1 (PGY-1) residents during mini-CEXs in EDs.Methods: This prospective observational study involved EDs at 20 teaching hospitals and comprised 893 mini-CEX encounters involving 230 PGY-1 trainees and 242 preceptors. All feedback forms, which contained three sections, namely “Positive Feedback,” “Negative Feedback,” and “Action Plan,” were assessed using qualitative content analysis techniques.Results: A total of 734 mini-CEX sessions (82.2%) contained positive feedback, 507 (63.8%) contained negative feedback, 350 (39.2%) contained action plans, and 131 (14.7%) had no feedback. These written feedback comments could be structured into 1,877 coded items and grouped into seven domains of clinical competence. These were: (1) medical interviewing, (2) physical examination, (3) professionalism, (4) clinical judgment, (5) counseling, (6) organization/efficiency, and (7) clinical procedures.Conclusion: During feedback from the mini-CEXs in the ED setting, preceptors to the PGY-1 students tend to emphasize clinical judgment and seemed to pay less attention to facilitate the development of reflective skills and communication skills.Mini-clinical evaluation exercise and feedback on postgraduate trainees in the emergency department: A qualitative content analysisChaou-Shune Lin, Te-Fa Chiu, David H.T. Yen, Chee-Fah Chong10.1016/j.jacme.2012.01.002Journal of Acute Medicine 2, 1 (2012)2012-02-20Journal of Acute Medicine2012-02-2021S2211-5587(12)X0002-5Original Research17http://www.e-jacme.com/article/PIIS2211558712000027/abstract?rss=yesAbstract: Purpose: To validate emergency department (ED) occupancy rate against ambulance diversion status at an urban academic ED in Taipei, Taiwan.Methods: This is a retrospective study conducted at an urban academic ED with annual census of 70,000 visits. From January 1, 2010 to December 31, 2010, the hourly ED occupancy rate and other customary measures were collected via the hospital information system. To assess the performance of ED occupancy rate as a measure of ED overcrowding, we used ambulance diversion status as the reference standard. The ROC curve, sensitivity and specificity were analyzed and the predictive ability of ED occupancy rate in terms of the 1-hour later and 2-hour later diversion status was examined.Results: A total of 8,728 data points together with their corresponding ambulance diversion status were analyzed. The ED occupancy rate was found to be moderate associated with ambulance diversion status (area under curve, AUC = 0.84, p = 0.004). When the sensitivity was fixed at 91%, the specificity was 60% and the corresponding ED occupancy rate was 1.25. ED occupancy rate was also associated with 1-hour and 2-hour later diversion status having AUCs of 0.83 and 0.82, respectively.Conclusion: This study suggests that ED occupancy rate, a simple index that can be easily implanted into any hospital information system, has the potential to become an universal ED crowding index and offers the opportunity for international comparison.Using ambulance diversion status to validate occupancy rate at an academic emergency department in Taipei, TaiwanPo-Liang Cheng, Tzong-Luen Wang, Chee-Fah Chong, Sheng-Wen Hou10.1016/j.jacme.2012.01.001Journal of Acute Medicine 2, 1 (2012)2012-02-27Journal of Acute Medicine2012-02-2721S2211-5587(12)X0002-5Original Research812http://www.e-jacme.com/article/PIIS2211558712000052/abstract?rss=yesAbstract: Background: Melioidosis has emerged as a global problem; however, few studies have specifically described the clinical characteristics and outcomes when patients with melioidosis are treated at an emergency department (ED).Purpose: The objective of this study was to examine the demographics and clinical characteristics of patients with melioidosis who visited an ED.Methods: A retrospective analysis of patients treated for melioidosis at an ED.Results: Of the 25 patients identified over 7 years, 22 patients had bacteremia, whereas diabetes mellitus was the most common underlying disease (17 patients). Acute respiratory failure requiring mechanical ventilation developed in 52% of the patients. The overall mortality rate was 40%, and death within 48 hours of presentation at the ED occurred in 24% of the patients. The most common infection site was the lungs (in 52% of patients), and 36% of the patients presented with community-acquired pneumonia (CAP) at the ED. A comparison of the CAP and non-CAP groups of patients revealed that the presence of shock upon arrival (56% vs. 0; p=0.002), total mortality (78% vs. 19%; p=0.009), and early mortality (56% vs. 6%; p=0.012) were significantly more common among the individuals who comprised the CAP group. Early mortality accounted for 60% of total deaths, and all of these patients died before final microbiologic data were available. CAP presentation (p=0.012), the presence of band-form leukocytes (p=0.001), increased serum creatinine (p=0.037), and shock on arrival (p=0.005) were significantly more common among patients with early mortality.Conclusion: Melioidosis is a devastating illness with a high rate