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Agarwal I, MacVane CZ. Shift Scheduling and Overnight Work Among Pregnant Emergency Medicine Residents. Ann Emerg Med 2024:S0196-0644(24)00041-6. [PMID: 38402481 DOI: 10.1016/j.annemergmed.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 01/11/2024] [Accepted: 01/22/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Isha Agarwal
- Department of Emergency Medicine, Maine Medical Center, Portland, Maine.
| | - Casey Z MacVane
- Department of Emergency Medicine, Maine Medical Center, Portland, Maine
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MacVane CZ, Puissant M, Fix M, Strout TD, Bonney C, Welsh L, Mittelman A, Ricker J, Agarwal I. Scheduling practices for pregnant emergency medicine residents. AEM Educ Train 2022; 6:e10813. [PMID: 36425789 PMCID: PMC9677363 DOI: 10.1002/aet2.10813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/22/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
Background Night shift work is associated with adverse pathophysiologic effects on maternal and fetal well-being. Although emergency medicine (EM) residents work frequent night shifts, there is no existing guidance for residency program directors (PDs) regarding scheduling pregnant residents. Our study assessed scheduling practices for pregnant EM residents, differences based on program and PD characteristics, barriers and attitudes toward implementing a formal scheduling policy, and PDs' awareness of literature describing adverse effects of night shifts on maternal-fetal outcomes. Methods We conducted an anonymous, web-based survey of U.S. EM residencies (N = 276). Quantitative data were summarized; chi-square analysis and logistic regression were used to assess relationships between program and PD characteristics and schedule accommodations. Qualitative description was used to analyze an open-ended question, organizing findings into major and minor themes. Results Of the 167 completed surveys (response rate 61%), 67% of programs reported no formal policy for scheduling pregnant residents but made adjustments on an individual basis including block changes (85%), decreased (46%) or no night shifts (34%), and working shifts earlier in pregnancy to cover later shifts (20%). Barriers to adjustments included staffing constraints (60%), equity concerns (45%), or impact on wellness (41%) among all residents and privacy (28%). PDs endorsed scheduling adjustments as important (mean 8.1, 0-10 scale) and reported guidance from graduate medical education governance would be useful (60%). Larger program size, but not PD gender or proportion of female residents, was associated with an increased likelihood of scheduling modifications. Twenty-five percent of PDs reported little knowledge of literature regarding night shift work and pregnancy. Qualitative themes supported quantitative findings. Conclusions Most EM residency programs do not have formal scheduling policies for pregnant residents, but most PDs support making adjustments and do so informally. More education and guidance for PDs are needed to promote the development of formal policies.
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Affiliation(s)
- Casey Z. MacVane
- Department of Emergency Medicine, Maine Medical CenterTufts University School of MedicinePortlandMaineUSA
| | | | - Megan Fix
- Department of Emergency MedicineUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Tania D. Strout
- Department of Emergency Medicine, Maine Medical CenterTufts University School of MedicinePortlandMaineUSA
| | - Caitlin Bonney
- Department of Emergency MedicineUniversity of New Mexico Health Sciences CenterAlbuquerqueNew MexicoUSA
| | - Laura Welsh
- Department of Emergency Medicine, Boston Medical CenterBoston University School of MedicineBostonMassachusettsUSA
| | - Andrew Mittelman
- Department of Emergency Medicine, Boston Medical CenterBoston University School of MedicineBostonMassachusettsUSA
| | - Jana Ricker
- Department of Emergency MedicineMaine Medical CenterPortlandMaineUSA
| | - Isha Agarwal
- Department of Emergency Medicine, Maine Medical CenterTufts University School of MedicinePortlandMaineUSA
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Graham EM, Ferrel MN, Wells KM, Egan DJ, MacVane CZ, Gisondi MA, Burns BD, Madsen TE, Fix ML. Gender-based Barriers in the Advancement of Women Leaders in Emergency Medicine: A Multi-institutional Qualitative Study. West J Emerg Med 2021; 22:1355-1359. [PMID: 34787562 PMCID: PMC8597699 DOI: 10.5811/westjem.2021.7.52826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/23/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction Leadership positions occupied by women within academic emergency medicine have remained stagnant despite increasing numbers of women with faculty appointments. We distributed a multi-institutional survey to women faculty and residents to evaluate categorical characteristics contributing to success and differences between the two groups. Methods An institutional review board-approved electronic survey was distributed to women faculty and residents at eight institutions and were completed anonymously. We created survey questions to assess multiple categories: determination; resiliency; career support and obstacles; career aspiration; and gender discrimination. Most questions used a Likert five-point scale. Responses for each question and category were averaged and deemed significant if the average was greater than or equal to 4 in the affirmative, or less than or equal to 2 in the negative. We calculated proportions for binary questions. Results The overall response rate was 55.23% (95/172). The faculty response rate was 54.1% (59/109) and residents’ response rate was 57.1% (36/63). Significant levels of resiliency were reported, with a mean score of 4.02. Childbearing and rearing were not significant barriers overall but were more commonly reported as barriers for faculty over residents (P <0.001). Obstacles reported included a lack of confidence during work-related negotiations and insufficient research experience. Notably, 68.4% (65/95) of respondents experienced gender discrimination and 9.5% (9/95) reported at least one encounter of sexual assault by a colleague or supervisor during their career. Conclusion Targeted interventions to promote female leadership in academic emergency medicine include coaching on negotiation skills, improved resources and mentorship to support research, and enforcement of safe work environments. Female emergency physician resiliency is high and not a barrier to career advancement.
