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<title>Emergency_Medicine RSS : Gourt</title>
<link>http://www.gourt.com/Health/Medicine/Medical-Specialties/Emergency-Medicine.html</link>
<description></description>
<dc:language>en-us</dc:language>
<dc:rights>Copyright 2007, Gourt.com</dc:rights>
<dc:date>2010-02-09T11:38+07:00
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<dc:publisher>rtruog@gourt.com</dc:publisher>
<dc:creator>rtruog@gourt.com</dc:creator>
<dc:subject>Emergency_Medicine RSS : Gourt</dc:subject>
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<item rdf:about="http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_georgia/page_24.html">
<title>Laid back Community Hospital feel with approx 1300 cases seen. Close to world class golfing and college town nearby. :: Georgia :: Candidate Direct Physician Staffing</title>
<link>http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_georgia/page_24.html</link>
<description><![CDATA[Emergency Jobs - Georgia  Physician Job Type:  Locum Tenens or Permanent in GA   Start:  Immediate Opening   Shift:  Flexible Scheduling Options   Salary:  Emergency job compensation within MGMA standards, ]]></description>
</item>

<item rdf:about="http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_missouri/page_3.html">
<title>90th% Earnings in St Louis, Free Private University Tuition for You and Your Family, #3367 :: Missouri :: Timeline Recruiting</title>
<link>http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_missouri/page_3.html</link>
<description><![CDATA[     Experiencing our exciting and rewarding atmosphere will be the first thing you notice about us. Committed to customer-focused quality health care, we are a Gold award recipient by the AHA, dedicated ]]></description>
</item>

<item rdf:about="http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_pennsylvania/page_33.html">
<title>1 Hour to Pittsburgh, &#x22;Doc-to-Door&#x22; in 30 Minutes, State-Owned University in Town, #5383 :: Pennsylvania :: Timeline Recruiting</title>
<link>http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_pennsylvania/page_33.html</link>
<description><![CDATA[   Our Emergency Department is growing and is in need of a skilled, confident and dependable Emergency Physician with excellent bedside manner. This is your opportunity to join an emergency department ]]></description>
</item>

<item rdf:about="http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_arizona/page_16.html">
<title>1 Hour to Tucson, Partnership, 300+ Days of Sunshine, Quality Over Quantity, #5329 :: Arizona :: Timeline Recruiting</title>
<link>http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_arizona/page_16.html</link>
<description><![CDATA[   Our Emergency Department is growing and is in need of a skilled, confident and dependable Emergency Physician with excellent bedside manner. Work with a team of physicians, all board certified in EM, ]]></description>
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<item rdf:about="http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_pennsylvania/page_17.html">
<title>40 Hour Week, Easy Trips to NYC, Philly and Pittsburgh, Zero Major Trauma, #5021 :: Pennsylvania :: Timeline Recruiting</title>
<link>http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_pennsylvania/page_17.html</link>
<description><![CDATA[    Make a difference in the lives of your patients and the direction of the hospital. We offer a collegial environment and the chance to work with a broad base of specialties. Your earnings and flexible ]]></description>
</item>

<item rdf:about="http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_maryland/page_16.html">
<title>EM Group Partnership, Baltimore Bedroom Community, 1 Hour to Washington, #5273 :: Maryland :: Timeline Recruiting</title>
<link>http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_maryland/page_16.html</link>
<description><![CDATA[   Join the premier EM group in the Mid-Atlantic!  Founded in 1971, we maintain 100% contract stability and service 11 EDs in the MD/Baltimore/DC/VA metro area.  We are recruiting EM BC or BP physicians ]]></description>
</item>

<item rdf:about="http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_louisiana/page_4.html">
<title>New Orleans Bedroom Community, New Emergency Care Center, #5170 :: Louisiana :: Timeline Recruiting</title>
<link>http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_louisiana/page_4.html</link>
<description><![CDATA[   Dont miss on the opportunity to join this well-established Emergency Medicine group in a new Emergency Care Center completed in 2004.You will have emergency medicine core RN support and technology ]]></description>
</item>

<item rdf:about="http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_california/page_3.html">
<title>Northern California, Mt. Shasta, Partnership Track, #5060 :: California :: Timeline Recruiting</title>
<link>http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_california/page_3.html</link>
<description><![CDATA[   We are looking for a well qualified Emergency Medicine Physician to join our group. With a longstanding tradition of service to the community, our system is one of the most progressive and best managed ]]></description>
</item>

<item rdf:about="http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_minnesota/page_16.html">
<title>Short Drive to Minneapolis, $300K Potential, #5039 :: Minnesota :: Timeline Recruiting</title>
<link>http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_minnesota/page_16.html</link>
<description><![CDATA[    Come join four physicians in an entirely new ER. As a leading provider of community based & regional health care services, we develop & deliver a broad array of services which offer significant value ]]></description>
</item>

<item rdf:about="http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_indiana/page_20.html">
<title>Seymour is within close proximity to Indianapolis :: Indiana :: Baumann &#x26; Associates</title>
<link>http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_indiana/page_20.html</link>
<description><![CDATA[  EM Full-time Opening in Southern Indiana    Nestled in beautiful southern Indiana, this emergency medicine group has an annual census of 22K visits and is staffed with 3 physician shifts (two 12 hour ]]></description>
</item>

