Utility of Routine Admission Serum Chemistry Panels in Adult Trauma Patients

Objectives: To determine the frequency of abnormal serum chemistries and whether they provide clinically useful information regarding trauma patients. To identify clinical criteria associated with critical serum chemistry values (CSCVs).
Methods: The records of all trauma patients admitted to one urban, Level I Trauma Center were retrospectively reviewed for the period (July 1-December 31, 1989). All trauma patients who had had serum chemistry determinations at hospital admission and at least once more prior to discharge were studied. The CSCVs were determined by a panel of experts prior to record review. Serum chemistry values, patient demographics, mechanisms of injury, and outcomes were statistically analyzed.
Results: Most (814/913; 89%) trauma patients had abnormal serum chemistry values. However, only 54/913 (6%) had CSCVs and only six of these CSCVs had prompted a change in resuscitation or treatment (therapeutic K⁺ infusions). Age > 50 years, a history of hypertension therapy, and a Glasgow Coma Scale score ± 10 were associated with CSCVs; and CSCVs were correlated with increased mortality and critical care unit admission.
Conclusion: Routine-admission serum chemistry values, while frequently abnormal for major trauma patients, generally do not provide clinically useful information in the resuscitation and treatment of trauma patients. Hypoglycemia and metabolic acidosis were more rapidly determined using bedside glucose determination and arterial blood gas evaluation. The routine-admission serum chemistry panel described in the study lacked utility for most trauma patients. Selective chemistry panel ordering should be used at the time of hospital admission for major trauma patients.     

Thoughts on the Clinician''s Response to Health Care Reform: A Cautionary Note

In the course of contemporary health care discussion, we frequently refer to “health care reform” and its effect on health care delivery. The context within which we use the expression somehow manages to convey the idea that there is some kind of discreet “fait accompli” to which we can point. This basic premise is incorrect and ascribing to it renders much of the discussion about it in error. [Sullivan MC: Thoughts on the clinician's response to health care reform: A cautionary note. Ann Emerg Med December 1997;30:739-741.]     

Poetic Imagination: A Qualitative Study on Emotion,Images, and Verses from Sacred Texts in the Praxis of Theological Reflection in Pastoral Care and Counseling

ABSTRACT

What is the role of emotions, imagination, and images in the praxis of theological reflection in pastoral care and counseling, and what images and/or verses from sacred texts best describe the process of theological reflection? These two questions guided this ethnographic study. Seventy-five practitioners of pastoral care and counseling were interviewed and field notes were also made. Findings include the importance of emotion and imagination with a variety of images and verses from sacred texts. Poetic imagination best describes the process. Discussion involves the implications of the findings with suggestions for teaching, ministry, and areas for future research.

Lovers and madmen have such seething brains, Such shaping fantasies, that apprehend More than cool reason ever comprehends The lunatic, the lover, and the poet Are of imagination all compact.…     

Colorectal cancer screening education, prioritization, and self-perceived preparedness among primary care residents: Data from a national survey

BACKGROUND: Colorectal cancer (CRC) screening remains underutilized in the United States. We conducted a national survey of CRC screening education, prioritization, and self-perceived preparedness among resident physicians in Family Practice (FP), Internal Medicine (IM), and Obstetrics and Gynecology (OB/GYN) training programs. METHODS: Directors/administrators from 1085 FP, IM, and OB/GYN training programs were contacted by e-mail with a request to forward an invitation to participate in our Web-based CRC screening education survey to all residents in their program. Willing residents submitted responses in anonymous fashion. Data were analyzed using chi2 tests and analysis of variance methods. RESULTS: In total, 243 program directors/administrators forwarded our invitation, and 835 residents responded (384 FP, 266 IM, 177 OB/GYN, 8 undesignated specialty). Nearly all resident responders (89%) had received CRC screening education, but few content delivery methods were reported. Most felt at least somewhat comfortable or somewhat knowledgeable with respect to advising patients about CRC screening (90%), currently endorsed CRC screening guidelines (89%), and criteria used to identify familial CRC syndromes (50%). However, substantially fewer respondents reported feeling very comfortable or very knowledgeable in these areas (45%, 23%, and 5%, respectively). Program specialty, level of training, and gender were the strongest indicators of self-perceived preparedness. CONCLUSIONS: Although based on a relatively small sample of all FP, IM, and OB/GYN residents, these data suggest tangible opportunities to improve the CRC screening curriculum in primary care residency programs.