To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The initial medical certificate (CMI) is a medico-legal document of great importance. Writing CMIs is a frequent act in emergency medicine. In 2011, the Haute Authority of Medicine (HAS) published good practice recommendations concerning the writing and content of these certificates. Nevertheless, this practice faces a difficult reality in the emergency services. The aim of this study was to analyze the writing quality of CMIs in terms of compliance of all the criteria collected with respect to HAS recommendations.
This was a retrospective study, evaluating professional practices over a period of two years in Ben Arous ED. We analyzed CMIs written by EPs. The certificates were subjected to a critical reading to begin a comparative study of the quality of writing of these certificates with the HAS recommendations using a criteria grid relating to the theoretical content of the certificates.
207 CMIs were analyzed (Acts of violence 88%, work accidents 12% and AVP less than 1%). The medical writers were mainly represented by general practitioners (98%). Not all of the CMIs complied with writing recommendations. The identity of the physician, the identity of the patient, the date of the examination and of the facts, the nature of the lesions, the handwritten signature of the doctor and the stamp were mentioned in more than 95% of the CMIs. The presence of CNOM registration number, the profession, the address and the number of the national identity of the patient, the place of the facts, the medical history and the previous condition of the patient were absent in more than 95% of the CMIs. The duration of the ITT was written in full in 36% of the cases.
The study revealed insufficiencies in the quality of CMI drafting written by EP. Specific training is underway to improve certificate redactions.
Handover is of big value in preserving continuity of the medical services chain when managing patients. Simulation is well accepted as a good learning method to acquire non-technical skills. Actual studies dealing with this issue are performed on paramedics. Studies involving physicians are rare and usually focus on interviews or questionnaires describing practical situations.
The aim of our study was to evaluate the utility of simulation in enhancing the quality of handover between both pre-hospital and intra-hospital physicians.
We conducted a prospective pre-test/post-test study in a regional Emergency Medical System (EMS) on the handover topic.
We included voluntary physicians who signed participation consent. The study was designed as a three-step project: theoretical training with pre-test and post-test, 1st simulation session, 2nd simulation session with post-test. The two simulation sessions were evaluated according to a specific score. We evaluated the progression of knowledge (tests means) and skills (percentages of good answers): before and after theoretical training and before and after simulation sessions.
Sixteen EMS physicians were enrolled. Thirteen were under 40 years old and ten were emergency medicine physician specialists. Theoretical training made progression in means and percentage good answers (post-test 1 vs. pré-test : 9.5±3.3 vs 6.9±2 ; p=0.008 et 22 vs. 10% ; p=0,001 respectively). Progression of means after simulation was noticed (2nd session vs. 1st session) (16.3±0.9 vs. 12.3±2.5 ; p<0.001). Simulation enhanced significant quality of handover. Means and percentage of good answers in tests was better after simulation sessions (post-test 2 vs. post-test 1 vs. pre-test : 10.7±2.8 vs. 9.5±3.3 vs. 6.9±2 ; p=0.01 et 29% vs. 22% vs. 10% ; p<0.001 respectively).
Our study showed the utility of simulation in enhancing handover between pre-hospital and intra-hospital physicians. Simulation as an active learning method, combined with theoretical training, can improve knowledge and enhance skills.
As a part of a primary intervention, Emergency Medical Services (EMS) may leave a patient at the scene. This decision is made in partnership with the dispatching center. The prognosis of these patients is often unknown. The aim of our study was to assess the outcomes of non-transported EMS patients.
It was a descriptive, prospective study conducted over a two-year-period. We included all alive non-transported EMS patients from the site of intervention after a primary mission of the EMS team based on a medical decision. The prognosis was assessed by unexpected events (UE) defined by death, second EMS call, urgent consultation or hospitalization/surgery within seven days. We considered two groups: a group with UME (UME+) and a group with good evolution (UE-).
We included 97 patients. The average age was 56±19 years. Seventeen patients (17,5%) had no medical histories. Hypoglycemia was observed in 43% of patients. Thirty-four patients (35%) had an UE. These UEs were distributed as the following: ten consulted a private doctor, ten consulted their family physician, seven called the EMS, three visited the emergency department and four died. There were no significant differences in demographic, anamnestic characteristics between two groups. Psychiatric pathology was more common in the UE- group(28% vs. 9%; p=0.0037). Intravenous injections were more common in the UE+ group (64% vs 39% ; p=0,019). Among the four deaths, three were unexpected.
One-third of non-transported EMS patients had UE. Unexpected death was rare (one patient). Setting-up a system for these patients including scores and algorithms, and a post-EMS compulsory visit in collaboration with family physicians could be beneficial.
The docimology or "science of examinations" is a scientific discipline devoted to the study of the examination in all its dimensions. The main objective is the development of standards guaranteeing valid, reliable and objective tests. It was adopted within a Medical School in 2007.