<item rdf:about="http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_indiana/page_19.html">
<title>$150/Hour in Greater Chicago Area, #3193 :: Indiana :: Timeline Recruiting</title>
<link>http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_indiana/page_19.html</link>
<description><![CDATA[     Greater Chicago AreaPractice Opportunity Make a difference in the lives of the patients you see, as well as the direction and mission of the hospital. This practice affords you a satisfying clinical ]]></description>
</item>

<item rdf:about="http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_indiana/page_6.html">
<title>Southeastern Indiana  Private Group :: Indiana :: Enterprise Medical Service</title>
<link>http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_indiana/page_6.html</link>
<description><![CDATA[9500 Volume ED in Southeast east Indiana seeks physician.  Shifts are generally 12 hours, but 24 hour shifts are an option if desired.  This is an independent contractor position offering an hourly rate ]]></description>
</item>

<item rdf:about="http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_missouri/page_2.html">
<title>Brand new ED, Great Compensation! :: Missouri :: Enterprise Medical Service</title>
<link>http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_missouri/page_2.html</link>
<description><![CDATA[Brand new, state-of-the-art ED, opening to the public in July, seeks two Emergency Medicine physicians.  This facility will house 16 private rooms, 2 trauma rooms, a decontamination chamber, EMR, monitors ]]></description>
</item>

<item rdf:about="http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_south_carolina/page_17.html">
<title>One Hour to Myrtle Beach! :: South Carolina :: Enterprise Medical Service</title>
<link>http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_south_carolina/page_17.html</link>
<description><![CDATA[Regional Tertiary Care Center with an ED annual volume of 60K seeks BC/BE EM Residency trained physician.  There are currently 15 RT/BC EM physicians working mostly 10 hour shifts providing 88 hours of ]]></description>
</item>

<item rdf:about="http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_tennessee/page_8.html">
<title>2 TN Locations :: Tennessee :: Nationwide Physician Recruitment</title>
<link>http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_tennessee/page_8.html</link>
<description><![CDATA[ Currently a large client that I represent has a need for ER physicians, in two different Tenn. communities. They are capable of working quickly, and being competitive.  (There is no personal state income ]]></description>
</item>

<item rdf:about="http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_texas/page_28.html">
<title>Brownsville :: Texas :: U.S.Physician Resources Intl, Inc.</title>
<link>http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_texas/page_28.html</link>
<description><![CDATA[Excellent opportunity for an Emergency Medicine Physician in Brownsville, Texas. The pay is more than quater million. All benefits. Email resume to somaz@usdrjobs.com or call 214-385-8438 or ]]></description>
</item>

<item rdf:about="http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_new_york/page_1.html">
<title>Schenectady :: New York :: Baumann &#x26; Associates</title>
<link>http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_new_york/page_1.html</link>
<description><![CDATA[  EMERGENCY MEDICINE     FULL TIME STAFF POSITION     Candidate Criteria:                         Board Certified/Eligible Emergency Medicine                              Board Certified -- Primary Care ]]></description>
</item>

<item rdf:about="http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_indiana/page_3.html">
<title>Bloomington :: Indiana :: Baumann &#x26; Associates</title>
<link>http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_indiana/page_3.html</link>
<description><![CDATA[  Emergency Medicine Full-Time Opening in Southern Indiana    Committed to providing employees with a comfortable, supportive work environment to optimize success, this fast paced emergency department ]]></description>
</item>

<item rdf:about="http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_texas/page_22.html">
<title>Nationwide :: Texas :: Physician Referral Network</title>
<link>http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_texas/page_22.html</link>
<description><![CDATA[Physician Referral Network is your best source to learn about the latest practice opportunities.  We are not a recruiting firm, so we promise you'll never be pressured to look at or take a position that ]]></description>
</item>

<item rdf:about="http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_oklahoma/page_6.html">
<title>Metro Area :: Oklahoma :: Nationwide Physician Recruitment</title>
<link>http://www.physemp.com/physician_jobs/perma_emergency_jobs_in_oklahoma/page_6.html</link>
<description><![CDATA[ Recently you logged on to our website requesting information.  Currently I have an excellent opportunity in Oklahoma (metro area) for an ER physician. This is with a large client that owns numerous hospitals ]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/1?rss=1">
<title>Primary Survey</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/1?rss=1</link>
<description><![CDATA[ ]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/2?rss=1">
<title>The Strategic Health Authorities&#x27; Emergency Services Review</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/2?rss=1</link>
<description><![CDATA[ ]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/3?rss=1">
<title>The service concept: the missing link in our specialty&#x27;s development?</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/3?rss=1</link>
<description><![CDATA[ ]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/5?rss=1">
<title>Performance of influenza rapid antigen testing in influenza in emergency department patients</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/5?rss=1</link>
<description><![CDATA[
Background:
The use of rapid antigen tests to triage specimens for polymerase chain reaction (PCR) testing from emergency department patients with influenza-like illness during surveillance for novel influenza viruses has been suggested.

Objective:
To measure the observed sensitivity and specificity for a widely used rapid antigen test (Binax) using a PCR-based assay (Medical Diagnostic Laboratories).