of mortality occurring within 48 hours of presentation. Melioidosis that presents with CAP is the most severe form of the disease and is associated with greatly increased early mortality.Clinical characteristics of patients with melioidosis treated in an emergency departmentChien-Hung Wu, Chu-Feng Liu, Shih-Hung Huang, Chen-Hsiang Lee, Chia-Te Kung10.1016/j.jacme.2012.02.001Journal of Acute Medicine 2, 1 (2012)2012-03-21Journal of Acute Medicine2012-03-2121S2211-5587(12)X0002-5Original Research1318http://www.e-jacme.com/article/PIIS2211558712000064/abstract?rss=yesAbstract: Background and goal: Relatively little is well known about the causes of emergency department (ED) adverse events/errors. The main purpose of this study was to explore clinically significant adverse events (CSAEs), with an emphasis on those related to physicians' factors, in discharged patients of emergency medicine (EM) through an analysis of the basic management process.Methods: We designed a retrospective study to determine CSAEs in the discharged patients of EM and explored these adverse events, based on the basic management process. The collected cases were those who returned to the ED within 3 days, after being discharged directly from the EM section (EMS), between February 1, 2002, and January 31, 2007. The basic management process includes history taking, physical examinations, laboratory/radiological examinations, and observation. Our main outcome measurements were the inadequacies, their related evidence, and their descriptive statistics (counts and proportions) in the basic management process in cases of CSAEs.Results: Among the 101,402 patients discharged from the EMS, 1,230 [1.21%, 95% confidence interval (CI)=1.03% – 1.39%] were determined to have CSAEs. Among these 1,230 cases, physicians' factors accounted for 722 (58.7%) and disease progress 508 (41.3%). The CSAEs rate related to physicians' factors was 0.7% (722/101,402, 95% CI=0.69% – 0.75%). Regarding the causes of CSAEs related to physicians' factors (772), lack of observation was the most common (42.4%, 306/722), followed by the inadequacy in history taking (34.2%, 247/722). Only 8 (8/722, 1.1%) of the CSAEs were determined as being caused purely by “judgment defects”.Conclusion: In this study, we found that 41.8% of CSAEs were due to disease process and 58.2% related to physicians' factors in the discharged patients of EM. Among CSAEs related to physicians' factors, most were caused by inadequacies in basic management flow and only a small minority was purely the result of “judgment defects”. After reviewing the related evidence with regards to these CSAEs, clusters of common causes were noted.Exploration of clinically significant adverse events in adult non-traumatic emergency department discharged patients through the basic management process analysis - A five-year experienceChii-Hwa Chern, Lee-Min Wang, Chorng-Kuang How10.1016/j.jacme.2012.03.001Journal of Acute Medicine 2, 1 (2012)2012-04-18Journal of Acute Medicine2012-04-1821S2211-5587(12)X0002-5Original Research1925http://www.e-jacme.com/article/PIIS2211558712000040/abstract?rss=yesAbstract: A case of left ventricle rupture caused by tire explosion is reported because it seems to be unique in literature. A 37-year-old male truck driver was injured in the chest-upper-abdomen level of his body by an exploding tire; the event resulted in him losing consciousness at the scene. An echocardiogram performed 30 min later after arrival at the emergency room showed a small left ventricle, a dilated left atrium, mild mitral regurgitation, and a large amount of pericardial effusion. There was no evidence of heart rupture at this point. The patient became agitated and was put under the tranquilizer control. It was then arranged for him to receive computed tomography of the brain and abdominal ultrasound. During these evaluations, the patient began to have episodes of hypotension despite adequate volume resuscitation. Therefore, he was taken to the operating room, where sternotomy and cardiorrhaphy (without cardiopulmonary bypass) was performed. Direct suturing of the damage to the heart was carried out. The patient recovered uneventfully after the operation.Left ventricle rupture in a truck driver caused by a tire explosionNan-Sung Chou, Chih-Chen Chen, Sen-Shan Lin, How-Ran Guo10.1016/j.jacme.2012.01.003Journal of Acute Medicine 2, 1 (2012)2012-03-05Journal of Acute Medicine2012-03-0521S2211-5587(12)X0002-5Case Reports2628http://www.e-jacme.com/article/PIIS2211558712000076/abstract?rss=yesAbstract: Acute myocardial infarction (AMI) is a rare complication following blunt trauma, which is difficult to diagnose early and manage promptly. We describe a 30-year-old man who developed ventricular tachycardia caused by AMI after blunt chest trauma.Acute myocardial infarction and ventricular tachycardia due to blunt chest traumaChia-Sheng Wang, Kun-Kuang Lee, Gwo-Fane Yu, Wei-Ting Lin10.1016/j.jacme.2012.02.002Journal of Acute Medicine 2, 1 (2012)2012-04-17Journal of Acute Medicine2012-04-1721S2211-5587(12)X0002-5Case Reports2930