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Affiliation(s)
- Emily M Graham
- University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Katie M Wells
- University of Vermont, Division of Emergency Medicine, Department of Surgery, Burlington, Vermont
| | - Daniel J Egan
- Massachusetts General Hospital/Brigham and Women's Hospital, Departments of Emergency Medicine, Boston, Massachusetts
| | - Casey Z MacVane
- Maine Medical Center, Department of Emergency Medicine, Portland, Maine
| | - Michael A Gisondi
- Stanford University, Department of Emergency Medicine, Palo Alto, California
| | - Boyd D Burns
- University of Oklahoma School of Community Medicine, Department of Emergency Medicine, Tulsa, Oklahoma
| | - Troy E Madsen
- University of Utah, Division of Emergency Medicine, Department of Surgery, Salt Lake City, Utah
| | - Megan L Fix
- University of Utah, Division of Emergency Medicine, Department of Surgery, Salt Lake City, Utah
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Huyler A, MacVane CZ, Strout T, Perron AD. Outpatient treatment of pulmonary embolism: A single center 4-year experience. Am J Emerg Med 2020; 45:169-172. [PMID: 33041137 DOI: 10.1016/j.ajem.2020.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/20/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Pulmonary embolus (PE) is associated with significant utilization of health resources. As patients can be risk-stratified, there is an opportunity for a subset of patients to be safely treated without hospitalization, thus reducing the associated costs of treatment. Our aim was to describe the population, treatment strategies, complications, and outcomes associated with outpatient management of PE following treatment in the ED. METHODS This retrospective health records survey investigated a 4-year cohort of patients presenting with PE who were discharged to home. RESULTS Data from 151 patients demonstrated that 78% (118/151) of patients were discharged directly home; 19% (28/151) were discharged following ED clinical decision unit observation. Treatment with a novel oral anticoagulant was provided in 40% of cases (61/151). Six patients (4%) experienced a medication-related complication; 26 (17%) had a return visit within 30 days. CONCLUSION In this cohort of patients with PE, outpatient management was safe and effective for the large majority. Immediate and 30-day complications were few.
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Affiliation(s)
- Anne Huyler
- Department of Emergency Medicine, Maine Medical Center, 47 Bramhall St. Portland, ME 04101, USA
| | - Casey Z MacVane
- Department of Emergency Medicine, Maine Medical Center, 47 Bramhall St. Portland, ME 04101, USA
| | - Tania Strout
- Department of Emergency Medicine, Maine Medical Center, 47 Bramhall St. Portland, ME 04101, USA
| | - Andrew D Perron
- Department of Emergency Medicine, Maine Medical Center, 47 Bramhall St. Portland, ME 04101, USA.
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Huyler A, Runkle A, MacVane CZ, Strout TD. Infant with bilious emesis. J Fam Pract 2019; 68:573-575. [PMID: 31860703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Clinical findings and imaging studies revealed an additional cause for concern.