Methods:
Nasopharyngeal samples were taken with flocked swabs (Copan Diagnostics) from patients presenting to the emergency department of a community hospital. Samples were analysed using a rapid antigen and a PCR-based test. PCR testing was used as the criterion reference. Sensitivity and specificity were calculated for influenza and influenza A. Positive predictive values were calculated over a range of possible prevalence.

Results:
Samples from 566 unique patients were tested using both methods. Sensitivity was 69.1% (95% CI 58.9% to 78.1%) and specificity was 97.7% (95% CI 95.8% to 98.8%) for the detection of any influenza and 75.3% (95% CI 64.7% to 84.0%) and 97.8% (95% CI 95.9% to 98.9%), respectively, for influenza A only. The resultant positive predictive value ranges from 23% to 77% when the prevalence ranges from 1% to 10%.

Conclusion:
When planning early outbreak surveillance, provision of adequate PCR testing capacity rather than triaging specimens using rapid antigen testing for influenza is advisable.

]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/8?rss=1">
<title>Sustained manual abdominal compression during cardiopulmonary resuscitation in a pig model: a preliminary investigation</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/8?rss=1</link>
<description><![CDATA[
Objectives:
The present study was undertaken to determine whether sustained manual abdominal compression (SMAC) using left paramedian compression technique can improve coronary perfusion pressure (CPP) during cardiopulmonary resuscitation (CPR) and resuscitation outcomes without causing liver laceration.

Methods:
Ventricular fibrillation was induced in 14 pigs, and circulatory arrest was maintained for 6 min. Animals were resuscitated either by standard CPR (control group) or by standard CPR with SMAC (SMAC-CPR group).

Results:
Mean blood pressure, aortic diastolic pressure and right atrial diastolic pressure in the SMAC-CPR group were significantly greater than in the control group throughout simulated basic life support. However, since the increases in aortic and right atrial diastolic pressures were similar, no significant intergroup difference was found in terms of CPP. Return of spontaneous circulation (ROSC) was attained in four of seven animals in the control group and in six of seven animals in the SMAC-CPR group (p = 0.55). Three animals in the control group and four in the SMAC-CPR group survived 24 h after ROSC (p = 1.00). Two of the seven animals in the SMAC-CPR group had a ruptured liver, but no such injury occurred in the control group.

Conclusions:
SMAC using left paramedian compression technique failed to improve CPP during CPR and resuscitation outcomes. Furthermore, this method could not avoid liver laceration.

]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/13?rss=1">
<title>Comparison of four manikins and fresh frozen cadaver models for direct laryngoscopic orotracheal intubation training</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/13?rss=1</link>
<description><![CDATA[
Objective:
To compare the acceptability and preference between manikin models and fresh frozen cadaver (FFC) for direct laryngoscopic orotracheal intubation training.

Methods:
In this prospective crossover trial, participants in the airway workshop performed direct laryngoscopic orotracheal intubation on four airway training manikins: Airway Management Trainer (Ambu, St Ives, UK), Airway Trainer (Laerdal, Medical, Stavanger, Norway), Airsim (Trucorp, Belfast, Northern Ireland) and "Bill 1" (VBM, Sulz, Germany), and FFC. Participants were asked to access the following: reality of jaw mobility, difficulty with mouth opening, reality of neck flexibility, difficulty with intubation, overall model reality and model preference for each model using a visual analogue scale (VAS) of 0&ndash;10 cm. The VAS scores for each model were compared.

Results:
Fifty-six participants were included in the study. The FFC had a highest VAS score for reality of jaw mobility, overall reality and preference of model. Trucorp manikin and Laerdal manikin followed cadaver. There were no significant statistical differences between Trucorp manikin and Laerdal manikin. In difficulty with mouth opening and difficulty with intubation, Trucorp manikin had the lowest VAS score.

Conclusion:
The FFC is a more realistic and preferred model for direct laryngoscopic orotracheal intubation training. Trucorp and Laerdal manikin can be used as alternative models.

]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/17?rss=1">
<title>An intervention trial increases the evidence-based use of bupivacaine in hand injuries</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/17?rss=1</link>
<description><![CDATA[
Aim:
Published evidence indicates that bupivacaine is the superior local anaesthetic for digital nerve blocks and where long-lasting analgesia is desirable. We aimed to develop and evaluate a multifaceted education initiative designed to improve the evidence-based use of bupivacaine in hand injuries.

Methods:
This was a pre- and post-intervention trial undertaken in a single emergency department (ED). All physicians working in the ED were included. The intervention comprised a specifically designed "e-learning module" supplemented by in-service training, reminder techniques and improved accessibility to bupivacaine. The primary end point was the proportion of patients with hand injuries administered bupivacaine in whom bupivacaine was the most appropriate local anaesthetic. Data were collected by explicit chart review of consecutive cases.

Results:
Both pre- and post-intervention periods were of 5 months&rsquo; duration. The charts of 107 pre-intervention and 111 post-intervention cases were reviewed. In the post-intervention period, the appropriate use of bupivacaine increased from 14.3% to 49.4% (difference 35.2%, 95% CI 20.9 to 49.4, p&lt;0.001); the appropriate use of lignocaine and bupivacaine increased from 38.3% to 59.5% (difference 21.1%, 95% CI 7.3 to 35.0, p = 0.003); the total number of bupivacaine ampoules issued rose by 308% (from 60 to 245); the total number of lignocaine ampoules issued decreased by 6.7% (from 2008 to 1873); and the number of files with adequate documentation increased from 56.3% to 63.4% (difference 7.1%, 95% CI &ndash;3.5 to 17.7, p = 0.20).

