4th of July Grilling Safety Tips

Grilling and hanging out at home are a great way to enjoy the 4^th of July. Many people don’t realized, however, just how dangerous the grill can be and how careful they need to be with children around this summertime item.

Children need to be kept away from the grill, both during the cooking and once you’re finished. Children don’t always realize how long the grill may remain hot and they can end up touching items on the grill that will burn them severely.

The person doing the grilling needs to take safety precautions as well. They should wear an apron and oven mitts that fit over their forearms. With a charcoal grill, they need to make sure to soak the coals with water before throwing them away.

Emergency room doctors like Dr. Josyann Abisabb see many people in the ER during the 4^th of July festivities.  Using common sense, keeping a watchful eye on children and practicing safety precautions can prevent these trips from occurring.

Readmission Rates to Hospitals for Recently Released Patients are Rising

A new study has confirmed that patients who come to the emergency room after a recent hospital stay are more than two times more likely to be readmitted than patients who have not recently spent time in the hospital.

The new research was conducted at the Perelman School of Medicine at the University of Pennsylvania, and was presented at the annual meeting of the Society of Academic Emergency Medicine.

“Patients who return to the emergency department within seven days of hospitalization have both relatively high and increasing rates of readmission,” says Zachary F. Meisel, MD, MPH, MSc, an emergency physician and a Robert Wood Johnson Foundation Clinical Scholar at the Hospital of the University of Pennsylvania, who led the study. “These findings are important because they come at a time when there is a great effort underway to reduce hospital re-admission rates, and they give us clues about how emergency departments can play a role in that process.”

Josyann Abisaab, MD, is an emergency room physician at Presbyterian Hospital in New York City.

Survey Shows PAs and NPs Are Not Accepted (Yet) in the ER

The American Journal of Bioethics recently published a survey evaluating the perception of patients towards the care they received in the emergency room, with a special emphasis on the impact physician assistants and nurse practitioners have on the overall quality of care experienced by the patients.

Eighty percent of the patients said that they expect to see a physician, such as a specialist in emergency care like Dr. Josyann Abisaab, when they arrive at the ER. Parents of child patients were even more insistent that their son or daughter be examined by a doctor, even for a relatively minor problem like a sprained ankle.

In the case of non-urgent illnesses or conditions patients had an overwhelming preference for seeing only a resident (60%) over seeing a PA (42%.) The survey also questioned residents’ preferences, which turned out to be not so different from non-medical patients. Residents preferred seeing a resident alone to seeing a PA by 65% to 38%.

Some analysts take issue with the study, saying it is flawed due to the fact that the small number of patients questioned were overwhelmingly urban, English speaking and educated. An additional improvement of the study would be to not only take a larger sample population, but to separate the answers based on age. It is believed that older patients are more inclined to prefer physicians over PAs and NPs, while younger patients are more willing to accept the new emergency room practices, which use NPs and PAs to a much greater extent than in the past.

ACEP Sueing Washington Over New Emergency Room Limits Policy

In an attempt to reduce costs associated with unnecessary visits to the emergency room Washington State enacted a new policy limiting non-emergency visits to the emergency room for low-income patients who receive Medicaid benefits to only three per year.

In response to this new policy the American College of Emergency Physicians has decided to sue the state of Washington, saying that this policy could actually lead to increased costs in the long-term, and could even lead to an increase in mortality.

The main problem with the policy is the list of symptoms that the state considers “non-emergencies,” including difficulty breathing, dizziness, early-pregnancy hemorrhage, gall stones, abdominal pains and chest pains not related to a heart attack, all of which, the state contends, could easily and more economically be dealt with in the context of a regular doctor’s visit.

The president of the Washington chapter of the ACEP Steve Anderson refutes this contention:

“The ACEP is opposing the limit primarily because of the list of diagnoses that the state is proposing to be non-emergencies, like chest pains and heart arrhythmias and dysrhythmias, which can result in sudden death, sudden blindness, and hemorrhages during miscarriage.”

Government officials assert that the new policy, which went into effect on October 1, 2011, will reduce the cost of emergency room overuse by about 35 million dollars of taxpayers’ money per year.

Seattle doctor Nathan Schlicher explained that the three visit limit could actually end up costing Washington State more money in the long-run. Some people might get more ill, and a large number of the conditions on the state’s non-emergency list are actually clarion calls that more serious health problems are brewing.

“There’s chest pain on this list, there’s issues of kidney stones, there’s hemorrhage and pregnancy, a threatened miscarriage,” Schlicher said.

Josyann Abisaab, MD, is an emergency room physician at Presbyterian Hospital in New York City.

Josyann Abisaab: Flu season is coming; don’t substitute the emergency room for a visit to your doctor

The National Center for Health Statistics estimates that the majority of the 300,000 daily visits to US emergency rooms each day are unnecessary. When emergency rooms are overused not only are the waiting times for people who really do need emergency care lengthened, but the cost to everyone for the use of the emergency room when it really is needed, goes up.

The public should be aware of when a symptom requires emergency care, and when a trip to a primary care physician is all that is required. The American College of Emergency Physicians (ACEP) explains that everyone benefits when emergency rooms are reserved just for emergencies; people who are seriously ill, or injured, and need immediate attention from specially trained doctors.

