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  1. Article ; Online: Kotter's 8 stages of change: implementation of clinical screening protocols for assessing patients for COVID-19 - a review of an academic medical centre's preparedness.

    Ravi, Shashank / Patel, Sunny R / Laurence, Sheneé K / Sebok-Syer, Stefanie S / Gharahbaghian, Laleh

    BMJ leader

    2022  Volume 6, Issue 4, Page(s) 319–322

    Abstract: Background: COVID-19 screening protocols rapidly evolved as a result of changing Centers for Disease Control and Prevention (CDC) and California Department of Public Health (CDPH) recommendations. These protocols led to operational improvements at one ... ...

    Abstract Background: COVID-19 screening protocols rapidly evolved as a result of changing Centers for Disease Control and Prevention (CDC) and California Department of Public Health (CDPH) recommendations. These protocols led to operational improvements at one large academic medical centre using change management methods explained in Kotter's 8-stage change model.
    Methods: We reviewed all iterations of clinical process maps for identifying, isolating and assessing COVID-19 infections in paediatric and adult populations within one emergency department (ED) from 28 February 2020 to 5 April 2020. We incorporated CDC and CDPH criteria for the various roles of healthcare workers in ED patient assessment.
    Results: Using Kotter's 8-stage change model, we outlined the chronological evolution of basic screening criteria, as well as how these were reviewed, modified and implemented during the onset and through the time of greatest uncertainty of COVID-19 in the USA. Our results demonstrate a successful creation, and subsequent execution, of rapidly changing protocols across a large workforce.
    Conclusion: We effectively applied a business change management framework to the hospital management response during a pandemic; we share these experiences and challenges to inform and guide future operational decision making during times of rapid change.
    MeSH term(s) Child ; Humans ; Change Management ; COVID-19/diagnosis ; Hospital Administration ; Public Health ; Transtheoretical Model ; United States/epidemiology
    Language English
    Publishing date 2022-04-20
    Publishing country England
    Document type Journal Article
    ISSN 2398-631X
    ISSN (online) 2398-631X
    DOI 10.1136/leader-2020-000379
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Cardiac Standstill With Intracardiac Clot Formation.

    Sakamoto, Jeffrey Tadashi / Storch, Ian / Gharahbaghian, Laleh

    Clinical practice and cases in emergency medicine

    2019  Volume 3, Issue 4, Page(s) 430–431

    Abstract: This case describes and depicts cardiac standstill with thrombosed blood within the chambers of the heart. This was likely due to stasis of blood from a prolonged no-flow state. After viewing this ultrasound finding, the decision was made to halt ... ...

    Abstract This case describes and depicts cardiac standstill with thrombosed blood within the chambers of the heart. This was likely due to stasis of blood from a prolonged no-flow state. After viewing this ultrasound finding, the decision was made to halt resuscitative efforts in this case of a patient in cardiac arrest.
    Language English
    Publishing date 2019-09-30
    Publishing country United States
    Document type Journal Article
    ISSN 2474-252X
    ISSN (online) 2474-252X
    DOI 10.5811/cpcem.2019.7.42932
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Clitoral priapism with no known risk factors.

    Gharahbaghian, Laleh

    The western journal of emergency medicine

    2009  Volume 9, Issue 4, Page(s) 235–237

    Abstract: Clitoral priapism is a rare condition that is associated with an extended duration of clitoral erection due to local engorgement of clitoral tissue resulting in pain. Although the pathophysiology is not completely understood, it has been associated with ... ...

    Abstract Clitoral priapism is a rare condition that is associated with an extended duration of clitoral erection due to local engorgement of clitoral tissue resulting in pain. Although the pathophysiology is not completely understood, it has been associated with specific classes of medications, diseases that alter clitoral blood flow or others associated with small to large vessel disease. We present a case report of a 26-year-old patient who developed clitoral priapism without a clear medication or disease related etiology. The patient was treated with opiates, imipramine, non-steroidal anti-inflammatory medication, and local ice packs. She recovered uneventfully.
    Language English
    Publishing date 2009-06-29
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2375700-0
    ISSN 1936-9018 ; 1936-900X
    ISSN (online) 1936-9018
    ISSN 1936-900X
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Welcome to the Resident/Student/Fellow Section of WestJEM!

    Gharahbaghian, Laleh

    The western journal of emergency medicine

    2009  Volume 9, Issue 1, Page(s) 46

    Language English
    Publishing date 2009-06-29
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2375700-0
    ISSN 1936-9018 ; 1936-900X
    ISSN (online) 1936-9018
    ISSN 1936-900X
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Point-of-care Ultrasonography for Detecting the Etiology of Unexplained Acute Respiratory and Chest Complaints in the Emergency Department: A Prospective Analysis.

