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Domanski K, Allswede M. The criminalisation of women's healthcare in the post-Dobbs era: an analysis of the anti-abortion trigger law statutes. EUR J CONTRACEP REPR 2023; 28:258-262. [PMID: 37590051 DOI: 10.1080/13625187.2023.2242546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023]
Abstract
On 24 June 2022, the U.S. Supreme Court's decision in Dobbs v. Jackson Women's Health Organisation held that:'The Constitution does not confer a right to abortion; Roe and Casey are overruled; and the authority to regulate abortion is returned to the people and their elected representatives.'Since the ruling, thirteen states have enacted 'trigger laws' that restrict access to abortion except in specified circumstances, such as to save the life of the pregnant patient in a medical emergency. These laws not only inappropriately insert the State into the physician-patient relationship, but create an uncertain practice landscape for physicians by placing them at risk of criminal penalties. We illustrate the complexity of medical decision making for pregnant patients using examples from the case report literature, and discuss how leaving the definition of 'medical emergency' up to courts to decide will create a patchwork of restrictive and permissive standards that criminalises physicians and creates a 'political standard of care' that replaces evidence based medical care.
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Affiliation(s)
- Kristina Domanski
- Department of Emergency Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA
| | - Michael Allswede
- Chicago Medical School, Rosalind Franklin University, North Chicago, IL, USA
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Pasichow S, Jarou Z, Nikolla D, Qureshi M, Epter M, Kane B, Totten V, Kraus C, Allswede M, Diercks D, Garg N, Ling L, McDonald E, Rosenau A, Wilk M, Holmes A, Hemminger A, Greenberg M. Response to “Creating Consensus: Revisiting the Emergency Medicine Scholarly Activity Requirement”. West J Emerg Med 2019; 20:376-379. [PMID: 30881560 PMCID: PMC6404718 DOI: 10.5811/westjem.2019.1.42332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/21/2019] [Indexed: 11/29/2022] Open
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Kane BG, Totten VY, Kraus CK, Allswede M, Diercks DB, Garg N, Ling L, McDonald EN, Rosenau AM, Wilk M, Holmes AD, Hemminger A, Greenberg MR. Creating Consensus: Revisiting the Emergency Medicine Resident Scholarly Activity Requirement. West J Emerg Med 2018; 20:369-375. [PMID: 30881559 PMCID: PMC6404691 DOI: 10.5811/westjem.2018.10.39293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 06/06/2018] [Revised: 08/27/2018] [Accepted: 10/17/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction In the context of the upcoming single accreditation system for graduate medical education resulting from an agreement between the Accreditation Council for Graduate Medical Education (ACGME), American Osteopathic Association and American Association of Colleges of Osteopathic Medicine, we saw the opportunity for charting a new course for emergency medicine (EM) scholarly activity (SA). Our goal was to engage relevant stakeholders to produce a consensus document. Methods Consensus building focused on the goals, definition, and endpoints of SA. Representatives from stakeholder organizations were asked to help develop a survey regarding the SA requirement. The survey was then distributed to those with vested interests. We used the preliminary data to find areas of concordance and discordance and presented them at a consensus-building session. Outcomes were then re-ranked. Results By consensus, the primary role(s) of SA should be the following: 1) instruct residents in the process of scientific inquiry; 2) expose them to the mechanics of research; 3) teach them lifelong skills, including search strategies and critical appraisal; and 4) teach them how to formulate a question, search for the answer, and evaluate its strength. To meet these goals, the activity should have the general elements of hypothesis generation, data collection and analytical thinking, and interpretation of results. We also determined consensus on the endpoints, and acceptable documentation of the outcome. Conclusion This consensus document may serve as a best-practices guideline for EM residency programs by delineating the goals, definitions, and endpoints for EM residents’ SA. However, each residency program must evaluate its available scholarly activity resources and individually implement requirements by balancing the ACGME Review Committee for Emergency Medicine requirements with their own circumstances.