Conclusion:
The education initiative resulted in significant improvements in the evidence-based use of bupivacaine, and its adoption by others is recommended.

]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/21?rss=1">
<title>Emergency Medicine Questions (EMQs): Theme: Vascular access</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/21?rss=1</link>
<description><![CDATA[ ]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/22?rss=1">
<title>How have changes to out-of-hours primary care services since 2004 affected emergency department attendances at a UK District General Hospital? A longitudinal study</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/22?rss=1</link>
<description><![CDATA[
Background:
The delivery of out-of-hours primary medical care in the United Kingdom has changed substantially since 2004, and there has been little examination of the effect that this has on secondary care.

Aim:
The authors aimed to quantify the change in patient type presenting to our emergency department.

Methods:
In this study, routinely collected coding data before, during and after the changes were analysed. Each September and October between 1999 and 2006 were included.

Results:
There was a steady increase in all attendances at our emergency department. The number and proportions of patients with non-traumatic conditions rose steadily throughout the study period. The number of patients presenting with traumatic conditions stayed the same. The number of patients presenting with non-traumatic conditions out-of-hours rose after the changes were implemented.

Interpretation:
The changes to the provision of out-of-hours primary care have been associated with an increase in patients with non-traumatic attendances presenting to our emergency department. This effect is most marked outside of office hours.

]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/26?rss=1">
<title>Emergency department attendance by children at risk of abuse</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/26?rss=1</link>
<description><![CDATA[
Background:
Frequency of emergency department (ED) attendance has long been thought to be a risk factor for child abuse. The aim of this study was to test this assumption by comparing the ED attendances of at-risk children (before being placed on a child protection register) with the attendances of an age-matched control group (before an index attendance)

Method:
A group of 220 children (aged 0&ndash;12 years inclusive) were identified from the two child protection registers in the Shropshire area in 2006. The ED attendances of these children in the 2 years before registration were identified using the computer records of the two local EDs. A control group of 150 children for each year of age (0&ndash;12 years inclusive) was then identified from ED attendances between October and December 2006. The attendances of these children in the 2 years before this index attendance were obtained. The data for these two groups of children were then compared.

Results:
The at-risk children did not attend the EDs more frequently than did the children in the control group.

Conclusion:
The identification of children who attend EDs frequently may be useful for other reasons but is unlikely to be an effective way to detect child abuse.

]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/29?rss=1">
<title>Oesophagography and oesophagoscopy are not necessary in patients with spontaneous pneumomediastinum</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/29?rss=1</link>
<description><![CDATA[
Background:
Because the condition is rare, the proper assessment of spontaneous pneumomediastinum (SPM) remains controversial. The purpose of this study was to determine whether additional oesophageal investigations beyond chest x ray and chest computed tomography (CT) scan are necessary for the diagnosis of SPM.

Methods:
The medical records of 25 patients diagnosed and treated for SPM from March 1986 to December 2007 were retrospectively reviewed.

Results:
There were 22 men and 3 women, with a median age of 19 years (range 15&ndash;57 years). All patients received chest x rays, which revealed air shadows within the mediastinum or subcutaneous emphysema in 24 patients. Twenty-two patients underwent chest CT scans, which showed pneumomediastinum in all cases. Oesophagography was performed in 14 patients and oesophagoscopy in three. All oesophagographies and oesophagoscopies were clear. Despite conservative treatment, no patients developed mediastinitis or complications associated with oesophageal injury.

Conclusions:
Chest x ray and CT scan are sufficient to diagnose SPM. Additional diagnostic assessments such as oesophagography and oesophagoscopy are not necessary in patients without evidence of mediastinitis or a history of oesophageal injury.

]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/32?rss=1">
<title>Evaluation of morning report in an emergency medicine department</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/32?rss=1</link>
<description><![CDATA[
Background:
Morning report is considered as an important educational tool in different branches of medicine. The purpose of the present study was to examine the method of case selection, the leadership, the participant&rsquo;s satisfaction and the educational value of morning report held in our centre.

Method:
In September 2007, a formal feedback about the morning report was provided by questionnaire surveys. The data on the method of case selection, the leadership, the participant&rsquo;s satisfaction and the educational value of the sessions were collected from the residents, medical students and the academic staff in emergency medicine department. Each questionnaire also contained an open-ended question, asking for the responders&rsquo; suggestions for improving these sessions.

Results:
73.2% of the responders were satisfied with the current model of the conference hall. The data showed that 46.3% of the participants believed these sessions are held for giving the medical team the required information and 65.9% for solving the patient&rsquo;s problems. The data showed that the participants had evaluated the presentation strategy to be good; however, the presentation pattern was reported to be traditional and based on differential diagnosis in 53.7% of the cases and modern problem oriented in only 39%.

Conclusion:
Most participants considered morning report sessions held in our hospital to be effective in the way it is; however, issues such as communication skill, emergency department management, critical thinking, ethics, professionalism and evidence-based medicine should also be added to the sessions.

