International Federation for Emergency Medicine Model Curriculum for Emergency Medicine Specialists.

To meet a critical and growing need for emergency physicians and emergency medicine resources worldwide, physicians must be trained to deliver time-sensitive interventions and lifesaving emergency care. Currently, there is no globally recognized, standard curriculum that defines the basic minimum standards for specialist trainees in emergency medicine. To address this deficit, the International Federation for Emergency Medicine convened a committee of international physicians, health professionals and other experts in emergency medicine and international emergency medicine development to outline a curriculum for training of specialists in emergency medicine. This curriculum document represents the consensus of recommendations by this committee. The curriculum is designed to provide a framework for educational programmes in emergency medicine. The focus is on the basic minimum emergency medicine educational content that any emergency medicine physician specialist should be prepared to deliver on completion of a training programme. It is designed not to be prescriptive but to assist educators and emergency medicine leadership to advance physician education in basic emergency medicine no matter the training venue. The content of this curriculum is relevant not just for communities with mature emergency medicine systems, but in particular for developing nations or for nations seeking to expand emergency medicine within the current educational structure. We anticipate that there will be wide variability in how this curriculum is implemented and taught. This variability will reflect the existing educational milieu, the resources available, and the goals of the institutions' educational leadership with regard to the training of emergency medicine specialists.

The efficacy and value of emergency medicine: a supportive literature review.

STUDY OBJECTIVES: The goal of this study was to identify publications in the medical literature that support the efficacy or value of Emergency Medicine (EM) as a medical specialty and of clinical care delivered by trained emergency physicians. In this study we use the term "value" to refer both to the "efficacy of clinical care" in terms of achieving desired patient outcomes, as well as "efficiency" in terms of effective and/or cost-effective utilization of healthcare resources in delivering emergency care. A comprehensive listing of publications describing the efficacy or value of EM has not been previously published. It is anticipated that the accumulated reference list generated by this study will serve to help promote awareness of the value of EM as a medical specialty, and acceptance and development of the specialty of EM in countries where EM is new or not yet fully established. METHODS: The January 1995 to October 2010 issues of selected journals, including the EM journals with the highest article impact factors, were reviewed to identify articles of studies or commentaries that evaluated efficacy, effectiveness, and/or value related to EM as a specialty or to clinical care delivered by EM practitioners. Articles were included if they found a positive or beneficial effect of EM or of EM physician-provided medical care. Additional articles that had been published prior to 1995 or in other non-EM journals already known to the authors were also included. RESULTS: A total of 282 articles were identified, and each was categorized into one of the following topics: efficacy of EM for critical care and procedures (31 articles), efficacy of EM for efficiency or cost of care (30 articles), efficacy of EM for public health or preventive medicine (34 articles), efficacy of EM for radiology (11 articles), efficacy of EM for trauma or airway management (27 articles), efficacy of EM for using ultrasound (56 articles), efficacy of EM faculty (34 articles), efficacy of EM residencies (24 articles), and overviews and editorials of EM efficacy and value (35 articles). CONCLUSION: There is extensive medical literature that supports the efficacy and value for both EM as a medical specialty and for emergency patient care delivered by trained EM physicians.

International Federation for Emergency Medicine model curriculum for medical student education in emergency medicine.

There is a critical and growing need for emergency physicians and emergency medicine resources worldwide. To meet this need, physicians must be trained to deliver time-sensitive interventions and life-saving emergency care. Currently, there is no internationally recognized, standard curriculum that defines the basic minimum standards for emergency medicine education. To address this lack, the International Federation for Emergency Medicine (IFEM) convened a committee of international physicians, health professionals, and other experts in emergency medicine and international emergency medicine development to outline a curriculum for foundation training of medical students in emergency medicine. This curriculum document represents the consensus of recommendations by this committee. The curriculum is designed with a focus on the basic minimum emergency medicine educational content that any medical school should be delivering to its students during their undergraduate years of training. It is not designed to be prescriptive, but to assist educators and emergency medicine leadership in advancing physician education in basic emergency medicine content. The content would be relevant, not just for communities with mature emergency medicine systems, but also for developing nations or for nations seeking to expand emergency medicine within current educational structures. We anticipate that there will be wide variability in how this curriculum is implemented and taught, reflecting the existing educational milieu, the resources available, and the goals of the institutions' educational leadership.