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Affiliation(s)
- Bryan G Kane
- Lehigh Valley Hospital, Department of Emergency Medicine and Hospital Medicine, Allentown, Pennsylvania.,University of South Florida, Morsani College of Medicine, Lehigh Valley Campus, Allentown, Pennsylvania
| | - Vicken Y Totten
- Kaweah Delta Medical Center, Department of Emergency Medicine, Visalia, California
| | - Chadd K Kraus
- Geisinger Health System, Department of Emergency Medicine, Danville, Pennsylvania
| | - Michael Allswede
- Mountainview Hospital, Department of Emergency Medicine, Las Vegas, Nevada
| | - Deborah B Diercks
- University of Texas Southwestern Medical Center, Department of Emergency Medicine, Dallas, Texas
| | - Nidhi Garg
- Long Island Jewish Medical Center, Northwell Health, Department of Emergency Medicine, New Hyde Park, New York
| | - Louis Ling
- Accreditation Council for Graduate Medical Education, Chicago, Illinois.,University of Minnesota, Department of Emergency Medicine, Minneapolis, Minnesota
| | - Eric N McDonald
- University of Mississippi, Department of Emergency Medicine, Oxford, Mississippi
| | - Alex M Rosenau
- Lehigh Valley Hospital, Department of Emergency Medicine and Hospital Medicine, Allentown, Pennsylvania.,University of South Florida, Morsani College of Medicine, Lehigh Valley Campus, Allentown, Pennsylvania
| | - Mike Wilk
- Brown University, Department of Emergency Medicine, Providence, Rhode Island
| | - Alexandria D Holmes
- Lehigh Valley Hospital, Department of Emergency Medicine and Hospital Medicine, Allentown, Pennsylvania.,University of South Florida, Morsani College of Medicine, Lehigh Valley Campus, Allentown, Pennsylvania
| | - Adam Hemminger
- Lehigh Valley Hospital, Department of Emergency Medicine and Hospital Medicine, Allentown, Pennsylvania.,University of South Florida, Morsani College of Medicine, Lehigh Valley Campus, Allentown, Pennsylvania
| | - Marna Rayl Greenberg
- Lehigh Valley Hospital, Department of Emergency Medicine and Hospital Medicine, Allentown, Pennsylvania.,University of South Florida, Morsani College of Medicine, Lehigh Valley Campus, Allentown, Pennsylvania
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McCrickard L, Marlow M, Self JL, Watkins LF, Chatham-Stephens K, Anderson J, Hand S, Taylor K, Hanson J, Patrick K, Luquez C, Dykes J, Kalb SR, Hoyt K, Barr JR, Crawford T, Chambers A, Douthit B, Cox R, Craig M, Spurzem J, Doherty J, Allswede M, Byers P, Dobbs T. Notes from the Field: Botulism Outbreak from Drinking Prison-Made Illicit Alcohol in a Federal Correctional Facility - Mississippi, June 2016. MMWR Morb Mortal Wkly Rep 2017; 65:1491-1492. [PMID: 28056003 DOI: 10.15585/mmwr.mm6552a8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Guyette F, Suyama J, Rosen J, Allswede M. Prevalence of Radioactive Signals from Surveillance of an Emergency Department. Prehosp Disaster Med 2012; 21:276-81. [PMID: 17076430 DOI: 10.1017/s1049023x00003836] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroduction:Since the 11 September 2001 terrorist attacks in the United States, concerns have been raised regarding the threat of a radiological terrorist weapon. Although the probability of the employment of a nuclear device is remote, the potential of a radiological dispersal device (RDD) or “dirty bomb” is of concern. While it is unlikely that such a device would produce massive numbers of casualties, it is far more likely that it would result in pub- lic panic and perhaps even disable the local healthcare system. The utility of surveillance with radiation detectors in the healthcare setting has not been fully evaluated.Objective:The objective of this study was to characterize the prevalence of radioactive sources entering an urban emergency department (ED).Methods:A retrospective review of data obtained from a radiation detector positioned to detect radioactive people entering an ED of an urban academic hospital that serves 45,000 patients/year was performed. Graphical outputs of radioactivity were recorded in Microsoft ExcelTM (Microsoft, Redmond, WA, US) spreadsheets in microREM/hour. Data were collected continuous-ly from 22 December 2003 to 22 January 2004. An event was defined as any elevation in radiation levels >95% confidence interval from the mean level of background radiation over 72 hours (h).Results:A total of 215 events were observed over a 28-day period, with a mean value of 7.7 events/day, and a maximum of 15 events/day. During the 28-day period, the baseline mean level of background radiation was 2–4 microREM/h. Readings ranged from 2,148.28–17,292.25 microREM/h with a maximum sustained detector exposure of 684.37 microREM. Distinct signal patterns were seen at both detectors including tonic, phasic, dual, and short duration spikes.Conclusion:The number of radioactive signals detected from persons entering the ED was much higher than expected. While the vast majority of these signals pose no health threat, they may make routine screening for a radiological terrorist event difficult.Further study is needed to determine this correlation.