]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/36?rss=1">
<title>Evaluation of a bedside immunotest to predict individual anti-tetanus seroprotection: a prospective concordance study of 1018 adults in an emergency department</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/36?rss=1</link>
<description><![CDATA[
Background:
Unscheduled tetanus prophylaxis (UTP) used in the emergency room (ER) in patients with wounds who are unaware of their vaccination history is erroneous in 40% of cases. Evaluation of bedside tetanus immunity with the T&eacute;tanos Quick Stick (TQS) test may improve UTP.

Objectives:
To show that (1) a positive TQS result reflects immunity to tetanus; and (2) TQS is reproducible by ER workers.

Methods:
In a prospective concordance study, immunity to tetanus of patients with wounds was assessed by two techniques: (1) TQS at the bedside, which detects specific tetanus antitoxins at concentrations &gt;=0.2 IU/ml in whole blood or &gt;=0.1 IU/ml in serum; (2) ELISA in the laboratory (threshold &gt;0.1 IU/ml). The study comprised three groups: (A) healthcare personnel self-tested with the two techniques to determine the effect of training; (B) selected patients with wounds were double-tested with TQS by two healthcare providers whose readings were compared to test reproducibility; and (C) all patients with wounds aged &gt;=15 years were consecutively included.

Results:
Of 1018 individuals included, 60 were in group A, 50 were in group B and 908 were in group C. 403 patients who were not included were similar to those included for age, vaccination history and types of wounds. The reproducibility of the test was 98%. TQS sensitivity was 83.0%, specificity 97.5%, positive predictive value 99.6% and negative predictive value 42.9%.

Conclusions:
TQS reliably predicts tetanus immunity and is reproducible by healthcare providers. Although it may not accurately discriminate between patients with ongoing and declining immunity, it is currently the most sensitive and specific tool for guiding tetanus prophylaxis and should be included in current guidelines on UTP.

]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/43?rss=1">
<title>Inappropriate use and interpretation of D-dimer testing in the emergency department: an unexpected adverse effect of meeting the &#x22;4-h target&#x22;</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/43?rss=1</link>
<description><![CDATA[
Introduction:
D-dimer tests were inappropriately overused in our emergency department as a result of bloods being taken before clinical assessment to help meet the "4-hour target". We introduced a multifaceted intervention to reduce the number of inappropriate D-dimer tests. The secondary aim was to improve the diagnostic workup of suspected pulmonary embolism (PE).

Method:
Rate of D-dimer test and ventilation/perfusion scan requests were compared before, during and after a staggered intervention at two hospitals in one National Health Service Trust. Audits before and after the intervention were done to determine whether test use was appropriate and whether the diagnostic workup was complete.

Results:
At hospital 1, D-dimer testing after the intervention was almost halved: ratio 0.59 (95% CI 0.55 to 0.63) (p&lt;0.0001). There was also a small reduction at hospital 2 (control): rate 0.88 (95% CI 0.78 to 0.99) (p = 0.03). After the formal introduction of change at hospital 2, there was a further reduction in tests: ratio 0.67 (95% CI 0.58 to 0.76) (p&lt;0.0001). In hospital 1, pretest probability assessment improved by 42% (p = 0.0004) and D-dimer test use was reduced by 12.5% (p = 0.04) between audits. Improvement in the use of D-dimer test according to the pathway was not significant (32.5%, p = 0.11), and there was no change in the proportion of patients with completion of their diagnostic workup for PE: 47.6% (95% CI 38.3% to 56%) before and 45.6% (95% CI 38.3% to 53.1%) after the intervention.

Conclusion:
Implementation of a multifaceted change program reduced the number of D-dimer test requests in both hospitals and may have improved the diagnostic workup for PE at hospital 1. Processes that speed patient transit through the emergency department may impact negatively on other aspects of patient care. This should be the subject of further studies.

]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/48?rss=1">
<title>The impact of a temporary ice rink on a local emergency department service</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/48?rss=1</link>
<description><![CDATA[
Ice skating is becoming more popular throughout the UK, with temporary ice rinks opening in many city centres during holiday periods, especially during Christmas. Data were collected from patients who presented to the local emergency department with injuries sustained on a nearby city-centre temporary ice rink. Injuries related to ice rinks accounted for 0.76% of all emergency department attendances and represented 0.29% of ice rink participants (2.9 per 1000). Women in the older age range sustained the most significant injuries. Our study has shown that the rate of injuries per 1000 ice rink participants is comparable with data recorded when a new ice rink is opened.
]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/50?rss=1">
<title>Google governance: increasing the effectiveness of critical care physicians through the use of an online usergroup</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/50?rss=1</link>
<description><![CDATA[
Aims:
The aim of this study was to describe the use of an online usergroup to enhance communication and productivity by critical care specialists.

Methods:
In this article, we provide a description of the first 6 months of use of an online usergroup by senior retrieval physicians.

Results:
Initially developed as a communication and online discussion tool, our online usergroup evolved to include a number of other utilities that support clinical governance. These included a repository for useful files, educational presentations, online rostering and "portfolio pages", updating aspects of an individual specialist&rsquo;s non-clinical activity. Its applications continue to evolve in number and utility. Participating physicians perceive an increase in organisational efficiency.

Conclusions:
An online usergroup such as Google Groups may provide powerful support to an organisation&rsquo;s clinical governance. We recommend this tool to other services with limited administrative personnel.

