Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Objective: To determine if improvement in patients’ metered dose inhaler (MDI) technique could be achieved in the emergency department (ED) with the use of a simple illustrated instruction sheet. Methods: Prospective evaluation of a convenience sample of patients with asthma or COPD. Patients were first subjectively and objectively evaluated on their usual MDI technique, then were given an illustrated instruction sheet to study for 5 minutes. There was no verbal coaching prior to the post-test. A post-test evaluation was then performed. Results were compared using paired Student t test. Results: A total of 115 patients were enrolled. Mean age was 34.9±13.1 years, and mean years using MDI was 5.7±3.8. Subjective improvement in technique was reported by 110 patients (96%) with a mean pre-test score of 7.4±1.5 and post-test score of 9.2±1.1 (p<0.0001, 10 point scale). Objective improvement was achieved in 113 patients (98%) with a mean pretest score of 3.9±1.3 and post-test score of 5.8±1.0 (p<0.0001, 7 point scale), corresponding to a 30% improvement in technique (95% CI: 22,39). Fortyfour patients (38%) reported never having been shown proper MDI technique by a health care professional, and 112 patients (97%) found the instruction sheet helpful. Conclusions: Rapid objective and subjective improvement of MDI technique from both patients’ and physicians’ perspective is possible in the ED with the use of an illustrated instruction sheet, and requires minimal effort from the treating emergency physician.

Objective: To establish point and one-year prevalence data regarding partner violence (PV) for women presenting to a university teaching hospital, University of California, Irvine Medical Center (UCIMC), one of 15 emergency departments in Orange County, and to determine differences in partner violence rates when comparing descriptive variables such as race, income and education. Methods: An anonymous, written survey was administered to a convenience sample of 370 women presenting to University of California Irvine Emergency Department over a 12 month period. Results: Partner violence has a point prevalence of 6.7% and a one-year prevalence of 37.0%. Women who have experienced previous abuse are more likely to present with complaints related to PV acutely. Lower income levels correlate with a higher incidence of physical, emotional, and sexual abuse. We found no correlation between race and likelihood of PV. Conclusion: PV in Orange County, California occurs quite frequently. The oneyear prevalence compares to that of the entire state of California, but is at the higher limit when other areas are compared. Detection rates among EPs should be improved, and services to women who have suffered PV will need to be enhanced within Orange County.

Objective: We sought to investigate the one-year point prevalence for male intimate partner violence (IPV) in men presenting to a university emergency department, to identify types of violence, to examine differences in male IPV rates based on patient demographics, and to identify any differences in prevalence based on types of partnership. Methods: This survey study was conducted from September 2001 until January 2002 at a tertiary, academic, Level I Trauma Center with an emergency department (ED) that has 40,000 visits per year. The anonymous written survey consisted of 16 questions previously validated in the Colorado Partner Violence Study, Index of Spouse Abuse and the Conflict Tactics Scale. This survey was administered to all consenting adult men who presented to the ED. Odds ratios (OR) with 95% CI were calculated when appropriate and a p-value of 0.05 was set for significance. Results: The oneyear point prevalence rate of male IPV was 24% in our study population (82/346). Among the men who experienced some form of abuse specified as either physical, emotional, or sexual, the prevalence was calculated to be 15.6% (54/346), 13.6% (47/346), and 2.6% (9/346), respectively. Education, income, age, and race did not demonstrate an association for any one variable to be associated with intimate partner abuse (p>0.05) with the exception of increased risk of IPV among unemployed men in the relationship (p<0.04, OR 0.592). IPV towards men was found to affect both heterosexual as well as homosexual relationships. Overall, 2% (8/346) of the men surveyed had received medical treatment as a result of IPV by their intimate partner within the past year. Three percent (11/344) of those men reporting abuse were abusers themselves. Conclusion: The point prevalence of IPV among our study population was 24%. In our study of 346 men, male IPV crossed all socioeconomic boundaries, racial differences, and educational levels regardless of the sex of the partner.