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Affiliation(s)
- Frank Guyette
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
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O'Connor RE, Lerner EB, Allswede M, Billittier IV AJ, Blackwell T, Hunt RC, Levinson R, Wang HE, White LJ, Wolff B. LINKAGES OFACUTECARE ANDEMERGENCYMEDICALSERVICES TOSTATE ANDLOCALPUBLICHEALTHPROGRAMS: THEROLE OFINTERACTIVEINFORMATIONSYSTEMS FORRESPONDING TOEVENTSRESULTING INMASSINJURY. PREHOSP EMERG CARE 2009. [DOI: 10.1080/312704000255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Suyama J, Savitz L, Chang H, Allswede M. Financial implications of hospital response to bioterrorism based on diagnosis-related group analysis. Prehosp Disaster Med 2007; 22:145-8. [PMID: 17591188 DOI: 10.1017/s1049023x00004532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION During an infectious disease outbreak, the ability of a hospital to continue routine operations depends upon its ability to absorb expected losses in revenue when the routine charge base is replaced by infectious disease-related charges. OBJECTIVE The purpose of this study was to determine the probable financial impact of a bioterrorism event or an infectious disease outbreak on an academic and a community hospital. METHODS During the fiscal year 01 July 2002-30 June 2003, the average number of inpatient charges identified by the diagnosis-related-groups (DRGs) of an academic, tertiary care, Level-1 trauma center (PUH) and a community hospital (StM) were obtained retrospectively. Per diem charges were determined for patients with: (1) gastroenteritis; (2) sepsis; (3) meningitis; (4) tuberculosis (TB); and (5) pneumonia. These charges were used to simulate the financial coding of patients exposed to biological agents. RESULTS The total average PUH per diem charges per patient for all 31,530 discharges was (US)$10,516. Specifically, the average changes were $20,499 for patients with transplants, $14,406 for receiving critical care services, $12,650 for the provision of cardiac care, $11,576 for trauma/orthopedic care, and $8,259 for services for patients who suffered a stroke. For patients with infectious diseases, the average per diem charges per patient were: (1) $6,184 for patients with gastroenteritis; (2) $7,842 for patients with sepsis; (3) $10,831 for patients with meningitis; (4) $6,118 for patients with TB; and (5) $4,586 for patients with pneumonia. Per patient per day, PUH would generate a potential net on average loss of: (1) $4,332 for gastroenteritis; (2) $2,674 for sepsis; (3) $4,398 for TB; and (4) $5,930 for pneumonia replaced an admission. Patients with meningitis on average generated a net gain ($315) compared to the average, but would not compensate for the denial of transplant, cardiac, trauma/orthopedic, and some critical care services during the event. Total average StM per diem charges per patient for all 10,470 discharges equaled $3,008. Specifically, $4,965 for critical care, $3,022 for cardiac care, $4,397 for trauma/orthopedic care, and $3,037 for stroke services. For infectious diseases, the average per diem charge per patient was: (1) $2,273 (+$735) for gastroenteritis; (2) $3,047 (+$39) for sepsis; (3) $2,504 (-$504) for meningitis; (4) $2,887 ($120) for TB; and (5) $2,652 (-$356) for pneumonia (net loss/gain in parenthesis). CONCLUSIONS Through DRG analysis, the probable financial impact of a bioterrorist attack on a Health Care Delivery System is largely detrimental. Preparedness for a biological event must include an assessment of hospital capability and capacity to handle these types of patients, but also must consider the financial ability to absorb expected losses in charges or ways in which to recover the losses.