]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/52?rss=1">
<title>Frenal injury in children is not pathognomic of non-accidental injury</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/52?rss=1</link>
<description><![CDATA[
Upper labial frenal tear in infants is classically taught as having associations with non-accidental injury. Collection of data for a 12-month period in our paediatric facial injury study revealed that this injury pattern is common in ambulant children and was associated with other facial trauma. In assessing the possibility of this injury being due to abuse, the importance of the mobility of the child and the mechanism of the injury are paramount.
]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/53-a?rss=1">
<title>Towards evidence based emergency medicine: Best BETs from the Manchester Royal Infirmary</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/53-a?rss=1</link>
<description><![CDATA[ ]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/53-b?rss=1">
<title>BET 1: Blood component therapy in trauma patients requiring massive transfusion</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/53-b?rss=1</link>
<description><![CDATA[ ]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/55?rss=1">
<title>BET 2: Potato peel dressings for burn wounds</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/55?rss=1</link>
<description><![CDATA[ ]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/56?rss=1">
<title>BET 3: Chlordiazepoxide, the management of alcohol withdrawal and the kindling effect</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/56?rss=1</link>
<description><![CDATA[ ]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/57?rss=1">
<title>BET 4: ACE inhibitors in addition to standard treatments in acute heart failure</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/57?rss=1</link>
<description><![CDATA[ ]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/59?rss=1">
<title>Chest compression first aid for respiratory arrest due to acute asphyxic asthma</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/59?rss=1</link>
<description><![CDATA[
This report demonstrates the importance of including external chest compression as a method of resuscitation in first aid for cases of life-threatening asphyxic asthma. Chest compression may be the only way that death of such patients may be avoided. Three such patients, two with respiratory arrest, were successfully treated by external chest compression.
During the 1960s, there was an increase in asthma deaths, 81% of which occurred unexpectedly, outside the hospital. This coincided with the abandonment of the trusted methods of chest compression and the introduction of mouth-to-mouth resuscitation. Acute asphyxic asthma was the most common cause of death. In acute asphyxic asthma, the chest wall does not deflate spontaneously. The trapped air must be expelled by external compression. Mouth-to-mouth resuscitation may not work because air is being blown in while none escapes.
]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/61?rss=1">
<title>Back pain after wild mushroom consumption</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/61?rss=1</link>
<description><![CDATA[ ]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/62?rss=1">
<title>Defining a standard medication kit for prehospital and retrieval physicians: a comprehensive review</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/62?rss=1</link>
<description><![CDATA[
Background:
There is little consolidated evidence for which prehospital and retrieval drugs a given service should carry.

Objectives:
To suggest a core group of drugs based on the best evidence currently available.

Methods:
This paper has reviewed documents from recognised evidence-based sources and put together an initial skeleton for an evidence-based drug pack.

Results:
The resultant list of drugs is divided up into core agents with suggestions for regional variations. This may be of particular interest to de novo services.

Conclusions:
This review offers a starting point for services based on the evidence currently available. It is hoped that prehospital and retrieval clinicians will start to look analytically at what they carry and, through a process of audit, aim to improve the evidence in this area. Future reviews and comparisons of worldwide prehospital and retrieval databases are suggested.

]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/72?rss=1">
<title>Delayed presentation following accidental inhalation of a pushpin</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/72?rss=1</link>
<description><![CDATA[
A previously fit and well 18-year-old woman presented to the accident and emergency department following referral by her general practitioner with a provisional diagnosis of appendicitis. The history obtained from the patient revealed the presence of a bitemporal headache with associated neck stiffness, photophobia and vomiting for approximately 1.5 weeks. The patient complained of abdominal pain localised to her right iliac fossa and anorexia for approximately 1 week. She also noted the presence of a cough productive of green sputum for 3 weeks. A chest radiograph was obtained which showed a large area of consolidation in the right lower lobe consistent with infection and a linear density in keeping with a metallic foreign body. Following review of the chest radiograph, the patient was interviewed further and recalled having inhaled a pushpin approximately 1 year before her presentation. Aspiration of foreign bodies is relatively common in children and is often associated with delayed diagnosis and high morbidity. To prevent delayed diagnosis, characteristic symptoms and clinical and radiological signs of foreign body aspiration should be checked in all suspected cases and a low index of suspicion for ordering additional imaging or using bronchoscopy for diagnostic purposes should be employed.
]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/74?rss=1">
<title>Possible interaction between pomegranate juice and warfarin</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/74?rss=1</link>
<description><![CDATA[
Pomegranate juice is growing in popularity in the UK. We report a potential interaction between pomegranate juice and warfarin. Laboratory studies have shown that pomegranate juice inhibits cytochrome P450 enzymes involved in warfarin metabolism. As with previous reports of interactions between food and warfarin, this case does not definitively prove the association between pomegranate juice consumption and increased warfarin bioactivity but highlights the importance of taking a complete drug, food and juice history when assessing patients with unstable anticoagulation.
]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/76?rss=1">
<title>An adolescent athlete with groin and hip pain</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/76?rss=1</link>
<description><![CDATA[
The case report is presented of a 14-year-old boy with persistent right hip and groin pain. After failing to respond to conventional management, the patient was admitted and investigated. He had a fever and raised inflammatory markers. MRI of the pelvis revealed pyomyositis of the right adductor compartment extending into the pelvis. Pyomyositis should be considered in a patient with pain disproportionate to the physical examination findings.
]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/77-a?rss=1">
<title>Inadvertent prostatic stimulation causing cardioversion of unstable superventricular tachycardia</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/77-a?rss=1</link>
<description><![CDATA[ ]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/77-b?rss=1">
<title>The radiology investigation of renal colic in the emergency department</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/77-b?rss=1</link>
<description><![CDATA[ ]]></description>
</item>