A mitochondrial mutation A4401G is involved in the pathogenesis of left ventricular hypertrophy in Chinese hypertensives.

The left ventricular hypertrophy (LVH) is one of the most important organ damage targets in hypertension. Despite the involvement of multiple factors, the genetic factors have been shown to have an important function in the pathogenesis of LVH. The aim of our study was to evaluate the role of mitochondria in LVH for Chinese hypertensives. A systematic and extended mutational screening for the mitochondrial genome has been initiated in a large cohort of Chinese population by the Geriatric Cardiology Clinic at the Chinese PLA General Hospital, Beijing, China. Specific mutations within the mitochondria were further evaluated. Changes of total RNAs (tRNAs) were measured by northern blotting using nonradioactive digoxigenin (DIG)-labeled oligodeoxynucleotides specific for each RNA. Rates of oxygen consumption in intact cells were determined with av YSI 5300 oxygraph. Sequence analysis of mitochondrial DNA in one Chinese pedigree identified a novel A-G transition at position 4401 (A4401G) at the junction of tRNA(Met) and tRNA(Gln). The noncoding region mutation appeared to affect the processing of precursors in these mitochondrial tRNAs. The reduction in the rate of respiration and marked decreases in the steady-state levels of tRNA(Met) and tRNA(Gln) were detected in the cells carrying this mutation. The novel mutation was absent in 270 Chinese control patients. In conclusion, the noncoding mitochondrial sequence alteration (A4401G) alters mitochondrial function, implicating this mutation in the pathogenesis of LVH in Chinese hypertensives.

Prehospital emergency medical services in Malaysia.

Once a very slowly developing country in a Southeast Asia region, Malaysia has undergone considerable change over the last 20 years after the government changed its focus from agriculture to developing more industry and technology. The well-known "Vision 2020," introduced by the late Prime Minister, set a target for the nation to be a developed country in the Asia region by the year 2020. As the economy and standard of living have improved, the demand from the public for a better health care system, in particular, emergency medical services (EMS), has increased. Despite the effort by the government to improve the health care system in Malaysia, EMS within the country are currently limited, best described as being in the "developing" phase. The Ministry of Health, Ministry of Education, Civil Defense, and non-governmental organizations such as Red Crescent and St. John's Ambulance, provide the current ambulance services. At the present time, there are no uniform medical control or treatment protocols, communication systems, system management, training or education, or quality assurance policies. However, the recent development of and interest in an Emergency Medicine training program has gradually led to improved EMS and prehospital care.

International emergency medicine and the role for academic emergency medicine.

International emergency medicine continues to grow and expand. There are now more than 30 countries that recognize emergency medicine as a specialty. As the field continues to develop, many physicians are reaching across borders and working with their colleagues to improve patient care, education, and research. The future growth and success of the specialty are based on several key components. These include faculty development (because this is the key driver of education), research, and curriculum development. Each country knows what resources it has and how best to utilize them. Countries that are developing the specialty can seek consultation from successful countries and develop their academic and community practice of emergency medicine. There are many resources available to these countries, including distance learning and access to medical journals via the Internet; international exchanges by faculty, residents, and medical students; and physicians who are in fellowship training programs. International research efforts require more support and effort to be successful. This report discusses some of the advantages and hurdles to such research efforts. Physicians have a responsibility to help one another succeed. It is the hope of the authors that many more emergency physicians will lend their skills to further global development of the specialty.

Luxatio erecta: clinical presentation and management in the emergency department.

Luxatio erecta (inferior glenohumeral dislocation) is an uncommon type of shoulder dislocation. Early recognition and reduction is important to prevent neurovascular sequelae. We report two cases of luxatio erecta in order to describe the clinical presentation and reduction technique in the Emergency Department.

History of the development of international emergency medicine.

A future challenge for international EM development is expanding the specialty to Africa, where it is non-existent. Another goal for international EM development is to assist in the peace process in the Middle East. There is increasing need for good EM development throughout the world. Development of international EM has been rapid, with most of the spread of development occurring in the last 10 years. There is great opportunity and reward for students, residents, and EM physicians to further promote and develop EM internationally.