Some, but not all, indications of a medical emergency are:

• Impaired breathing, shortness of breath
• Chest pain; upper abdominal pain; or pressure which lasts at least two minutes
• Unexplained sudden faintness, weakness or dizziness
• Loss of consciousness
• Sudden impaired vision or dimness

For a complete list of symptoms of a medical emergency, check here.

Josyann Abisaab, MD, is an emergency room physician at Presbyterian Hospital in New York City.

Neuromuscular Diseases & The ER

Anyone with a neuromuscular disease knows that going to the emergency room isn’t a simple activity.  Many ER doctors don’t understand these diseases well, as reported by Gregory Carter, medical director of the MDA Regional Neuromuscular Center at Providence St. Peter Medical Center in Olympia, Wash., and co-director of the MDA/ALS Center at the University of Washington Medical Center in Seattle.

Common reasons that patients with neuromuscular diseases end up in the ER include respiratory problems, dehydration and abdominal pain. The doctor may misinterpret the issues and treat the patient incorrectly.

In order to ensure proper care in the ER where doctors like Dr. Josyann Abisaab give patients the best treatment they can, make sure to do the following.

1.      Have your medical information with you when you go to the emergency room, including a MedicalAlert if you have one.

2.      Take an advocate with you so that someone can explain your history and your background. They can push the call button if you can’t and can explain your situation in more depth.

3.      Have advance directives in place if you want your wishes listened to in a life-or-death situation.

Leaving the ER: Dr. Josyann Abisaab

Of course, no one wants to have to visit the ER.  It can be incredibly scary to feel like you (or someone you love) need emergency medical car.  However, thankfully should this become the situation, there are excellent ER places available.  In addition, there are many ways the whole process can be facilitated and in this article tips are provided by health care professionals on steps to take when leaving the ER to ensure it is the most efficient and painless possible.

First, ensure that you leave with all your test results (or at least copies of them) and make sure the administration sends these to your doctor. Think ahead if you can and be sure to make a follow-up appointment with your doctor to ensure you received all the care you needed and to make a plan for further steps, if needed.

If you need to take medication or do exercises once you get home, try to ensure the member of staff who has made this suggestion has also written it down for you; when you are in the ER you are taking in a lot of information at once, during a most vulnerable time.  Getting stuff written down can guard against the natural process of forgetting some important stuff. It’s important that even if you are feeling better, you follow these instructions; this will be your best line of defense against having to return to the ER.

Remember, when you first arrived at the ER you probably weren’t in such a good state but were cared for extremely well.  If staff treated you well, now that you are more functioning, ensure you thank them before leaving.

Dr. Josyann Abisaab has seen many such cases, as an ER physician who practices in the Columbia Presbyterian Medical Center in New York City.

Josyann Abisaab and Preterm Labor

One of the more dangerous complications of pregnancy is premature or preterm labor.

Preterm labor is defined as labor which begins earlier than 37 weeks of gestation. Early birth puts the newborn in danger of developing many complications, and understanding the symptoms of preterm labor can sometimes help prevent preterm birth with the hope that the pregnancy can continue to full term, increasing the baby’s chances of a positive birth outcome.

If you have any of the following symptoms, it is prudent to call your health care provider:

• More than five contractions or cramps with 60 minutes.
• Bright red blood coming from the vagina.
• Pain while urinating. This could signify a bladder, urinary tract, or kidney infection.
• Sudden release of clear watery fluid from the vagina.
• Backache.
• Strong pressure felt in the pelvis.

Not all preterm labor can be prevented, but there are cases in which contractions can be stopped using simple methods. Preterm labor can sometimes be triggered by dehydration, so it is crucial to drink plenty of liquids, water being the best. Stay alerted to infections of the bladder, or yeast infections, and the like.

Never hesitate to call your health care provider if you have any questions or concerns. It is much better to ere on the side of caution when it comes to the health of you and your baby.

Josyann Abisaab, MD, is an emergency room physician at Columbia Presbyterian Hospital in New York.

Josyann Abisaab: New Study on Pap Tests Shows Less May Be Better

As researchers continue to study the benefits and risks involved in routine screening tests, they are able to more precisely understand which tests are better predictors and how often those tests should be undertaken by patients as part of their preventative health care program.

In the case of the routine screening test for cervical cancer, known as the Pap test, a large study conducted by the Kaiser Permanente health group indicates that less is probably better.

Less is Better

The study showed that women in most cases can safely reduce the frequency with which they get the test from the present recommendation of once a year down to only once in three years.

“For the time being, women should get a Pap test every three years if they’ve had three normal yearly Pap tests in the past, and they might want to get HPV testing, which might make things even safer,” said Dr. Otis Brawley, chief medical officer of the American Cancer Society.

HPV Better Indicator of Cervical Cancer

Getting the HPV test is safer because testing for HPV seems to be a more accurate predictor of cervical cancer than the Pap test. The abstract of the study said that,

“In routine clinical practice, a single HPV test was clearly superior to a single Pap smear for predicting who would develop… cancer within 5 years.”

Dr. Josyann Abisaab is an emergency room physician at the New York Presbyterian Hospital.

Dr. Josyann Abisaab: Understanding Heart Attacks

Josyann Abisaab, MD, recommends knowing all you can about atherosclerosis and heart attacks so that you will know the symptoms if you ever experience a heart attack, or someone near you does. Knowing what to look for and what to do can help you save your own life or the life of someone else. View this short video for a clear animated explanation of how atherosclerosis can lead to a heart attack.