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Goddard HM, MacVane CZ, Strout TD. Abdominal Pain After a Football Game. Ann Emerg Med 2019; 73:315-319. [PMID: 30797299 DOI: 10.1016/j.annemergmed.2018.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Heidi M Goddard
- Department of Emergency Medicine, Maine Medical Center, Portland, ME
| | - Casey Z MacVane
- Department of Emergency Medicine, Maine Medical Center, Portland, ME; Tufts University School of Medicine, Boston, MA
| | - Tania D Strout
- Department of Emergency Medicine, Maine Medical Center, Portland, ME; Tufts University School of Medicine, Boston, MA
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Nelson SW, Germann CA, MacVane CZ, Bloch RB, Fallon TS, Strout TD. Intern as Patient: A Patient Experience Simulation to Cultivate Empathy in Emergency Medicine Residents. West J Emerg Med 2017; 19:41-48. [PMID: 29383055 PMCID: PMC5785200 DOI: 10.5811/westjem.2017.11.35198] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/18/2017] [Accepted: 11/04/2017] [Indexed: 12/30/2022] Open
Abstract
Introduction Prior work links empathy and positive physician-patient relationships to improved healthcare outcomes. The objective of this study was to analyze a patient experience simulation for emergency medicine (EM) interns as a way to teach empathy and conscientious patient care. Methods We conducted a qualitative descriptive study on an in situ, patient experience simulation held during EM residency orientation. Half the interns were patients brought into the emergency department (ED) by ambulance and half were family members. Interns then took part in focus groups that discussed the experience. Data collected during these focus groups were coded by two investigators using a grounded theory approach and constant comparative methodology. Results We identified 10 major themes and 28 subthemes in the resulting qualitative data. Themes were in three broad categories: the experience as a patient or family member in the ED; application to current clinical practice; and evaluation of the exercise itself. Interns experienced firsthand the physical discomfort, emotional stress and confusion patients and families endure during the ED care process. They reflected on lessons learned, including the importance of good communication skills, frequent updates on care and timing, and being responsive to the needs and concerns of patients and families. All interns felt this was a valuable orientation experience. Conclusion Conducting a patient experience simulation may be a practical and effective way to develop empathy in EM resident physicians. Additional research evaluating the effect of participation in the simulation over a longer time period and assessing the effects on residents' actual clinical care is warranted.
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Affiliation(s)
- Sara W Nelson
- Maine Medical Center, Department of Emergency Medicine, Portland, Maine
| | - Carl A Germann
- Maine Medical Center, Department of Emergency Medicine, Portland, Maine
| | - Casey Z MacVane
- Maine Medical Center, Department of Emergency Medicine, Portland, Maine
| | - Rebecca B Bloch
- Maine Medical Center, Department of Emergency Medicine, Portland, Maine
| | - Timothy S Fallon
- Maine Medical Center, Department of Emergency Medicine, Portland, Maine
| | - Tania D Strout
- Maine Medical Center, Department of Emergency Medicine, Portland, Maine
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Kring RM, Goddard HM, Wilmot MT, MacVane CZ. Woman With Headache and Neck Swelling. Ann Emerg Med 2017; 70:747-756. [PMID: 29056212 DOI: 10.1016/j.annemergmed.2017.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Randy M Kring
- Department of Emergency Medicine, Maine Medical Center, Portland, ME
| | - Heidi M Goddard
- Department of Emergency Medicine, Maine Medical Center, Portland, ME
| | - Michael T Wilmot
- Department of Emergency Medicine, Maine Medical Center, Portland, ME
| | - Casey Z MacVane
- Department of Emergency Medicine, Maine Medical Center, Portland, ME; Tufts University School of Medicine, Portland, ME
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MacVane CZ, Fix ML, Strout TD, Zimmerman KD, Bloch RB, Hein CL. Congratulations, You're Pregnant! Now About Your Shifts . . . : The State of Maternity Leave Attitudes and Culture in EM. West J Emerg Med 2017; 18:800-810. [PMID: 28874931 PMCID: PMC5576615 DOI: 10.5811/westjem.2017.6.33843] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/23/2017] [Accepted: 06/30/2017] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Increasing attention has been focused on parental leave, but little is known about early leave and parental experiences for male and female attending physicians. Our goal was to describe and quantify the parental leave experiences of a nationally representative sample of emergency physicians (EP). METHODS We conducted a web-based survey, distributed via emergency medicine professional organizations, discussion boards, and listservs, to address study objectives. RESULTS We analyzed data from 464 respondents; 56% were women. Most experienced childbirth while employed as an EP. Fifty-three percent of women and 60% of men reported working in a setting with a formal maternity leave policy; however, 36% of women and 18% of men reported dissatisfaction with these policies. Most reported that other group members cover maternity-related shift vacancies; a minority reported that pregnant partners work extra shifts prior to leave. Leave duration and compensation varied widely, ranging from no compensated leave (18%) to 12 or more weeks at 100% salary (7%). Supportive attitudes were reported during pregnancy (53%) and, to a lesser degree (43%), during leave. Policy improvement suggestions included the development of clear, formal policies; improving leave duration and compensation; adding paternity and adoption leave; providing support for physicians working extra to cover colleagues' leave; and addressing breastfeeding issues. CONCLUSION In this national sample of EPs, maternity leave policies varied widely. The duration and compensation during leave also had significant variation. Participants suggested formalizing policies, increasing leave duration and compensation, adding paternity leave, and changing the coverage for vacancies to relieve burden on physician colleagues.