Lessons learned from international emergency medicine development.

The lessons learned from development of EM around the world span several key areas including general development, systems comparisons, models of EM practice, and education and training. Neither definitive nor exhaustive, these lessons learned are intended to be viewed as sign posts along the road traveled at this point in international EM development. It is hoped that future participants in international EM development can assimilate these lessons learned, adopt the most relevant ones, and add their own insight and wisdom to this growing list. Most importantly, it is hoped that by whichever path future development takes, we all reach the same destination of providing the best possible emergency medical care for the people of the world.

Conservative treatment of giant abdominal wall hematoma.

A fifty-seven-year-old male patient on warfarin therapy presented to the emergency department with severe abdominal pain that had started after a cough episode and persisted for four days. Ultrasonography showed an extensive hematoma, 17x14x7 cm in size, but failed to determine whether it was located intra-abdominally or in the abdominal wall. Computed tomography confirmed the diagnosis of abdominal wall hematoma (25x21x10 cm). The patient was treated conservatively, and abdominal findings resolved progressively in three days. This case report illustrates that ultrasonography findings may sometimes be inconclusive and, in the early period, computed tomography may be required to confirm the diagnosis of abdominal wall hematomas. Giant abdominal wall hematomas can be successfully treated with conservative methods even physical findings of acute abdomen accompany the clinical picture. To our knowledge, this is the largest abdominal wall hematoma hitherto reported in the literature.

Evaluation of physical findings in acute wrist trauma in the emergency department.

OBJECTIVE: The aim of the study was to evaluate the value of physical findings to predict fracture in patients with acute wrist trauma. METHODS: This prospective clinical study was conducted over a period of four months from December 1998. The patients who were older than 18 years and presenting with acute wrist trauma within 24 hours of the time of injury were included in the study. Magnetic resonance imaging (MRI) was done for the patients who had inconsistency between clinical and radiographic diagnosis. RESULTS: Fifty-five patients were included in the study. Four fractures were diagnosed on the MRI of eight patients who have contradiction between clinical diagnosis and X-ray studies. The positive predictive values of edema, localized tenderness, pain on active and passive motion, pain with grip and pain in supination were found as 95.2%, 67.3%, 77.3%, 91,7%, 89.3%, and 96%, respectively. Physical findings having high sensitivity were found as localized tenderness (94.3%), pain on the active and passive motion (97.1%, 94.3%, respectively). Pain on the active and passive motion were determined as physical findings with highest negative predictive values (%90.9, %89.5, respectively). CONCLUSION: Edema, pain on grip and supination, and especially pain on passive and active motion and localized tenderness can be valuable to predict or rule out fracture in acute wrist trauma cases who have no deformity.

[Emergency physicians and "burn out" syndrome]. / Acil servis hekimleri ve "tükenme" sendromu.

Emergency physicians are continuously under stress because of overcrowded departments, severity of cases, and their work schedules. In addition to this work stress, unregular social and family life are the main components of ongoing burn out process in these professionals. Burn out is the end point of the process which is complicated by the loss of professional enthusiasm and satisfaction, and negative behavioral approach to the patients. This review includes detailed statements on specific headlines, such as residency period, shift system, sleep management, risk of physical and psychological diseases, and stress management for emergency physicians.

A proposed universal medical and public health definition of terrorism.

The lack of a universally applicable definition of terrorism has confounded the understanding of terrorism since the term was first coined in 18th Century France. Although a myriad of definitions of terrorism have been advanced over the years, virtually all of these definitions have been crisis-centered, frequently reflecting the political perspectives of those who seek to define it. In this article, we deconstruct these previously used definitions of terrorism in order to reconstruct a definition of terrorism that is consequence-centered, medically relevant, and universally harmonized. A universal medical and public health definition of terrorism will facilitate clinical and scientific research, education, and communication about terrorism-related events or disasters. We propose the following universal medical and public definition of terrorism: The intentional use of violence--real or threatened--against one or more non-combatants and/or those services essential for or protective of their health, resulting in adverse health effects in those immediately affected and their community, ranging from a loss of well-being or security to injury, illness, or death.