<item rdf:about="http://emj.bmj.com/cgi/content/short/27/1/78?rss=1">
<title>Sophia</title>
<link>http://emj.bmj.com/cgi/content/short/27/1/78?rss=1</link>
<description><![CDATA[ ]]></description>
</item>

<item rdf:about="http://gruntdoc.com/2010/02/body-found-in-planes-landing-gear-bay-in-japan-cnn-com.html">
<title>Body found in plane&#x2019;s landing gear bay in Japan &#x2013; CNN.com</title>
<link>http://gruntdoc.com/2010/02/body-found-in-planes-landing-gear-bay-in-japan-cnn-com.html</link>
<description><![CDATA[Tokyo, Japan (CNN) &#8212; A body was found in the landing gear bay of an airplane that arrived at Tokyo&#38;apos;s Narita Airport Sunday, the airport announced.
The dead man was not carrying a passport or personal belongings, airport police said.
via Body found in plane&#8217;s landing gear bay in Japan &#8211; CNN.com.
JFK to Narita.  Someone was able [...]


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</item>

<item rdf:about="http://gruntdoc.com/2010/02/beer-may-be-good-for-your-bones-livescience.html">
<title>Beer May Be Good For Your Bones | LiveScience</title>
<link>http://gruntdoc.com/2010/02/beer-may-be-good-for-your-bones-livescience.html</link>
<description><![CDATA[If you downed one too many while watching the Super Bowl, here&#38;apos;s at least one reason to hold your head high: Drinking beer can be good for your health.
But seriously, a new analysis of 100 commercial beers shows the hoppy beverage is a significant source of dietary silicon, a key ingredient for bone health.
via Beer [...]


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Nascar infield, alcohol and golf carts Just my patients, 2/3 falls involving the above resuted in...


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</item>

<item rdf:about="http://gruntdoc.com/2010/02/report-a-bad-doctor-to-the-authorities-go-to-jail-it-might-really-happen-for-anne-mitchell-rn-in-winkler-county-texas-respectful-insolence.html">
<title>Report a bad doctor to the authorities, go to jail? It might really happen for Anne Mitchell, RN in Winkler County, Texas : Respectful Insolence</title>
<link>http://gruntdoc.com/2010/02/report-a-bad-doctor-to-the-authorities-go-to-jail-it-might-really-happen-for-anne-mitchell-rn-in-winkler-county-texas-respectful-insolence.html</link>
<description><![CDATA[Report a bad doctor to the authorities, go to jail? It might really happen for Anne Mitchell, RN in Winkler County, Texas : Respectful Insolence.
He&#8217;s been on this from the beginning.  Good news: one of the nurses was dismissed; bad news, the other is on trial.
Atrocious.
My grandparents lived in Winkler County (Kermit), and are gone [...]


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Is there a doctor in the house?: And I was doing so well Is there a doctor in the house?: And I was...


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</item>

<item rdf:about="http://gruntdoc.com/2010/02/wd-40-may-have-screwed-up-here.html">
<title>WD-40 may have screwed up here</title>
<link>http://gruntdoc.com/2010/02/wd-40-may-have-screwed-up-here.html</link>
<description><![CDATA[Look at the picture of the new WD-40 can. It has a new pivoting gadget that combines spray or straw use without any plugging in, trying to find the little orifice with a stiff red piece of plastic, etc. 
As an engineering piece ( and without having used it ) it looks terrific. 
But, I [...]


Related posts:Weirdest prescription? From an old HS buddy (also a Navy Man) now...


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</item>

<item rdf:about="http://gruntdoc.com/2010/02/military-increases-availability-of-morning-after-pill-cnn-com.html">
<title>Military increases availability of morning-after pill &#x2013; CNN.com</title>
<link>http://gruntdoc.com/2010/02/military-increases-availability-of-morning-after-pill-cnn-com.html</link>
<description><![CDATA[Washington (CNN) &#8212; All U.S. military health facilities around the world will now carry the emergency contraception pill known as Plan B One-Step, according to a new Department of Defense policy.
The decision to carry the pill, often referred to as the morning-after pill, was based on a recommendation by the Pentagon&#38;apos;s Pharmacy and Therapeutics Committee, [...]


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<item rdf:about="http://gruntdoc.com/2010/02/ohio-com-akron-general-puts-er-wait-times-on-billboards-internet.html">
<title>Ohio.com &#x2013; Akron General puts ER wait times on billboards, Internet</title>
<link>http://gruntdoc.com/2010/02/ohio-com-akron-general-puts-er-wait-times-on-billboards-internet.html</link>
<description><![CDATA[Trying to avoid a painfully long wait in the ER?
One local hospital system is publicly sharing the current average wait time to see a doctor at all its emergency departments.
Akron General Health System recently began advertising up-to-the-minute wait times for its emergency rooms on billboards throughout town.
Six digital billboards in Akron are automatically updated every [...]