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Affiliation(s)
- Joe Suyama
- Department of Emergency Medicine, University of Pittsburgh, 230 McKee Place, Suite 500, Pittsburgh, PA 15213, USA.
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Abstract
A large number of biological agents can cause natural or bioterroristic disease outbreaks and each can present in a bewildering number of ways (e.g., a few cases versus many cases, confined to a building versus widely disseminated). This 'problem space' is a challenge for designers of early warning systems for disease outbreaks and the sheer size of this space is a barrier to progress. This paper addresses this problem by deriving nine categories of threats that represent a parsimonious characterization of the problem space. A literature search also identified one or more example outbreaks for each of the nine categories. These outbreaks have occurred in recent times and could be used by researchers in need of actual outbreak data for investigations of the role of different types of surveillance data and algorithms in outbreak detection. The methodological contribution of this research is a Criterion Set of threats for analysis and evaluation of detection systems. This set characterizes the problem space in a tractable manner with less loss of generality than analyses based on one or two selected diseases, which is representative of current analyses.
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Affiliation(s)
- Michael M Wagner
- The Real-Time Outbreak and Disease Surveillance Laboratory, Center for Biomedical Informatics, University of Pittsburgh, Suite 550, 100 Technology Drive, Pittsburgh, PA 15219, USA.
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O'Connor RE, Lerner EB, Allswede M, Billittier AJ, Blackwell T, Hunt RC, Levinson R, Wang HE, White LJ, Wolff B. Linkages of acute care and emergency medical services to state and local public health programs: the role of interactive information systems for responding to events resulting in mass injury. PREHOSP EMERG CARE 2004; 8:237-53. [PMID: 15295723 PMCID: PMC7119111] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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M'ikanatha NM, Lautenbach E, Kunselman AR, Julian KG, Southwell BG, Allswede M, Rankin JT, Aber RC. Sources of Bioterrorism Information among Emergency Physicians During the 2001 Anthrax Outbreak. Biosecur Bioterror 2003; 1:259-65. [PMID: 15040206 DOI: 10.1089/153871303771861469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Allswede M. Bioterroism: Guidelines for Medical and Public Health Management: Edited by Donald A. Henderson, Thomas V. Inglesby, and Tara O'Toole. Chicago, IL: AMA Press, 2002, 244 pages, $29.95 (softcover). Acad Emerg Med 2003. [DOI: 10.1197/s1069-6563(03)00331-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
The woody nightshade, Solanum dulcamara, belongs to the genus Solanum and its primary toxin is solanine. We report a large nightshade ingestion in a 4-yr-old girl who presented to the emergency department in acute anticholinergic crisis. The child was given 0.2 mg of intravenous physostigmine (0.02 mg/kg). Within 50 min, the patient received two additional equal doses with complete resolution of symptoms. After 36 h of observation, the child was discharged. Our patient presented with symptoms more suggestive of the deadly nightshade species, Atropa belladonna, which is native to Europe; however, a detailed laboratory analysis of the suspect berries revealed no atropine or hyoscyamine. Analysis did reveal sterols consistent with solanine. This is a unique case presentation of woody nightshade, S. dulcamara, poisoning presenting with anticholinergic crisis and responding to physostigmine.
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Affiliation(s)
- L J Ceha
- Cook County Hospital Department of Emergency Medicine, University of Illinois College of Pharmacy, Chicago, USA
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