    Lamsam, Layton / Gharahbaghian, Laleh / Lobo, Viveta

    Cureus

    2018  Volume 10, Issue 8, Page(s) e3218

    Abstract: Introduction  Point-of-care ultrasound (POCUS) is increasingly used as a diagnostic tool in emergency departments. As the number and type of POCUS protocols expand, there is a need to validate their efficacy in comparison with current diagnostic ... ...

    Abstract Introduction  Point-of-care ultrasound (POCUS) is increasingly used as a diagnostic tool in emergency departments. As the number and type of POCUS protocols expand, there is a need to validate their efficacy in comparison with current diagnostic standards. This study compares POCUS to chest radiography in patients with undifferentiated respiratory or chest complaints. Methods A prospective convenience sample of 59 adult patients were enrolled from those presenting with unexplained acute respiratory or chest complaints (and having orders for chest radiography) to a single emergency department in an academic tertiary-care hospital. After a brief educational session, a medical student, blinded to chest radiograph results, performed and interpreted images from the modified Rapid Assessment of Dyspnea in Ultrasound (RADiUS) protocol. The images were reviewed by a blinded ultrasound fellowship-trained emergency physician and compared to chest radiography upon chart review. The primary "gold standard" endpoint diagnosis was the diagnosis at discharge. A secondary analysis was performed using the chest computed tomography (CT) diagnosis as the endpoint diagnosis in the subset of patients with chest CTs. Results When using diagnosis at discharge as the endpoint diagnosis, the modified RADiUS protocol had a higher sensitivity (79% vs. 67%) and lower specificity (71% vs. 83%) than chest radiography. When using chest CT diagnosis as the endpoint diagnosis (in the subset of patients with chest CTs), the modified RADiUS protocol had a higher sensitivity (76% vs. 65%) and lower specificity (71% vs. 100%) than chest radiography. The medical student performed and interpreted the 59 POCUS scans with 92% accuracy. Conclusion The sensitivity and specificity of POCUS using the modified RADiUS protocol was not significantly different than chest radiography. In addition, a medical student was able to perform the protocol and interpret scans with a high level of accuracy. POCUS has potential value for diagnosing the etiology of undifferentiated acute respiratory and chest complaints in adult patients presenting to the emergency department, but larger clinical validation studies are required.
    Language English
    Publishing date 2018-08-28
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.3218
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Detection of Type B Aortic Dissection in the Emergency Department with Point-of-Care Ultrasound.

    Earl-Royal, Emily / Nguyen, Phi D / Alvarez, Al'ai / Gharahbaghian, Laleh

    Clinical practice and cases in emergency medicine

    2019  Volume 3, Issue 3, Page(s) 202–207

    Abstract: Aortic dissection (AD) is a rare, time-sensitive, and potentially fatal condition that can present with subtle signs requiring timely diagnosis and intervention. Although definitive diagnosis is most accurately made through computed tomography ... ...

    Abstract Aortic dissection (AD) is a rare, time-sensitive, and potentially fatal condition that can present with subtle signs requiring timely diagnosis and intervention. Although definitive diagnosis is most accurately made through computed tomography angiography, this can be a time-consuming study and the patient may be unstable, thus preventing the study's completion. Chest radiography (CXR) signs of AD are classically taught yet have poor diagnostic reliability. Point-of-care ultrasound (POCUS) is increasingly used by emergency physicians for the rapid diagnosis of emergent conditions, with multiple case reports illustrating the sonographic signs of AD. We present a case of Stanford type B AD diagnosed by POCUS in the emergency department in a patient with vague symptoms, normal CXR, and without aorta dilation. A subsequent review of CXR versus sonographic signs of AD is described.
    Language English
    Publishing date 2019-07-08
    Publishing country United States
    Document type Case Reports
    ISSN 2474-252X
    ISSN (online) 2474-252X
    DOI 10.5811/cpcem.2019.5.42928
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Clitoral Priapism with No Known Risk Factors

    Gharahbaghian, Laleh

    Western Journal of Emergency Medicine, Vol 9, Iss 4, Pp 235-

    2008  Volume 237

    Abstract: Clitoral priapism is a rare condition that is associated with an extended duration of clitoral erection due to local engorgement of clitoral tissue resulting in pain. Although the pathophysiology is not completely understood, it has been associated with ... ...

