Some psychological disorder-comorbid with a medical diagnosis-presents a challenge for treatment because of diagnostic and treatment dilemmas. This study investigated associations between Psychoticism and Paranoid ideas in internal medicine and A&E1patient in a university hospital.

In this cross-sectional study, we checked 150 patients of internal medicine department and 150 patients, who have admitted to the A&E department as a control group. They have chosen by a Purposive accessible sampling method. The psychopathological profile was assessed using the SCL-90 questionnaire by Iranian version. Data have been computed and analyzed by SPSS V.17 and we used t-student, Mann-Whitney tests and logistic regression methods. The results have been considered significant when the two tailed p-value was less than 0.05.

In internal ward 70% and A&E department 43.3% of patient have had Paranoid ideas (OR= 4.2; 95% CI, 1.9 to 8.9). Psychoticism were observed in 38% of internal medicine patients and 20% of A&E's patients (OR= 7.64; 95% CI, 3.2 to 17.8).

The present results confirm the high prevalence rate of Psychoticism and Paranoid ideas in patients that hospitalized in internal to A & E ward. Recommendation are made to further investigate by greater sample size and different setting in this field is warranted.

The aim of this study was to describe an educational method teaching Disaster Medicine to American Emergency Medicine (EM) physicians and to evaluate knowledge attainment using this method.

This was an observational study using a pre-test and a post-test. A full-scale disaster exercise (FSE) was conducted at a large academic center with two hospitals in Brooklyn, New York (USA). Eighty-two EM residents (physicians in training, post medical school) participated in the study. Inclusion criteria for study participation was all EM residents training at the State University of New York (SUNY) Downstate at the time of the study. There were no exclusion criteria. The exercise was a disaster drill designed as “Olympic Games.” Participants in the exercise took a pre-test and a post-test. The primary outcome of the study was the mean difference between pre-test and post-test scores of the study participants using independent sample t-tests. Secondary outcomes of the study were percent of critical actions met by the residents and the hospitals as measured by direct observation of trained study personnel during the exercise.

Mean resident post-test scores were higher than pre-test scores to a degree that was statistically significant (62% versus 53%; P =.002). The residents’ performances ranged from 48% to 63% of objectives met. The hospitals’ performances met 50% to 100% of their objectives.

The use of an Olympic Games format was an effective model for disaster education for physicians. The model allowed for evaluation of performance and protocols of participants and hospital systems, respectively, and may be used objectively to evaluate for areas of improvement. The Disaster Olympics drill was found to improve emergency preparedness knowledge in the population studied and may constitute a novel and efficacious methodology in disaster training.

DanielP, GistR, GrockA, KohlhoffS, RoblinP, ArquillaB. Disaster Olympics: A Model for Resident Education. Prehosp Disaster Med. 2016;31(3):237–241.

Patients in the emergency department (ED) who have been admitted to hospital (inpatient “boarders”) are associated with ED overcrowding. They are also a symptom of a hospital-wide imbalance between demand and supply of resources. We analyzed the trends of inpatient admissions, ED boarding volumes, lengths of stay and bed resources of 3 major admitting services at our teaching institution.

We used hospital databases from Jan. 1, 2004, to Dec. 31, 2007, to analyze ED visits that resulted in admission to hospital.

During the study period, 21 986 ED patients were admitted to hospital. The percentage of cancer-related admissions to the oncology admitting service decreased from 48% in 2004 to 24% in 2007, and admissions to general internal medicine (GIM) increased nearly 2-fold, from 28% in 2004 to 54% in 2007. In addition, GIM admitted about 10% more myocardial infarction and heart failure patients than did cardiology. General internal medicine constituted the majority of ED boarders and had a median boarding length of stay of approximately 15 hours. Inpatient beds on oncology and cardiology services remained static.

Without bed capacity to admit more patients, our specialty services relied on GIM to serve as a safety net. At the same time, GIM was cited as a main source of ED congestion as their patients occupied more ED beds for longer periods than any other admitting service. The data presented in this study has helped effect positive change within our institution. Other hospitals running at or near capacity and faced with similar ED congestion may apply the methods we used in this study to analyze the cause and nature of their situation.