LAC+USC Medical Center

About: LAC+USC Medical Center is a healthcare organization based out in Los Angeles, California, United States. It is known for research contribution in the topics: Population & Poison control. The organization has 1348 authors who have published 886 publications receiving 21927 citations. The organization is also known as: County/USC & Los Angeles County General.

Premature Rupture of Membranes and Preterm Labor

Abstract: Preterm labor and delivery are challenging obstetric complications for any emergency physician. In the United States, preterm delivery complicates approximately one in ten births and is the cause of at least 75% of neonatal deaths, not including congenital malformations. Although the causes are often unknown, emergency physicians should be familiar with predisposing risk factors. The rate of fetal and maternal morbidity can be reduced with accurate diagnosis of preterm labor, intervention to delay preterm delivery, timely administration of corticosteroids, and in certain cases magnesium sulfate and antibiotics. When preterm rupture of membranes occurs, several complications can occur including infection, premature delivery, placental abruption, and umbilical cord prolapse. The initial management in the emergency department involves an exam, obstetric ultrasound, labs, and cultures as indicated. Fetal malpresentations should be anticipated in the setting of preterm PROM with preterm labor. Considerations should be given immediately to transport to a tertiary care center with neonatal intensive care unit, especially if less than 34 weeks gestational age. Contraindications to transport include imminent delivery, fetal or maternal distress or unstable status, or if there is no safe transport to a referral center.

Defining the "Problem Resident" and the Implications of the Unfixable Problem: The Rationale for a "Front-door" Solution.

Abstract: Author(s): Taira, Taku; Santen, Sally A.; Roberts, Nicole K. | Abstract: Introduction: Problem residents are common in graduate medical education, yet little is known about their characteristics, deficits, and the consequences for emergency medicine (EM) residencies. The American Board of Internal Medicine (ABIM) defines a problem resident as “a trainee who demonstrates a significant enough problem that requires intervention by someone of authority, usually the program director [PD] or chief resident.” Although this is a comprehensive definition, it lacks specificity. Our study seeks to add granularity and nuance to the definition of “problem resident,” which can be used to guide the recruitment, selection, and training of residents. Methods: We conducted semi-structured interviews with a convenience sample of EM PDs between 2011 and 2012. We performed qualitative analysis of the resulting transcripts with our thematic analysis based on the principles of grounded theory. We reached thematic sufficiency after 17 interviews. Interviews were coded as a team through consensus. Results: The analysis identified diversity in the type, severity, fixability, and attribution of problems among problem residents. PDs applied a variety of thresholds to define a problem resident with many directly rejecting the ABIM definition. There was consistency in defining academic problems and some medical problems as “fixable.” In contrast, personality problems were consistently defined as “non-fixable.” Despite the diversity of the definition, there was consensus that residents who caused “turbulence” were problem residents. Conclusion: The ABIM definition of the problem resident captures trainees who many PDs do not consider problem residents. We propose that an alternative definition of the problem resident would be “a resident with a negative sphere of influence beyond their personal struggle.” This combination acknowledges the identified themes of turbulence and the diversity of threshold. Further, the combination of PDs’ unwillingness to terminate trainees and the presence of non-fixable problems implies the need for a “front-door” solution that emphasizes personality issues at the potential expense of academic potential. This “front-door” solution depends on the commitment of all stakeholders including medical schools, the Association of American Medical Colleges, and PDs.