    Abstract Clitoral priapism is a rare condition that is associated with an extended duration of clitoral erection due to local engorgement of clitoral tissue resulting in pain. Although the pathophysiology is not completely understood, it has been associated with specific classes of medications, diseases that alter clitoral blood flow or others associated with small to large vessel disease. We present a case report of a 26-year-old patient who developed clitoral priapism without a clear medication or disease related etiology. The patient was treated with opiates, imipramine, non-steroidal anti-inflammatory medication, and local ice packs. She recovered uneventfully. [WestJEM. 2008;9:235-237.]
    Keywords priapism ; clitoris ; vulvar pain ; emergency medicine ; Medicine ; R ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9
    Language English
    Publishing date 2008-11-01T00:00:00Z
    Publisher eScholarship Publishing, University of California
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  8. Article ; Online: Protecting the emergency physician workforce during the coronavirus disease 2019 pandemic through precision scheduling at an academic tertiary care trauma center.

    Lee, Moon O / Ribeira, Ryan / Fang, Andrea / Cantwell, Lauren / Khanna, Kajal / Smith, Cherrelle / Gharahbaghian, Laleh

    Journal of the American College of Emergency Physicians open

    2021  Volume 2, Issue 1, Page(s) e12221

    Abstract: The coronavirus disease 2019 (COVID-19) pandemic created new emergency physician staffing challenges. Emergency physicians may be taken out of the workforce because of respiratory symptoms or pending severe acute respiratory syndrome coronavirus 2 test ... ...

    Abstract The coronavirus disease 2019 (COVID-19) pandemic created new emergency physician staffing challenges. Emergency physicians may be taken out of the workforce because of respiratory symptoms or pending severe acute respiratory syndrome coronavirus 2 test results. Vulnerable emergency physician populations with increased risk of serious disease and death from COVID-19 include physicians at older ages; those with chronic medical conditions, including cardiac and pulmonary diseases and immunosuppression; and potentially pregnancy. We present our approach to planning for staffing issues through precision scheduling. We describe the actions taken to protect our vulnerable physicians and maximize our physician coverage. Measures include optimizing workforce; increasing backup call system; adjusting shifts based on patient arrival times, volume, and surge predictions; minimizing exposure to COVID-19 and reduce personal protective equipment use through telemedicine, huddles, and, creating lower risk emergency department care areas; and standardizing intubations to limit exposure.
    Language English
    Publishing date 2021-02-09
    Publishing country United States
    Document type Journal Article
    ISSN 2688-1152
    ISSN (online) 2688-1152
    DOI 10.1002/emp2.12221
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Ultrasound Detection of Patellar Fracture and Evaluation of the Knee Extensor Mechanism in the Emergency Department.

    Carter, Kiersten / Nesper, Arica / Gharahbaghian, Laleh / Perera, Phillips

    The western journal of emergency medicine

    2016  Volume 17, Issue 6, Page(s) 814–816

    Abstract: Traumatic injuries to the knee are common in emergency medicine. Bedside ultrasound (US) has benefits in the rapid initial detection of injuries to the patella. In addition, US can also quickly detect injuries to the entire knee extensor mechanism, ... ...

    Abstract Traumatic injuries to the knee are common in emergency medicine. Bedside ultrasound (US) has benefits in the rapid initial detection of injuries to the patella. In addition, US can also quickly detect injuries to the entire knee extensor mechanism, including the quadriceps tendon and inferior patellar ligament, which may be difficult to diagnose with plain radiographs. While magnetic resonance imaging remains the gold standard for diagnostic evaluation of the knee extensor mechanism, this can be difficult to obtain from the emergency department. Clinicians caring for patients with orthopedic injuries of the knee would benefit from incorporating bedside musculoskeletal US into their clinical skills set.
    MeSH term(s) Adult ; Emergency Service, Hospital ; Fractures, Bone/diagnosis ; Fractures, Bone/diagnostic imaging ; Humans ; Knee Injuries/diagnosis ; Knee Injuries/diagnostic imaging ; Knee Joint ; Magnetic Resonance Imaging ; Male ; Patella/injuries ; Ultrasonography/methods
    Language English
    Publishing date 2016-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2375700-0
    ISSN 1936-9018 ; 1936-900X
    ISSN (online) 1936-9018
    ISSN 1936-900X
    DOI 10.5811/westjem.2016.8.31051
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Diagnosis of pneumoperitoneum with bedside ultrasound.

    Chao, Alice / Gharahbaghian, Laleh / Perera, Phillips

    The western journal of emergency medicine

    2015  Volume 16, Issue 2, Page(s) 302

    MeSH term(s) Aged, 80 and over ; Female ; Humans ; Pneumoperitoneum/diagnostic imaging ; Point-of-Care Systems ; Ultrasonography
    Language English
    Publishing date 2015-03
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 2375700-0
    ISSN 1936-9018 ; 1936-900X
    ISSN (online) 1936-9018
    ISSN 1936-900X
    DOI 10.5811/westjem.2014.12.24945
    Database MEDical Literature Analysis and Retrieval System OnLINE

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