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Column: Doctors ignore Internet at their own peril &#8211; Opinion &#8211; USATODAY.com Kevin, MD continues his takeover of the media, with another...
CNN Political Ticker: Senate confirms Benjamin as surgeon general CNN Political Ticker: All politics, all the time Blog Archive...


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</item>

<item rdf:about="http://gruntdoc.com/2010/02/realclearpolitics-video-obama-mispronounces-corpsman-at-prayer-breakfast.html">
<title>RealClearPolitics &#x2013; Video &#x2013; Obama Mispronounces &#x201C;Corpsman&#x201D; At Prayer Breakfast</title>
<link>http://gruntdoc.com/2010/02/realclearpolitics-video-obama-mispronounces-corpsman-at-prayer-breakfast.html</link>
<description><![CDATA[RealClearPolitics &#8211; Video &#8211; Obama Mispronounces &#8220;Corpsman&#8221; At Prayer Breakfast.
And, I don&#8217;t care.  Yes, he mispronounced a word I think he should have known, or asked about.  He didn&#8217;t, and that&#8217;s just one of many things I wish he&#8217;d done differently.  Who cares.
He did recognize the service of this corpsman (pronounced cor-man), and to me [...]


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RealClearPolitics &#8211; Socialized Medicine? Bring It On Sometimes you can see the trees, and think it&#8217;s a...
Holman Jenkins: Why Obama Bombed on Health Care &#8211; WSJ.com Holman Jenkins: Why Obama Bombed on Health Care &#8211; WSJ.com...


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<item rdf:about="http://gruntdoc.com/2010/02/grand-rounds-vol-6-no-19-a-groundhogs-perspective-on-med-blogs-more-ipad.html">
<title>Grand Rounds Vol 6, No. 19 | A Groundhog&#x2019;s Perspective on Med Blogs | More iPad</title>
<link>http://gruntdoc.com/2010/02/grand-rounds-vol-6-no-19-a-groundhogs-perspective-on-med-blogs-more-ipad.html</link>
<description><![CDATA[Grand Rounds Vol 6, No. 19 &#124; A Groundhog&#8217;s Perspective on Med Blogs &#124; More iPad.
Grand Rounds from Doctor Rob.  Fun!


Related posts:ACP Internist: Grand Rounds at ACP Internist ACP Internist: Grand Rounds at ACP Internist Grand Rounds are...
MedBlogs Grand Rounds 5:43 Medicine and Technology by Dr. Joseph Kim [part of the...
Dr. Nick hosts Grand Rounds [...]


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MedBlogs Grand Rounds 5:43 Medicine and Technology by Dr. Joseph Kim [part of the...
Dr. Nick hosts Grand Rounds The Godfather of the Medblog Grand Rounds series hosts this...


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</item>

<item rdf:about="http://gruntdoc.com/2010/02/were-failing-our-residents-training-ed-docs-for-the-real-w-emergency-medicine-news.html">
<title>We&#x2019;re Failing Our Residents: Training ED Docs for the Real W&#x2026; : Emergency Medicine News</title>
<link>http://gruntdoc.com/2010/02/were-failing-our-residents-training-ed-docs-for-the-real-w-emergency-medicine-news.html</link>
<description><![CDATA[Emergency Medicine News:
February 2010 &#8211; Volume 32 &#8211; Issue 2 &#8211; p 5, 24, 25, 26
Residents training in large urban centers typically see more than 200 patients a day. They have access to all subspecialty care, typically available 24 hours a day. Residents have around-the-clock access to angioplasty, interventional radiology, hand surgeons, neurosurgeons, and plastic [...]


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Parkland hospital streamlines emergency room procedures | News for Dallas, Texas | Dallas Morning News | Life/Travel: Health Parkland hospital streamlines emergency room procedures | News for Dallas,...
More on the DO/MD controversy in Fort Worth I missed this the other day, but better late than...


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</item>

<item rdf:about="http://gruntdoc.com/2010/01/homoeopathy-sceptics-plan-mass-overdose-health-news-health-families-the-independent.html">
<title>Homoeopathy sceptics plan mass &#x2018;overdose&#x2019; &#x2013; Health News, Health &#x26; Families &#x2013; The Independent</title>
<link>http://gruntdoc.com/2010/01/homoeopathy-sceptics-plan-mass-overdose-health-news-health-families-the-independent.html</link>
<description><![CDATA[First, don&#8217;t do this:
In what is being billed as &#8220;rationalism&#38;apos;s Kool-Aid moment&#8221;, a mass &#8220;overdose&#8221; is being planned next week in protest at the marketing of homoeopathic medicines.
More than 300 people who style themselves as &#8220;homoeopathy sceptics&#8221; will each swallow an entire bottle of homoeopathic pills in protest at the continued marketing of homoeopathic medicines [...]


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BBC NEWS | Health | Steaming hot tea linked to cancer From the &#8216;life causes cancer&#8217; files: BBC NEWS | Health...
Parkland hospital streamlines emergency room procedures | News for Dallas, Texas | Dallas Morning News | Life/Travel: Health Parkland hospital streamlines emergency room procedures | News for Dallas,...


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