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Affiliation(s)
- Casey Z MacVane
- Maine Medical Center, Department of Emergency Medicine, Portland, Maine.,Tufts University School of Medicine, Boston, Massachusetts
| | - Megan L Fix
- University of Utah Hospital, Department of Emergency Medicine, Salt Lake City, Utah
| | - Tania D Strout
- Maine Medical Center, Department of Emergency Medicine, Portland, Maine.,Tufts University School of Medicine, Boston, Massachusetts
| | - Kate D Zimmerman
- Maine Medical Center, Department of Emergency Medicine, Portland, Maine.,Tufts University School of Medicine, Boston, Massachusetts
| | - Rebecca B Bloch
- Maine Medical Center, Department of Emergency Medicine, Portland, Maine.,Tufts University School of Medicine, Boston, Massachusetts
| | - Christine L Hein
- Maine Medical Center, Department of Emergency Medicine, Portland, Maine.,Tufts University School of Medicine, Boston, Massachusetts
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Zemrak WR, Kelley E, Kovacic NL, Mooney DM, Morris JG, MacVane CZ, Rosenblatt JA. Thrombotic complications following the administration of high-dose prothrombin complex concentrate for acute warfarin reversal. Am J Emerg Med 2016; 34:1736.e1-3. [DOI: 10.1016/j.ajem.2015.12.069] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 12/22/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022] Open
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Frizell AW, MacVane CZ. Images in Emergency Medicine. Woman With Syncope. Twiddler's Syndrome. Ann Emerg Med 2015; 66:19, 22. [PMID: 26097023 DOI: 10.1016/j.annemergmed.2014.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 07/16/2014] [Accepted: 08/08/2014] [Indexed: 11/27/2022]
Affiliation(s)
| | - Casey Z MacVane
- Department of Emergency Medicine, Maine Medical Center, Portland, ME
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Kelley C, Quimby T, MacVane CZ. Unusual shoulder injury from a motorcycle crash. Luxatio erecta. J Fam Pract 2013; 62:255-257. [PMID: 23691538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Ward NJ, MacVane CZ. Blistering rash in an older man. J Fam Pract 2013; 62:151-153. [PMID: 23520587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The patient kept hoping that the rash would go away on its own, but as time went by the rash spread and the pain became intolerable.
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Affiliation(s)
- Nathaniel J Ward
- Department of Emergency Medicine, Maine Medical Center, Portland, ME, USA
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Nicolet J, MacVane CZ. Infant with head injury. Ping-pong fracture. Ann Emerg Med 2012; 59:442, 450. [PMID: 22525536 DOI: 10.1016/j.annemergmed.2011.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 08/04/2011] [Accepted: 08/05/2011] [Indexed: 11/27/2022]
Affiliation(s)
- Jack Nicolet
- Department of Emergency Medicine, Maine Medical Center, Portland, USA
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MacVane CZ, Irish CB, Strout TD, Owens WB. Implementation of transvaginal ultrasound in an emergency department residency program: an analysis of resident interpretation. J Emerg Med 2012; 43:124-8. [PMID: 22244288 DOI: 10.1016/j.jemermed.2011.05.099] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 01/24/2011] [Accepted: 05/28/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Emergency physicians are increasingly performing transvaginal ultrasound (TVUS) to rule out ectopic pregnancy. However, little is known about appropriate educational pathways to train emergency medicine residents in TVUS. STUDY OBJECTIVES To evaluate the ability of Emergency Medicine (EM) residents who underwent a training program in TVUS to detect the presence or absence of an intrauterine pregnancy (IUP) in patients of < 13 weeks gestation with vaginal bleeding or abdominal pain, as compared to the final interpretation of each study as determined by the Emergency Department (ED) Director of Ultrasound. METHODS This was a prospective, observational study in a single residency program. Training included a lecture, competency examination, and 10 supervised TVUSs. The EM residents then performed TVUSs with the goal of determining the presence or absence of an IUP without input from an attending physician. Correlation with the ED Director of Ultrasound was assessed for the cohort, and stratified by year of training. RESULTS There were 22 residents who performed 75 TVUSs over 17 months. Correlation with the ED Director of Ultrasound was 93.3%. Differences in correlation with the ED Director of Ultrasound were noted when compared by year of training: post-graduate year (PGY)-3 (93.3%), PGY-2 (92.1%), and PGY-1 (100%); p < 0.001. CONCLUSION Residents were able to perform TVUSs to determine the presence or absence of an IUP in patients in whom the diagnosis of ectopic pregnancy was being considered with a high degree of correlation with the ED Director of Ultrasound after a brief training program. Correlation with the ED director of ultrasound was influenced by year of training.
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Affiliation(s)
- Casey Z MacVane
- Department of Emergency Medicine, Maine Medical Center, Portland, Maine, USA
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MacVane CZ, Doty CI. Clinicopathological conference: a deadly cause of seizures in a 67-year-old alcoholic. Acad Emerg Med 2011; 18:e77-83. [PMID: 21883639 DOI: 10.1111/j.1553-2712.2011.01146.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Casey Z MacVane
- Department of Emergency Medicine, Maine Medical Center, Portland, USA.
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