Search PubMed⌕ Search

Biomedical subjects

D Sklar

Publications and source records attributed to D Sklar.

30 records · Page 2Linked to original sources
PubMed1995

Health care reform and emergency medicine.

The twin goals of health care reform--providing universal coverage and limiting health care costs--will require increased primary care access and reductions in the overuse of inappropriate subspecialty interventions. The emergency department provides acute care access for all patients and nonemergency care for those patients unable to find other sources of care. Implementation of marketplace reforms may direct patients away from EDs to other primary care sites and reallocate residency positions now available for training of emergency physicians to other primary care specialties. These two effects may endanger the viability of the ED as the safety net of the health care system. The impact of health care reform on the emergency care system of the nation requires careful analysis to protect the important role of the ED in providing acute care and in guaranteeing access to care.

Cost Control↗
PubMed1994

Floating nights: a 5-year experience with an innovative ED schedule.

An academic emergency group was surveyed to determine if scheduling night shifts in blocks ("floats") improved attitudes and functioning. Seven physicians worked most of their nights as floats. Another four chose only isolated nights. Float physicians were surveyed for isolated and block nights. Faculty in the float group had poorer attitudes compared with the nonfloat group when both worked isolated nights (P = .0053). Working night floats eliminated these differences. Float physicians had more difficulty with sleep regardless of their schedule. They took longer to recover from an isolated night shift, drank more coffee, and used more postcall sedatives than their colleagues (P = .0108). The ideal night float was 2 to 4 weeks with shifts less than 10 hours, but careful attention to sleep hygiene remained essential. Physicians have different adaptability to night work. For some, concentrating night shifts is a useful strategy for improving shift work. This would require shorter shifts and larger groups than are now commonplace.

Attitude↗
PubMed1993

Selection of emergency medicine residents.

The selection of emergency medicine residents requires review of medical school performance and, usually, an interview in which applicants and program directors exchange important information. Computer technology is available to assist programs in the analysis of information about applicants. Ethnic diversity and minority recruitment should also be considered as 40% of all emergency medicine residencies have no minority residents. Suggestions for developing a valid, humane, and fair selection process are made.

Educational Status↗
PubMed1992

Motorcycle fatalities in New Mexico: the association of helmet nonuse with alcohol intoxication.

STUDY OBJECTIVE: To determine the relationship among helmet use, alcohol use, and ethnicity in people killed on motorcycles. DESIGN: Retrospective review of all motorcycle fatalities in New Mexico from 1984 through 1988. SETTING: Office of the Medical Investigator, State of New Mexico. TYPE OF PARTICIPANTS: All decedents of motorcycle crashes in New Mexico from 1984 through 1988. INTERVENTIONS: Review of all autopsies, medical investigator reports, traffic fatality reports, and toxicological studies on fatally injured motorcyclists. RESULTS: Nine of the helmeted drivers (18%) were legally intoxicated compared with 67 of the nonhelmeted drivers (51%) (chi 2 = 15.7, P less than .0001); 42 of the white nonHispanic decedents (37%), ten of Hispanic decedents (12%), and none of the Native-American decedents were wearing helmets. The head and neck region was the most severely injured body region in 42 of the nonhelmeted cases (84%) and in eight of the helmeted cases (50%) (Fisher's exact test, P less than .02). CONCLUSION: There is an association between nonuse of helmets and alcohol intoxication in fatally injured motorcyclists in New Mexico. Strategies for preventing motorcycle fatalities should address alcohol abuse and ethnicity in conjunction with helmet use.

Abbreviated Injury Scale↗
PubMed1989

Randomized double-blind trial of intravenous prochlorperazine for the treatment of acute headache.

In a prospective, randomized, double-blind clinical trial, intravenous prochlorperazine edisylate (Compazine Edisylate) was compared with a placebo in the treatment of severe headaches. Eighty-two adult patients with vascular or tension-type headaches were identified at the time of presentation to one of three participating emergency departments. After the patient gave informed consent, a 2-mL intravenous injection of sterile saline solution or prochlorperazine edisylate (10 mg) was given to each patient at the time of randomization. The treatment groups were similar with regard to age, sex, and type and duration of headache. Within 60 minutes after injection, 74% (31/42) of those who received prochlorperazine had complete relief; 14% (6/42) of the patients had partial relief. Overall, there was complete or partial relief of pain in 88% (37/42) of the drug group and in 45% (18/40) of the placebo group. This difference was statistically significant using chi 2 analysis. Adverse effects were minimal; one patient experienced asymptomatic orthostatic hypotension. These results suggest that intravenous prochlorperazine is an effective treatment for patients with severe vascular or tension headaches who present to the emergency department.

Acute Disease↗
PubMed1984

Successful treatment of paroxysmal supraventricular tachycardia with MAST.

We have noted that inflation of the military antishock trousers (MAST) successfully converted five of six patients with paroxysmal supraventricular tachycardia to normal sinus rhythm. In all patients the usual "vagal" maneuvers were tried first and were unsuccessful. MAST inflation may be a safe and useful addition to the traditional vagal maneuvers used to treat paroxysmal supraventricular tachycardia.

Adult↗
PubMed1980

Diagnostic dilemmas and cultural diversity in emergency rooms.

Language and cultural beliefs play an extremely important role in the interaction between patients from diverse cultural groups and physicians. Especially in emergency rooms, there are many dangers in missed communications. A patient from a foreign culture, especially one who does not speak English, often expresses symptoms in ways that are unfamiliar to many American physicians. Specific areas of cultural vulnerability can be identified for the major ethnic groups in the United States as they interact with the scientific medical system. A short review of folk medical beliefs and recommendations for improving diagnostic accuracy and treatment may assist emergency room staffs in offering care that is culturally acceptable to patients of diverse ethnic backgrounds.

Adult↗
PubMedDate not supplied

The HIV-infected health care worker: legal, ethical, and scientific perspectives.

Emergency medical health care workers may face restrictions on their practices as state responses to federal mandates concerning human immunodeficiency virus (HIV) and hepatitis B virus (HBV) evolve. This article presents an analysis of legal, ethical, and scientific considerations for making decisions about the practices of HIV-infected health care workers (HCWs). A four-factor product analysis is proposed for risk assessment, and recommendations are developed related to decreasing the risk of HIV transmission in the health care setting while maintaining HCW rights.

Beneficence↗