Our aim was to analyze results of docimological survey results of written acute medicine examinations through a global approach, by discipline and by item.
This was a retrospective study analyzing the notes of acute medicine examinations (January and May sessions) of Second Cycle Medical Studies 3). We have calculated docimological parameters allowing three levels of assessment: global, by discipline, and items analysis.
We analyzed 407 scripts, 99 questions and 6,919 pieces of data. The overall success rate was 97.6%. Highest success rates were found in Medical resuscitation (87%). The lowest rate was found in emergency medicine (53%). The difficulty index for the January session was 0.53 and 0.61 for the May session. For the January session: 24% of questions were easy, 14% of questions were difficult and 61% were of acceptable difficulty. For the May session: 40% of questions were easy, 6% of questions were difficult and 54% were of acceptable difficulty. The discrimination index was 0.27 for the January session and 0.24 for the May session. Discrimination was very good in 18% of items and good in 25%. Useless and bad discrimination items were about 35% for both sessions. Average Cronbach’s Alpha was 0.84, showing good internal-consistency.
Overall, acute medical examinations have joined docimological recommendations and had an acceptable internal consistency and a good level of difficulty and discrimination. However, some weaknesses had been revealed specially for the discipline with low weighting. A reflection on the integration of questions would make up for these weaknesses. This would ensure better assessment and training.
Including a multi-year collection of samples (2004–2011) the present research fills 20 years of an information gap regarding the PCB burden in south-west Atlantic franciscana dolphins (Pontoporia blainvillei) while aiming to test the null hypothesis that PCBs congeners are increasingly bioaccumulating in south-west Atlantic specimens in relation to northern hemisphere records. In addition, the present survey analyses indicators of potential biological impairment associated to PCBs tissue burden. The results could associate each sampling area group of dolphins to one or two Aroclor® patterns and point to dominant regional diffuse sources entering PCBs mixtures to the marine environment with a possible regional/long-range atmospheric contribution. In addition, total PCB levels were from four to seven times lower than the closer precedents for the area (18–26 years ago) indicating a progress in the environmental release and biota exposure of PCBs and posing an objective indicator of success of the present international elimination programme. Further, when compared with regional and global bioaccumulation patterns, PCBs congeners in Argentinean specimens appeared to occur in a decreasing tendency. Finally, calculated TEQs TCDD levels raised a concern in regards to environmental safety, showing guideline values to be widely exceeded and the occasional occurrence of positive correlations between PCBs bioaccumulation vs. sexual immaturity.
This study focuses on the dynamics of copepod abundances and species composition in the upper water column of a marine outfall area Tso-Ying (T-Y) in the boundary waters of the north-eastern South China Sea and the Taiwan Strait as an example. Zooplankton samples were collected in March, June and September 2002. Mean copepod abundance at all stations ranged from a minimum of 9.4 (individuals m−3) in March to a maximum of 1685 (individuals m−3) in June. A total of 66 copepod species belonging to 31 genera and 19 families were identified during three cruises. Copepod assemblages were dominated by Temora turbinata which occurred in >97% samples with a relative abundance of 75.46% combining all three sampling cruises. The ordination diagram derived from non-metric multidimensional scaling separated samples on the basis of season and revealed that different sampling stations clustered differently during each cruise. The second and third most dominant species were Acrocalanus gracilis and Acrocalanus gibber, representing 1.73% and 1.65% of the total copepod abundance respectively. The outfall area studied here correlates with lower copepod densities represented by a few species that show a higher relative abundance in comparison with non-affected areas. We provide here the first example where plankton assemblages indicate useful information about environmental changes in the course of sewage disposal at a stable outlet site.
The catch from bottom longline stations sampled from a series of research cruises around Lanzarote and Fuerteventura (Canary Islands, NE Atlantic) was analysed in terms of fish distribution, density and diversity. The distribution of the number of species and individuals caught per station appeared to fit well the Poisson and Exponential distribution function, respectively. In particular, the parameter of the Poisson’s distribution appeared to provide an index of the point (at station scale) diversity, and its confidence interval, allowing for statistical comparisons. The relationships between point diversity, the alpha diversity (in the depth strata) and the beta diversity (along the depth gradient) were investigated. Around the islands, the density and the point diversity of the predator fish declined with depth down to about 800 m and then increased in the deeper stratum. The alpha diversity was the lowest in the deeper stratum but the taxonomic distinctness was similar to that of shallower strata. The beta diversity showed some faunal breaks along the depth gradient. The carnivorous fish fauna can be understood as comprised of three major assemblages: shelf, upper slope and mid-slope that are different both in terms of species composition and point, alpha and beta diversities. The relevance of this simple method for ecological studies of fish assemblage in the context of non-trawlable grounds is discussed, in particular for the slope and other areas of established or developing deep-water fisheries.
Email your librarian or administrator to recommend adding this to your organisation's collection.