The Perceived Effectiveness of Total Quality Management as a Tool for Quality Improvement in Emergency Medicine

OBJECTIVES: To describe the perceived effectiveness of using the Total Quality Management (TQM) approach to quality improvement in both academic and nonacademic EDs, and to discuss some important barriers to effectiveness of TQM programs. METHOD: A mail survey of 100 EDs was conducted with telephone follow-up. Hospitals were randomly selected from three subgroups: university teaching hospitals, nonuniversity teaching hospitals, and private nonteaching hospitals. ED physician directors or nonphysician administrators with knowledge of departmental quality improvement initiatives were surveyed. RESULTS: The overall response rate was 60%. Of the respondents, 54 (90.0%) used TQM techniques as part of their quality improvement initiatives. TQM techniques were used more frequently and for a longer duration in academic programs. ED staff participation in TQM projects was relatively low; less than 25% in the majority (79.6%) of all EDs. TQM initiatives were ranked least effective in university settings, of which 11 of 13 (84.6%) rated their TQM programs as ineffective or having no effect. More mature programs (>5 years old) had a significantly higher ranking for effectiveness than those programs less than 2 years old. CONCLUSIONS: Total Quality Management is being utilized in a large number of EDs. TQM initiative is perceived as having little or no positive effect. This is particularly the case in academic EDs.     

Hearing threshold shift measured by otoacoustic emissions after shooting noise exposure in soldiers using hearing protectors.

OBJECTIVE: The aim of the study was to assess the influence of short-term impulse noise to temporary threshold shift in soldiers using hearing protectors. STUDY DESIGN AND SETTING: The study included 80 subjects with correct tympanic membrane and thresholds measured by pure-tone audiometry less than 20 dB. There were two groups: 40 soldiers protected during shooting and 40 young males who didn't shoot. TEOAE were performed by ILO 292 Echoport Otodynamics device 3 to 5 minutes before shooting and 2 minutes and 1, 2, and 3 hours after shooting. RESULTS: Short-term exposure to impulse noise generated by five gunshots from the rifle kbk AKMS hasn't induced temporary threshold shift of hearing for chosen frequencies in soldiers using hearing protectors. Spectral analysis for chosen frequencies revealed that measurement reproducibility, stimuli level, and probe stability appeared to be comparable and repeatable. CONCLUSION: Our results show that the use of hearing protectors safeguarded against impulse noise. SIGNIFICANCE: The use of earmuffs is strongly recommended because they seem to sufficiently attenuate shooting noise.     

NMR probes for measuring magnetic fields and field dynamics in MR systems

High‐resolution magnetic field probes based on pulsed liquid‐state NMR are presented. Static field measurements with an error of 10 nanotesla or less at 3 tesla are readily obtained in 100 ms. The further ability to measure dynamic magnetic fields results from using small (～1 μL) droplets of MR‐active liquid surrounded by susceptibility‐matched materials. The consequent high field homogeneity allows free induction decay signals lasting 100 ms or more to be readily achieved. The small droplet dimensions allow the magnetic field to be measured even in the presence of large gradients. Highly sensitive detection yields sufficient SNR to follow the relevant field evolution without signal averaging and at bandwidths up to hundreds of kHz. Transient, nonreproducible effects and drifts are thus readily monitored. The typical application of k‐space trajectory mapping has been demonstrated. Potential further applications include characterization, tuning, and maintenance of gradient systems as well as the mapping of the static field distribution of MRI magnets. Connection of the probes to a standard MR spectrometer is similar to that used for imaging coils. Magn Reson Med 60:176–186, 2008. © 2008 Wiley‐Liss, Inc.     

Neighborhood Characteristics and Emergency Department Utilization

OBJECTIVES: Neighborhood environments have been linked to the prevalence and incidence rates of a variety of diseases and injuries. This study assessed the relations between neighborhood demographic and socioeconomic characteristics and emergency department (ED) utilization. METHODS: Billing data for the calendar year 2000 for adult patients residing within a one-mile radius of the study ED were geo-coded based on home addresses and merged with neighborhood data from the U.S. Census Bureau. Annual ED visit rates per 100 population were computed for each census block within the study area and analyzed in relation to neighborhood characteristics. RESULTS: The study area consisted of 714 census blocks and 42,278 adult residents, with a total of 16,427 visits to the study ED. Annual ED visit rates increased from 17 visits per 100 population for neighborhoods where less than 50% of the population were African American to 51 visits per 100 population for neighborhoods where all residents were African American (p < 0.001). Annual ED visit rates decreased from 53% for neighborhoods where <20% of housing units were owner-occupied to 27% for neighborhoods with >45% owner-occupied housing units (p < 0.001). Multivariate linear regression modeling revealed that proportions of African American residents and owner-occupied housing units were significantly associated with ED utilization, independent of age and gender compositions and the distance between residence and the study ED. CONCLUSIONS: Even within a small geographic area, ED utilization may vary greatly by neighborhood characteristics. Neighborhood racial composition and housing tenure are independent predictors of ED visit rates in this urban community.     

Inflammation of the frontal intersinus septal air cell as a cause of headaches

INTRODUCTION

The aim of this paper is to present a rare case of frontal intersinus septal air cell inflammation as a cause of headaches.

PRESENTATION OF CASE

A 23-year-old patient was admitted to the Department of Otolaryngology and Laryngological Oncology for severe headaches during an upper respiratory tract infection. After neurological consultation including brain MRI and CT scanning of the paranasal sinuses, the inflammation of the frontal intersinus septal air cell was diagnosed. After examination, the patient was qualified for external osteoplasty. Under general endotracheal anaesthesia, the frontal intersinus septal air cell was intraoperatively opened from the side of the right frontal sinus, the mucoid content was aspirated and a plate of bone was removed. The patient reported complete relief from headaches on the second day after surgery.

DISCUSSION

According to the previous studies, the frontal intersinus septal cell is more frequent in patients with frontal sinus inflammation than in the patients without inflammatory changes. Further, the conducted research indicates that its occurrence does not result in significant disorders in the drainage and ventilation of the frontal sinuses, and as such is not likely to be the cause of inflammation.

CONCLUSION

In the case of inflammatory changes in the frontal intersinus septal air cell without concomitant frontal or ethmoid sinusitis, surgery via the external approach appears to be an effective method for the radical removal of pathological changes.