Minimal impact of an electronic medical records system.

BACKGROUND: Electronic medical records (EMRs) implementation in hospitals and emergency departments (EDs) is becoming increasingly more common. The purpose of this study was to determine the impact of an EMR system on patient-related factors that correlate to ED workflow efficiency. METHODS: A retrospective chart review assessed monthly census reports of all patients who registered and were treated to disposition during conversion from paper charts to an EMR system. The primary outcome measurement was an analysis of the time of registration to discharge or total ED length of stay as well as rate of those who left without being seen, eloped, or left against medical advice. These data were recorded from 3 periods, for 18 months: before installation of the EMR system (pre-EMR), during acclimation to the EMR, and post acclimation (post-EMR). RESULTS: A total of 61626 individual patient records were collected and analyzed. The total ED length of stay across all patient subtypes was not significantly affected by the installation of the hospital-wide EMR system (P = .481); however, a significant decrease was found for patients who were admitted to the hospital from the ED (P < .00001). The percentage of patients who left without being seen between the pre-EMR and post-EMR periods was 1.8% and 2.7%, respectively, representing a significant increase (P < .0001). The number of patients who left against medical advice did not change across the periods of the present investigation (P > .25). CONCLUSIONS: Installation of a hospital-wide EMR system had minimal impact on workflow efficiency parameters in an ED.

Treatment of ectopic intratracheal thyroid with a holmium laser.

The report describes an 85-year-old woman who underwent ectopic intratracheal thyroid ablation with a holmium laser. This represents a novel use of a holmium laser and a potential alternative for commonly performed open intratracheal thyroid excisions.

Development of cytomegalovirus-mediated sensorineural hearing loss in a Guinea pig model.

OBJECTIVE: To develop an animal model for cytomegalovirus (CMV)-induced sensorineural hearing loss. DESIGN: Guinea pig model. SETTING: University of Utah otolaryngology research labs. PARTICIPANTS: Thirty-one Hartley guinea pig pups were divided into 4 groups. Group 1 pups were delivered from pregnant dams inoculated with 1 x 10(5) plaque-forming units (PFU) of guinea pig CMV (gpCMV). Group 2 and group 3 pups were delivered from pregnant dams inoculated with higher doses of 2 and 4 x 10(5) PFU of gpCMV, respectively. Group 4 pups, the control group, were delivered from uninoculated dams. MAIN OUTCOME MEASURES: All groups underwent weekly auditory brainstem response studies. Six weeks after delivery, the brain, cochlea, salivary glands, lungs, liver, and kidneys were harvested. All tissue except the cochlea was analyzed for histologic evidence of the virus. All tissue underwent polymerase chain reaction (PCR) to detect gpCMV. RESULTS: Seven of the 19 (37%) inoculated pups developed a 30-dB hearing loss; none of the animals in the control group had a worse click threshold than 20 dB. Group 1 pups demonstrated statistically significant asymmetric hearing loss. All 3 inoculated groups showed evidence of progressive hearing loss over time. The control group did not demonstrate evidence of progressive threshold worsening. The PCR testing detected gpCMV in the cochleas of group 2 and group 3 animals. CONCLUSIONS: We have successfully demonstrated elevated auditory brainstem response click thresholds with characteristics of progressive and asymmetric loss that have been reported in clinical reports of congenital CMV infection. We also detected gpCMV via PCR testing in the cochleas of inoculated pups.

Karyotype determination and gene mapping in two clinical isolates of Penicillium marneffei.

Electrophoretic karyotypes from two clinical isolates of Penicillium marneffei were derived using contoured-clamped homogeneous electric field (CHEF) gel electrophoresis. Five chromosome-sized DNA fragments were resolved from each isolate. Chromosomal length polymorphisms were evident among the three largest molecules. Based upon these electrophoretic separation patterns, individual chromosomes were estimated to range in size from 2.0 to > or = 6.3 Mbp with a total genome size of 20.6 to > or = 21.6 Mbp. However, Southern blot analysis using a telomeric probe suggests that P. marneffei may possess as many as seven chromosomes, including two pairs of molecules that co-migrate under the CHEF separation conditions employed in this study. Hence, the total genome size of P. marneffei may be as large as 25.7 to > or = 26.7 Mbp. Further hybridization analysis mapped four chitin synthase homologues to specific chromosomes as well as genes for chitinase, malate synthase, isocitrate lyase, isocitrate dehydrogenase, 5.8S rRNA, and 23S rRNA. The mapping analyses also suggested the existence of multiple chitinase gene homologues in P. marneffei. The collective results of this investigation provide additional foundations for facilitating the genetic characterization of P. marneffei and the molecular epidemiology of penicilliosis due to this fungus.

Epistaxis.

Epistaxis is a common occurrence. The estimated lifetime incidence of epistaxis is approximately 60% and it ranges in severity from a minor nuisance to a life-threatening hemorrhage. Evaluation of recurrent or severe cases includes a search for underlying causes, such as bleeding disorders and neoplasia. Many techniques, materials, and procedures treat nasal bleeding effectively and sometimes more than one treatment must be used. Otolaryngologists must be prepared to deal with severe or refractory bleeding through the use of medications, packing materials, and radiologic or surgical interventions. This article reviews nasal vascular anatomy, common causes of epistaxis, and treatments, including biomaterials and minimally invasive surgical techniques.